ImportanceHeart failure (HF) prevention is paramount to public health in the 21st century.ObjectiveTo examine incident HF and its subtypes with preserved ejection fraction (HFpEF) and reduced EF (HFrEF) according to accelerometer-measured physical activity (PA) and sedentary time.Design, Setting, and ParticipantsThis was a prospective cohort study, the Objective Physical Activity and Cardiovascular Health (OPACH) in Older Women study, conducted from March 2012 to April 2014. Included in the analysis were women aged 63 to 99 years without known HF, who completed hip-worn triaxial accelerometry for 7 consecutive days. Follow-up for incident HF occurred through February 2022. Data were analyzed from March to December 2023.ExposureDaily PA (total, light, moderate to vigorous PA [MVPA], steps) and sedentary (total, mean bout duration) behavior.Main Outcomes and MeasuresAdjudicated incident HF, HFpEF, and HFrEF.ResultsA total of 5951 women (mean [SD] age, 78.6 [6.8] years) without known HF were included in this analysis. Women self-identified with the following race and ethnicity categories: 2004 non-Hispanic Black (33.7%), 1022 Hispanic (17.2%), and 2925 non-Hispanic White (49.2%). There were 407 HF cases (257 HFpEF; 110 HFrEF) identified through a mean (SD) of 7.5 (2.6) years (range, 0.01-9.9 years) of follow-up. Fully adjusted hazard ratios (HRs) for overall HF, HFpEF, and HFrEF associated with a 1-SD increment were 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.67-0.91), and 1.02 (95% CI, 0.81-1.28) for minutes per day total PA; 0.74 (95% CI, 0.63-0.88), 0.71 (95% CI, 0.57-0.88), and 0.83 (95% CI, 0.62-1.12) for steps per day; and 1.17 (95% CI, 1.04-1.33), 1.29 (95% CI, 1.10-1.51), and 0.94 (95% CI, 0.75-1.18) for minutes per day total sedentary. Cubic spline curves for overall HF and HFpEF were significant inverse for total PA and steps per day and positive for total sedentary. Light PA and MVPA were inversely associated with overall HF (HR per 1 SD: 0.88; 95% CI, 0.78-0.98 and 0.84; 95% CI, 0.73-0.97) and HFpEF (0.80; 95% CI, 0.70-0.93 and 0.85; 95% CI, 0.72-1.01) but not HFrEF. Associations did not meaningfully differ when stratified by age, race and ethnicity, body mass index, physical function, or comorbidity score. Results for sedentary bout duration were inconsistent.Conclusions and RelevanceHigher accelerometer-measured PA (MVPA, light PA, steps per day) was associated with lower risk (and greater total sedentary time with higher risk) of overall HF and HFpEF in a racially and ethnically diverse cohort of older women. Increasing PA and reducing sedentary time for primary HFpEF prevention may have relevant implications for cardiovascular resilience and healthy aging in later life.

中文翻译：

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加速计测量 63 至 99 岁女性的体力活动、久坐时间和心力衰竭风险

重要性心力衰竭 (HF) 预防对于 21 世纪的公共卫生至关重要。目的根据加速计测量的体力活动 (PA) 和久坐时间，检查射血分数保留 (HFpEF) 和射血分数降低 (HFrEF) 的心力衰竭及其亚型。设计、设置和参与者这是一项前瞻性队列研究，即老年女性客观体力活动和心血管健康 (OPACH) 研究，于 2012 年 3 月至 2014 年 4 月进行。分析包括年龄在 63 至 99 岁、无已知心力衰竭、连续 7 天完成髋部佩戴三轴加速度测量。心力衰竭事件的随访持续至 2022 年 2 月。数据分析时间为 2023 年 3 月至 12 月。ExposureDaily PA（总、轻度、中度至剧烈 PA [MVPA]、步数）和久坐（总、平均发作持续时间）行为。主要结果判定事件 HF、HFpEF 和 HFrEF。结果 本次分析中纳入了总共 5951 名没有已知 HF 的女性（平均 [SD] 年龄，78.6 [6.8] 岁）。女性自我认同为以下种族和民族类别：2004 年非西班牙裔黑人 (33.7%)、1,022 名西班牙裔 (17.2%) 和 2925 名非西班牙裔白人 (49.2%)。通过平均 (SD) 7.5 (2.6) 年（范围 0.01-9.9 年）的随访发现了 407 例 HF 病例（257 HFpEF；110 HFrEF）。与 1-SD 增量相关的总体 HF、HFpEF 和 HFrEF 的完全调整风险比 (HR) 分别为 0.85 (95% CI, 0.75-0.95)、0.78 (95% CI, 0.67-0.91) 和 1.02 (95% CI，0.81-1.28) 每天总 PA 分钟数；每日步数为 0.74 (95% CI, 0.63-0.88)、0.71 (95% CI, 0.57-0.88) 和 0.83 (95% CI, 0.62-1.12)；每天总久坐分钟数为 1.17 (95% CI, 1.04-1.33)、1.29 (95% CI, 1.10-1.51) 和 0.94 (95% CI, 0.75-1.18)。总体 HF 和 HFpEF 的三次样条曲线与总 PA 和每日步数呈显着负相关，与总久坐呈正相关。轻度 PA 和 MVPA 与总体 HF（HR 每 1 SD：0.88；95% CI，0.78-0.98 和 0.84；95% CI，0.73-0.97）和 HFpEF（0.80；95% CI，0.70-0.93 和 0.85）呈负相关; 95% CI, 0.72-1.01) 但不是 HFrEF。当按年龄、种族和民族、体重指数、身体机能或合并症评分分层时，关联没有显着差异。久坐持续时间的结果不一致。结论和相关性在不同种族和族裔中，加速度计测量的 PA（MVPA、轻度 PA、每天步数）越高，与总体 HF 和 HFpEF 的较低风险（总久坐时间越长，风险越高）相关。多元化的老年妇女群体。增加 PA 和减少久坐时间来预防 HFpEF 可能对晚年心血管​​恢复能力和健康老龄化产生相关影响。