Association between wearable device-measured moderate-to-vigorous physical activity and major cardiovascular events: evidence from populations stratified by right ventricular structure
J Zhao, N Zhang, T LiuAbstract
Background
Moderate-to-vigorous physical activity (MVPA) reduces cardiovascular risk, but whether this benefit varies by right ventricular (RV) structure remains uncertain. RV dilation is a marker of cardiac remodelling that may influence the cardiovascular benefits of MVPA.
Purpose
To investigate the association between accelerometer-measured MVPA and incident major adverse cardiovascular events (MACE), and to determine whether RV dilation modifies this association.
Methods
This study was based on the UK Biobank and included participants who underwent wrist-worn accelerometry and cardiac MRI (2013–2015). MVPA volume (minutes/week) was objectively quantified using accelerometry. RV end-diastolic volume index (RVEDVi) was calculated as RV end-diastolic volume to body surface area. The primary outcome was incident MACE (myocardial infarction, heart failure, stroke, or cardiovascular death). Restricted cubic splines (RCS) and Cox models examined the association between MVPA volume and MACE. Mediation analysis assessed the role of BMI using bootstrap methods. Stratified analyses were performed according to RV structural status. Sensitivity analyses included Fine-Gray models, MVPA per WHO recommendations, and exclusion of MACE within two years.
Results
Among 14,435 MACE-free participants at baseline (Figure 1a; median age 61.9 years [IQR 55.4–67.2]; 7,956 [55.1%] women), 482 developed MACE during a median follow-up of 8.9 years (IQR 8.4–9.3). The distribution of first component events is shown in the Venn diagram (Figure 1b). Covariates were selected based on the directed acyclic graph presented in Figure 1c. Based on RVEDVi tertiles, participants were categorised into three groups: reference (156 MACE/4,812 participants), mildly dilated (163/4,811), and more dilated (163/4,812). RCS revealed a significant inverse association between MVPA and MACE risk in the reference (P = 0.044, Figure 2a) and more dilated (P = 0.034, Figure 2c) group. In multivariable Cox models (Figure 2d), per 1-SD increase in MVPA (approximately 4 hours/week) was associated with a 21% lower risk of MACE in the reference group (HR 0.79, 95% CI 0.63–0.98; P=0.035) and a 16% lower risk in the more dilated group (HR 0.84, 95% CI 0.72–0.98; P=0.028). The observed associations were attenuated after adjusting for BMI (model 3). Mediation analysis further revealed that BMI mediated approximately 30% of the total effect in both the reference and more dilated groups. Subgroup analyses showed consistent associations across all strata. Sensitivity analyses confirmed the robustness of the main findings.
Conclusion
Higher volumes duration of MVPA are associated with reduced MACE risk across RV structure categories, with a stronger association observed among individuals without RV dilation. These findings support the cardiovascular benefits of MVPA irrespective of RV structure and highlight the importance of promoting physical activity in the general population.Figure 1Figure 2