Longitudinal Associations Between Cumulative Physical Activity and Change in Structure and Function of the Left Side of the Heart: The Tromsø Study 2007-2016

Kim Arne Heitmann; Boye Welde; Maja-Lisa Løchen; Michael Stylidis; Henrik Schirmer; Bente Morseth

doi:10.3389/fcvm.2022.882077

Longitudinal Associations Between Cumulative Physical Activity and Change in Structure and Function of the Left Side of the Heart: The Tromsø Study 2007-2016

Front Cardiovasc Med. 2022 May 12:9:882077. doi: 10.3389/fcvm.2022.882077. eCollection 2022.

Authors

Kim Arne Heitmann^{1

2}, Boye Welde¹, Maja-Lisa Løchen³, Michael Stylidis³, Henrik Schirmer^{4

5

6}, Bente Morseth^{1

2}

Affiliations

¹ School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
² Centre for Research and Education, University Hospital of Northern Norway, Tromsø, Norway.
³ Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁴ Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.

Abstract

Background: Current knowledge about the relationship between physical activity (PA) and cardiac remodeling is mainly derived from cross-sectional studies of athletes, and there is a knowledge gap of this association in the general adult and elderly population. Therefore, we aimed to explore the longitudinal association between cumulative PA and change in cardiac structure and function in a general adult and elderly population.

Methods: This longitudinal study includes 594 participants from the sixth (Tromsø6, 2007-08) and seventh (Tromsø7, 2015-16) survey of the Tromsø Study. Cardiac structure and function were assessed by echocardiography at two time points, and PA was self-reported by questionnaire at both time points. PA volume was expressed as cumulative PA (Low, Moderate, and Hard) and the association with left atrial (LA) and left ventricular (LV) structure and function was assessed using ANCOVA.

Results: Overall, LA diameter index (LADi) increased significantly more in Hard compared to Moderate PA (+0.08 cm/m², 95% CI 0.01-0.15, p = 0.020) from Tromsø6 to Tromsø7. When stratified by sex or age, higher levels of cumulative PA were associated with increased LADi in males and in participants <65 years only. Indexed LV mass (LVMi) increased significantly more in Moderate than in Low PA (+3.9 g/m^2.7, 95% CI 0.23-7.57, p = 0.037). When stratified by sex or age, these changes in LVMi and indexed LV diameter (LVDi) were only significant in females. No significant associations were observed between cumulative PA and change in relative wall thickness, E/e' ratio, e' velocity, LV ejection fraction, and LADi/LVDi ratio.

Conclusion: Higher levels of cumulative PA were associated with increased LADi in males and participants <65 years, and with increased LVMi and LVDi in females. Despite cardiac chamber enlargement, the pump function of the heart did not change with higher levels of PA, and the atrioventricular ratio was unchanged. Our results indicate that cardiac chamber enlargement is a physiological response to PA.

Keywords: athlete's heart; cardiac; echocardiography; ejection fraction; exercise; left atrium; left ventricle; public health.