Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health

Hugo Klarenberg; Jeroen Hpm van der Velde; Carel Fw Peeters; Ilona A Dekkers; R de Mutsert; J Wouter Jukema; Frits R Rosendaal; Tim Leiner; Martijn Froeling; Harald Jorstad; S Matthijs Boekholdt; Gustav J Strijkers; Hildo J Lamb

doi:10.1136/bmjsem-2023-001778

Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health

BMJ Open Sport Exerc Med. 2024 Feb 6;10(1):e001778. doi: 10.1136/bmjsem-2023-001778. eCollection 2024.

Authors

Affiliations

¹ Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
² Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
³ Division of Mathematical & Statistical Methods - Biometris, Wageningen University & Research, Wageningen, The Netherlands.
⁴ Department of Epidemiology & Datascience, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
⁵ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Department of Radiology, UMC Utrecht, Utrecht, The Netherlands.
⁸ Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

Objectives: To investigate the association between leisure time physical activity (LTPA) and MRI-based diastolic function and the mediating role of metabolic health.

Methods: This cross-sectional analysis comprised 901 participants (46% women, mean age (SD): 56 (6) years (The Netherlands, 2008-2012)). LTPA was assessed via questionnaire, quantified in metabolic equivalent of tasks (METs)-minutes per week and participants underwent abdominal and cardiovascular MRI. Confirmatory factor analysis was used to construct the metabolic load factor. Piecewise structural equation model with adjustments for confounders was used to determine associations between LTPA and diastolic function and the mediating effect of metabolic load.

Results: Significant differences in mitral early/late peak filling rate (E/A) ratio per SD of LTPA (men=1999, women=1870 MET-min/week) of 0.18, (95% CI= 0.03 to 0.33, p=0.021) were observed in men, but not in women: -0.01 (-0.01 to 0.34, p=0.058). Difference in deceleration time of mitral early filling (E-DT) was 0.13 (0.01 to 0.24, p=0.030) in men and 0.17 (0.05 to 0.28, p=0.005) in women. Metabolic load, including MRI-based visceral and subcutaneous adipose tissue, fasting glucose, high-density lipoprotein cholesterol and triglycerides, mediated these associations as follows: E/A-ratio of 0.030 (0.000 to 0.067, 19% mediated, p=0.047) in men but not in women: 0.058 (0.027 to 0.089, p<0.001) and E-DT not in men 0.004 (-0.012 to 0.021, p=0.602) but did in women 0.044 (0.013 to 0.057, 27% mediated, p=0.006).

Conclusions: A larger amount of LTPA was associated with improved diastolic function where confirmatory factor analysis-based metabolic load partly mediated this effect. Future studies should assess whether improving indicators of metabolic load alongside LTPA will benefit healthy diastolic function even more.

Keywords: MRI; cardiology; cardiovascular epidemiology; metabolism; physical activity.