Background and Aims Physical activity has proven effective in preventing atherosclerotic cardiovascular disease, but its role in preventing degenerative valvular heart disease (VHD) remains uncertain. This study aimed to explore the dose–response association between moderate to vigorous physical activity (MVPA) volume and the risk of degenerative VHD among middle-aged adults. Methods A full week of accelerometer-derived MVPA data from 87 248 UK Biobank participants (median age 63.3, female: 56.9%) between 2013 and 2015 were used for primary analysis. Questionnaire-derived MVPA data from 361 681 UK Biobank participants (median age 57.7, female: 52.7%) between 2006 and 2010 were used for secondary analysis. The primary outcome was the diagnosis of incident degenerative VHD, including aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR). The secondary outcome was VHD-related intervention or mortality. Results In the accelerometer-derived MVPA cohort, 555 incident AS, 201 incident AR, and 655 incident MR occurred during a median follow-up of 8.11 years. Increased MVPA volume showed a steady decline in AS risk and subsequent AS-related intervention or mortality risk, levelling off beyond approximately 300 min/week. In contrast, its association with AR or MR incidence was less apparent. The adjusted rates of AS incidence (95% confidence interval) across MVPA quartiles (Q1–Q4) were 11.60 (10.20, 13.20), 7.82 (6.63, 9.23), 5.74 (4.67, 7.08), and 5.91 (4.73, 7.39) per 10 000 person-years. The corresponding adjusted rates of AS-related intervention or mortality were 4.37 (3.52, 5.43), 2.81 (2.13, 3.71), 1.93 (1.36, 2.75), and 2.14 (1.50, 3.06) per 10 000 person-years, respectively. Aortic valve stenosis risk reduction was also observed with questionnaire-based MVPA data [adjusted absolute difference Q4 vs. Q1: AS incidence, −1.41 (−.67, −2.14) per 10 000 person-years; AS-related intervention or mortality, −.38 (−.04, −.88) per 10 000 person-years]. The beneficial association remained consistent in high-risk populations for AS, including patients with hypertension, obesity, dyslipidaemia, and chronic kidney disease. Conclusions Higher MVPA volume was associated with a lower risk of developing AS and subsequent AS-related intervention or mortality. Future research needs to validate these findings in diverse populations with longer durations and repeated periods of activity monitoring.

中文翻译：

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可穿戴设备测量中度至剧烈的体力活动和退行性主动脉瓣狭窄的风险


背景和目的 身体活动已被证明可有效预防动脉粥样硬化性心血管疾病，但其在预防退行性瓣膜性心脏病 (VHD) 中的作用仍不确定。本研究旨在探讨中年成年人中度至剧烈体力活动 (MVPA) 量与退行性 VHD 风险之间的剂量反应关系。方法 使用 2013 年至 2015 年间 87 248 名英国生物银行参与者（中位年龄 63.3 岁，女性：56.9%）的一整周加速度计衍生的 MVPA 数据进行初步分析。使用 2006 年至 2010 年间 361 681 名英国生物银行参与者（中位年龄 57.7 岁，女性：52.7%）的问卷调查得出的 MVPA 数据进行二次分析。主要结局是诊断退行性 VHD，包括主动脉瓣狭窄 (AS)、主动脉瓣关闭不全 (AR) 和二尖瓣关闭不全 (MR)。次要结局是 VHD 相关干预或死亡率。结果 在加速度计衍生的 MVPA 队列中，中位随访时间为 8.11 年，其中发生了 555 例 AS、201 例 AR 和 655 例 MR。 MVPA 量的增加表明 AS 风险以及随后的 AS 相关干预或死亡风险稳步下降，在每周约 300 分钟后趋于稳定。相比之下，它与 AR 或 MR 发生率的关联不太明显。 MVPA 四分位数（第 1 季度至第 4 季度）的 AS 发生率（95% 置信区间）调整后分别为 11.60 (10.20, 13.20)、7.82 (6.63, 9.23)、5.74 (4.67, 7.08) 和 5.91 (4.73, 7.39)。 10 000 人年。相应调整后的 AS 相关干预或死亡率分别为每万人年 4.37 (3.52, 5.43)、2.81 (2.13, 3.71)、1.93 (1.36, 2.75) 和 2.14 (1.50, 3.06)。 基于问卷调查的 MVPA 数据也观察到主动脉瓣狭窄风险降低[调整后的绝对差 Q4 与 Q1：AS 发生率，每 10 000 人年 -1.41 (-.67, -2.14)； AS 相关干预或死亡率，每 10 000 人年 -.38 (-.04, -.88)]。这种有益关联在 AS 高危人群中保持一致，包括高血压、肥胖、血脂异常和慢性肾脏病患者。结论 较高的 MVPA 体积与较低的发生 AS 以及随后的 AS 相关干预或死亡率的风险相关。未来的研究需要在不同人群中验证这些发现，并进行更长持续时间和重复周期的活动监测。