Background-Obesity increases heart failure (HF) risk; however, the independent effect of physical activity and the joint effect of physical activity and adiposity on HF risk are not established. We evaluated the single and joint associations of physical activity and different indicators of adiposity (body mass index, waist circumference, and waist-to-hip ratio) with HF risk. Methods and Results-Study cohorts included 59 178 Finnish participants who were 25 to 74 years of age and free of HF at baseline. During a mean follow-up of 18.4 years, 1921 men and 1693 women developed HF. The multivariable-adjusted hazard ratios of HF associated with low, moderate, and high physical activity were 1.00, 0.79, and 0.69 (P(trend) < 0.001) for men and 1.00, 0.86, and 0.68 (P(trend) < 0.001) for women, respectively. The multivariable-adjusted hazard ratios of HF at different levels of body mass index (<25, 25 to 29.9, and >= 30 kg/m(2)) were 1.00, 1.25, and 1.99 (P(trend) < 0.001) for men and 1.00, 1.33, and 2.06 (P(trend) < 0.001) for women, respectively. Abdominal adiposity, measured by waist circumference or waist-to-hip ratio, was associated with a greater risk of HF among both men and women (all P(trend) < 0.01). In joint analyses, the protective effect of physical activity was consistent in subjects at all levels of body mass index. Conclusions-General overweight and general and abdominal obesity are independently associated with an increased risk of HF, whereas moderate or high levels of physical activity are associated with a reduced risk of HF. The protective effect of physical activity on HF risk is observed at all levels of body mass index. (Circulation. 2010; 121: 237-244.)
