Association between stress and physical activity by heart failure phenotype

Cortisol, a stress biomarker, may be associated with lower physical activity (PA) tolerance. This study examined the associations between stress (both subjective and objective) and PA in patients with heart failure (HF) with systolic, diastolic, and combined (systolic + diastolic) HF phenotypes.

In this cross-sectional study, patients with a diagnosis of heart failure/cardiomyopathy reported stress levels subjectively using the Perceived Stress Scale (PSS-10). Hair strands, collected from the posterior vertex of each participant's head, were processed using enzyme immunoassay to measure hair cortisol concentration (HCC; pg/mg). PA was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Participants included 28 systolic, 7 diastolic, and 11 combined HF patients. PA levels were low across all groups, with combined HF patients showing a trend towards the lowest PA levels. Combined HF patients also demonstrated a higher trend towards perceived stress (16.9 ± 5.1) and HCC (15.3 ± 17.9 pg/mg). HCC did not show a strong associated with perceived stress in any group. However, HCC was strongly and positively associated with PA among patients with diastolic HF (r = 0.91), but not among patients with systolic HF (r = -0.09) or combined HF (r = 0.26).

A potential dissociation between psychological and physiological stress was noted. PA was significantly and positively associated with HCC in diastolic HF, suggesting that PA may serve as a physiological stressor. Both subjective and objective markers of stress were higher in patients with combined HF. More research is needed to investigate these findings.