New Delhi: Heart attacks often seem to be sudden and shocking, but the reality tells a different story. The strokes usually are result of a slow and silent process, which starts many years before one suffers angina (chest pain or discomfort caused by reduced blood flow to the heart muscle) or emergencies arise.
A Coronary Artery Risk Development in Young Adults (CARDIA) study, which is a long-term research project examining the development of cardiovascular disease or CVD in young adults, reveals that moderate-to-vigorous physical activity (MVPA) such as brisk walking, cycling or swimming begins to drop steadily about 12 years before heart disease shows up.
Many mistake this decline for normal aging, caution doctors who suggest that recognising it early opens a wide window for prevention and treatment. This window helps avoid serious heart problems.
The study titled ‘Trajectories of Physical Activity Before and After Cardiovascular Disease Events in CARDIA Participants’ observed people over decades. Researchers compared those who later developed CVD with those who did not. They found MVPA declines begin around 12 years before a heart attack. The decline becomes sharpest two years before diagnosis. And after a heart attack, activity levels often remain low that widens the gap with healthier peers. This long-term tracking revealed the slow decline rather than a one-time drop.
CARDIA collected repeated data on activities that raise heart rate and breathing. These include brisk walking, jogging, cycling, swimming and sports. The questionnaires gave a life-long picture, not a single snapshot. A single visit showing low activity misses the downward trend.
Researchers highlight the steady and accelerating drop in MVPA as a key early warning. This drop in activity links directly to changes raising heart risk. The heart weakens without regular exercise. It pumps less blood and tires more easily. Blood vessels suffer. Poor movement harms the lining and promotes plaque buildup. Metabolism shifts. Inactivity increases weight, insulin resistance and bad cholesterol. Inflammation rises. Sedentary life triggers mild inflammation and harms heart rate regulation.
These changes feed one another and build over years, leading to heart attacks or strokes. Health experts stress staying active to break this harmful cycle.
The study also found differences by race and gender. Black women had lower activity levels throughout adulthood. Some groups showed more steady declines, increasing their heart risk. This means prevention should fit cultural and social realities. Broad advice alone cannot solve this.
The researchers say doctors should look for trends in stamina, not only one low activity report and ask patients about their energy and exercise over years reveals more than a single checkup.
Using risk tools alongside activity history helps identify those who need early care. Lifestyle coaching, exercise support and medicine can reduce risks if started soon.
If someone notices a steady drop in stamina, these steps help:
Basic heart tests: blood pressure, waist size, cholesterol blood sugar.
Simple activity checks: timed walks or questions about effort levels.
Social questions: work, caregiving duties, safe spaces and time for exercise.
Public health guidelines recommend 150 minutes of moderate activity weekly or 75 minutes of vigorous exercise. Breaking this into daily short sessions works well. Choosing enjoyable activities like walking, swimming or dancing helps keep it up. Adding movement to daily life, such as walking to work or taking stairs, also helps. Overcoming barriers like childcare or unsafe neighbourhoods is also important.
For those who suffer heart attacks, early cardiac rehabilitation offers monitored exercise, diet help and emotional support. Starting with short walks in recovery, patients build up to regular aerobic workouts. Rehab reduces death risk and improves strength.
Tracking tools can spot worrying trends early. Wearable devices and phone apps record weekly activity and show long-term changes. Simple logs or repeated walk tests provide low-tech tracking.
The researchers are of the view that doctors should ask, “Is usual activity harder now than two years ago?” A “yes” prompts deeper checks. Spotting this slow warning from the heart allows time to act. Small steps taken now can prevent life-threatening events later.