Physical Activity, Sedentary Behavior, Cardiorespiratory Fitness with Cardiac Adiposity: A Narrative Review.

Background: Pericardial adipose tissue (PAT), an ectopic fat depot surrounding the coronary arteries, is a significant pathogenic risk factor for cardiometabolic diseases. Due to its anatomical proximity to the heart, PAT is considered a more potent risk factor for cardiovascular conditions compared to other visceral adipose tissues located in other parts of body. Modifiable lifestyle factors such as physical activity (PA), sedentary behavior (SB), exercise interventions, and cardiorespiratory fitness (CRF) have been associated with various health outcomes, but their relationship with PAT remains less understood. Summary: This review synthesizes current evidence on the associations of PA, SB, exercise interventions, and CRF with PAT. Increasing PA and CRF while reducing SB appears to be associated with lower PAT accumulation with age, independent of key health characteristics across diverse populations. Also, exercise interventions may be effective in reducing PAT. PAT is emerging as a critical cardiovascular disease and cardiometabolic risk factor. The review highlights the importance of PA, SB, exercise participations, and CRF as modifiable strategies to potentially mitigate this risk. Despite the documented benefits of PA, exercise interventions, and CRF and the negative impacts of SB on health, further research is warranted to explore these associations more comprehensively. Most existing studies are limited by small sample sizes, cross-sectional designs, and reliance on self-reported measures. Recent longitudinal studies suggest that PA, SB, and CRF may influence PAT volumes over time, though findings are often affected by baseline abdominal adiposity and the use of indirect measures. Key Messages: (i) Increasing PA, exercise participation, and CRF while reducing SB may prevent PAT accumulation with age, independent of other health factors. (ii) PAT is a significant, emerging risk factor for cardiovascular and metabolic diseases, underscoring the need for effective lifestyle interventions. (iii) Future research should focus on larger, more diverse cohorts using objective measures to better understand the complex relationships between PA, SB, CRF, and PAT. (iv) Comprehensive exploration of these associations will aid in developing interventions to reduce cardiac adiposity and enhance cardiovascular health outcomes.