INS and obesity due to melanocortin 4 receptor deficiency: Physical activity could reduce the risk of heart failure indirectly by improving body weight control and lowering risk of overweight and obesity and weight gain [64–66], improving insulin sensitivity [67] and lowering the risk of type 2 diabetes [56], reducing blood pressure and the risk of hypertension [66, 68–70], and lowering resting heart rate [66] and reducing the risk of coronary heart disease [71], as all these risk factors are associated with increased risk of heart failure [5, 6, 72].