Higher Physical Activity Is Associated with Improved Ventricular–Arterial Coupling: Assessment Using the cfPWV/GLS Ratio in Primary Care—A Pilot Study

Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal strain (cfPWV/GLS) ratio, in a Romanian primary care cohort. Methods: The prospective cohort analysis was performed on 81 adults (49 females, mean age 50.27 ± 12.93 years). Physical activity was quantified through anamnesis using metabolic equivalents (METs) according with Compendium of Physical Activities, and patients were stratified into four groups: G1 (METs < 1.5, <i>n</i> = 39), G2 (METs = 1.5–2.9, <i>n</i> = 2), G3 (METs = 3–5.9, <i>n</i> = 23), and G4 (METs ≥ 6, <i>n</i> = 17). Demographic and echocardiographic data were recorded to explore associations between physical activity and VAC. Results: The cfPWV/GLS ratio differed significantly across groups (<i>p</i> = 0.012), with the lowest values present in the moderate-intensity group (G3). VAC ≥ 0.391 can predict sedentary lifestyles (AUC = 0.730; CI: 0.617–0.833, <i>p</i> > 0.001). Multivariate analysis revealed that age, arterial age, and hypertension independently predict VAC. Conclusions: Higher physical activity is inversely associated with VAC (cfPWV/GLS ratio) and can predict sedentary lifestyles. Encouraging moderate-to-vigorous exercise in primary care may improve cardiovascular function and aid prevention.