Elsevier

Heart Rhythm

Volume 18, Issue 4, April 2021, Pages 520-528
Heart Rhythm

Clinical
Atrial Fibrillation
Self-reported physical activity and atrial fibrillation risk: A systematic review and meta-analysis

https://doi.org/10.1016/j.hrthm.2020.12.017Get rights and content

Background

Although physical activity (PA) is an important component of cardiovascular disease prevention and treatment, its role in atrial fibrillation (AF) risk is less well established.

Objective

The purpose of this study was to systematically summarize the evidence pertaining to the relationship of PA and risk of AF.

Methods

We searched the PubMed and Embase databases for prospective cohort studies reporting the risk of AF associated with a specific PA volume through March 2020. From each study, we extracted the risk associated with a given PA level, in comparison with insufficiently active (“inactive”) individuals. The reported risk was normalized to metabolic equivalent of task (MET)-minutes per week. A random-effects meta-analysis was used to compare AF risk between those who met and those who did not meet PA recommendations (450 MET-minutes per week), and a dose-response analysis between the level of PA and the risk of AF was performed.

Results

Fifteen studies reporting data from 1,464,539 individuals (median age 55.3 years; 51.7% female) were included. Individuals achieving guideline-recommended level of PA had a significantly lower risk of AF (hazard ratio 0.94; 95% confidence interval 0.90–0.97; P = .001). Dose-response analysis showed that PA levels up to 1900 MET-minutes per week were associated with a lower risk of AF, with less certainty beyond that level.

Conclusion

PA at guideline-recommended levels and above are associated with a significantly lower AF risk. However, at 2000 MET-minutes per week and beyond, the benefit is less clear.

Introduction

Atrial fibrillation (AF) is a growing public health problem globally due to its rising prevalence and associated high morbidity and mortality.1 Although the success rates of catheter ablation are fairly high, it remains associated with significant recurrence and the potential for serious complications.

A large body of evidence demonstrates that cardiovascular risk factors such as hypertension, diabetes, obstructive sleep apnea, and obesity increase the risk of AF.2 New-onset AF is frequently the consequence of left atrial electrical and structural remodeling induced by the development of these risk factors, a complex pathogenic process that includes atrial inflammation and fibrosis, conduction abnormalities, and autonomic dysfunction.2

Physical activity (PA) is an essential component in the management of cardiovascular risk. Moreover, current guidelines recommend at least 150 minutes per week of moderate-intensity PA or 75 minutes per week of vigorous-intensity PA, equivalent to 450 metabolic equivalent of task (MET)-minutes per week of PA for significant health benefits.3 However, the association between PA and AF risk is less clear. Although the main challenges in evaluating the relationship of PA and AF are the subjectivity and time-varying nature of PA, the emergence of recent data presents the opportunity for more detailed analyses.

The aim of this study was to systematically summarize the evidence pertaining to the association between PA and risk of AF. We conducted a systematic review and meta-analysis to evaluate the overall association between PA and incident AF. We hypothesize that PA per guideline recommendations is associated with lower risk of incident AF.

Section snippets

Methods

This review is reported in accordance with the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines4 and has been registered in PROSPERO (Registration No. CRD42020197228).

Results

A total of 24,205 records were identified from the initial searches. After screening of titles and abstracts, 26 articles were selected for full-text review, out of which 15 were finally included (Figure 1).

Major findings

This analysis presents the most comprehensive findings to date regarding the relationship between PA and incident AF. First, performing PA as recommended by current guidelines is associated with a lower risk of AF. Second, although PA per recommended by guidelines was significantly associated with a lower risk of AF compared to inactive, the lowest AF risk seems to occur at a higher range of approximately 1500 MET-minutes per week. Third, beyond this level of PA, there is less certainty

Conclusion

PA exhibits a dose-dependent relationship with AF risk, with higher levels of PA associated with lower risk of incident AF. Therefore, regular PA should be recommended for those at risk of developing AF, highlighting its role as a primary preventative strategy in AF development. Further studies looking at AF risk at higher volumes of PA are required to define optimal levels of benefit.

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  • Cited by (0)

    Funding sources: The authors have no funding sources to disclose. Disclosures: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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