Atrial fibrillation and physical activity: Should we exercise caution?

Area of Science:

• Cardiology
• Exercise Physiology
• Epidemiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia.
• The relationship between physical activity (PA) and AF risk is complex and debated, particularly in athletes.
• Understanding these associations is crucial for public health recommendations.

Purpose of the Study:

• To review existing evidence on the impact of varying physical activity (PA) levels on the incidence of atrial fibrillation (AF).
• To differentiate effects in the general population versus endurance athletes.
• To assess the strength and quality of evidence using the GRADE system.

Main Methods:

• A comprehensive PubMed search was conducted using relevant keywords and MeSH terms for atrial fibrillation and exercise.
• Included observational studies (cohort, case-control, cross-sectional), prioritizing larger prospective cohorts.
• Evidence quality and strength were assessed using the GRADE system.

Main Results:

• A dose-response relationship exists: increased PA generally correlates with reduced AF incidence in women and in men at low to moderate activity levels.
• In men, high PA levels are associated with a moderately increased risk of AF (HR ~1.29 in some studies), though findings are not entirely consistent.
• Overall, regular exercisers have a lower AF risk compared to sedentary individuals.

Conclusions:

• Physical activity is likely protective against atrial fibrillation, with a clear dose-response effect.
• Exercise promotion for general well-being and mortality reduction is advised.
• Men engaging in very high levels of PA should be informed of a potential, albeit modest and inconsistently supported, increased AF risk compared to sedentary individuals.