Physical activity volume in relation to risk of atrial fibrillation. A non-linear meta-regression analysis

Abstract

Background

Light physical activity is known to reduce atrial fibrillation risk, whereas moderate to vigorous physical activity may result in an increased risk. However, the question of what volume of physical activity can be considered beneficial remains poorly understood. The scope of the present work was to examine the relation between physical activity volume and atrial fibrillation risk.

Design

A comprehensive systematic review was performed following the PRISMA guidelines.

Methods

A non-linear meta-regression considering the amount of energy spent in physical activity was carried out. The first derivative of the non-linear relation between physical activity and atrial fibrillation risk was evaluated to determine the volume of physical activity that carried the minimum atrial fibrillation risk.

Results

The dose–response analysis of the relation between physical activity and atrial fibrillation risk showed that physical activity at volumes of 5–20 metabolic equivalents per week (MET-h/week) was associated with significant reduction in atrial fibrillation risk (relative risk for 19 MET-h/week = 0.92 (0.87, 0.98). By comparison, physical activity volumes exceeding 20 MET-h/week were unrelated to atrial fibrillation risk (relative risk for 21 MET-h/week = 0.95 (0.88, 1.02).

Conclusion

These data show a J-shaped relation between physical activity volume and atrial fibrillation risk. Physical activity at volumes of up to 20 MET-h/week is associated with reduced atrial fibrillation risk, whereas volumes exceeding 20 MET-h/week show no relation with risk.

Keywords

Physical activity atrial fibrillation risk meta-regression

Get full access to this article

View all access options for this article.

References

Benjamin

Wolf

D'Agostino

et al.

Impact of atrial fibrillation on the risk of death the Framingham Heart Study. Circulation 1998; 98: 946–952.

Thrall

Lane

Carroll

et al.

Quality of life in patients with atrial fibrillation: A systematic review. Am J Med 2006; 119: 448. e1–. e19.

Mourtzinis

Schiöler

Kahan

et al.

Antihypertensive control and new-onset atrial fibrillation: Results from the Swedish Primary Care Cardiovascular Database (SPCCD). Eur J Prev Cardiol 2017; 24: 1206–1211.

Ruddox

Sandven

Munkhaugen

et al.

Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: A systematic review and meta-analysis. Eur J Prev Cardiol 2017; 24: 1555–1566.

Bayturan

Puri

Tuzcu

et al.

Atrial fibrillation, progression of coronary atherosclerosis and myocardial infarction. Eur J Prev Cardiol 2017; 24: 373–381.

Berntsson

Smith

Nilsson

et al.

Pro-atrial natriuretic peptide and prediction of atrial fibrillation and stroke: The Malmö Preventive Project. Eur J Prev Cardiol 2017; 24: 788–795.

Coyne

Paramore

Grandy

et al.

Assessing the direct costs of treating nonvalvular atrial fibrillation in the United States. Value Health 2006; 9: 348–356.

Hylek

Phillips

et al.

Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370–2375.

Alonso

Krijthe

Aspelund

et al.

Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: The CHARGE-AF consortium. J Am Heart Assoc 2013; 2: e000102.

10.

Mohanty

Tamaki

et al.

Differential association of exercise intensity with risk of atrial fibrillation in men and women: Evidence from a meta-analysis. J Cardiovasc Electrophysiol 2016; 27: 1021–1029.

11.

Abdulla

Nielsen

. Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace 2009; 11: 1156–1159.

12.

Kwok

Anderson

Myint

et al.

Physical activity and incidence of atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2014; 177: 467–476.

13.

Zhu

Wan

Din

et al.

Sex differences in the association between regular physical activity and incident atrial fibrillation: A meta-analysis of 13 prospective studies. Clin Cardiol 2016; 39: 360–367.

14.

Shephard

Tudor-Locke

. The objective monitoring of physical activity: Contributions of medical accelerometer-determined steps per day in US adults and steps/day in a free-living sample of overweight and obese adults. J Phys Activity Health 2013; 10: 263–270. .

15.

Moher

Liberati

Tetzlaff

et al.

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–269.

16.

Stang

. Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603–605.

17.

Sterne

Egger

Smith

. Investigating and dealing with publication and other biases in meta-analysis. BMJ 2001; 323: 101–105.

18.

Orsini

Bellocco

Greenland

. Generalized least squares for trend estimation of summarized dose-response data. Stata J 2006; 6: 40–57.

19.

Aizer

Gaziano

Cook

et al.

Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol 2009; 103: 1572–1577.

20.

Andersen

Farahmand

Ahlbom

et al.

Risk of arrhythmias in 52 755 long-distance cross-country skiers: A cohort study. Eur Heart J 2013; 34: 3624–3631.

21.

Azarbal

Stefanick

Salmoirago-Blotcher

et al.

Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. J Am Heart Assoc 2014; 3: e001127.

22.

Bapat

Zhang

Post

et al.

Relation of physical activity and incident atrial fibrillation (from the Multi-Ethnic Study of Atherosclerosis). The Am J Cardiol 2015; 116: 883–8.

23.

Drca

Wolk

Jensen-Urstad

et al.

Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart 2014; 100: 1037–1042.

24.

Drca

Wolk

Jensen-Urstad

et al.

Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart 2015; 101: 1627–1630.

25.

Everett

Conen

Buring

et al.

Physical activity and the risk of incident atrial fibrillation in women. Circ Cardiovasc Qual Outcomes 2011; 4: 321–327.

26.

Faselis

Kokkinos

Tsimploulis

et al.

Exercise capacity and atrial fibrillation risk in veterans: A cohort study. Mayo Clin Proc 2016; 91: 558–566.

27.

Frost

Vestergaard

. Work related physical activity and risk of a hospital discharge diagnosis of atrial fibrillation or flutter: The Danish Diet, Cancer, and Health Study. Occup Environ Med 2005; 62: 49–53.

28.

Ghorbani

Willett

Mozaffarian

. Abstract P427: Physical activity and incidence of atrial fibrillation: The Health Professionals Follow-up Study. Circulation 2014; 129(Suppl. 1): AP427.

29.

Huxley

Misialek

Agarwal

et al.

Physical activity, obesity, weight change and risk of atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study. Circ Arrhythm Electrophysiol 2014; 7: 620–625.

30.

Knuiman

Briffa

Divitini

et al.

A cohort study examination of established and emerging risk factors for atrial fibrillation: The Busselton Health Study. Eur J Epidemiol 2014; 29: 181–190.

31.

Morseth

Graff-Iversen

Jacobsen

et al.

Physical activity, resting heart rate, and atrial fibrillation: the Tromsø Study. Eur Heart J 2016; 37: 2307–2313.

32.

Mozaffarian

Furberg

Psaty

et al.

Physical activity and incidence of atrial fibrillation in older adults. Circulation 2008; 118: 800–807.

33.

Skielboe

Marott

Dixen

et al.

Occupational physical activity, but not leisure-time physical activity increases the risk of atrial fibrillation: The Copenhagen City Heart Study. Eur J Prev Cardiol 2016; 23: 1883–1893.

34.

Thelle

Selmer

Gjesdal

et al.

Resting heart rate and physical activity as risk factors for lone atrial fibrillation: A prospective study of 309 540 men and women. Heart 2013; 99: 1755–1760.

35.

Williams

Franklin

. Reduced incidence of cardiac arrhythmias in walkers and runners. PLoS One 2013; 8: e65302.

36.

Woodward

Tin

Doughty

et al.

Atrial fibrillation and cycling: Six year follow-up of the Taupo bicycle study. BMC Public Health 2015; 15: 23–29.

37.

Sun

G-Z

Guo

Wang

X-Z

et al.

Prevalence of atrial fibrillation and its risk factors in rural China: A cross-sectional study. Int J Cardiol 2015; 182: 13–17.

38.

Brunetti

Santoro

Correale

et al.

Incidence of atrial fibrillation is associated with age and gender in subjects practicing physical exercise: A meta-analysis and meta-regression analysis. Int J Cardiol 2016; 221: 1056–1060.

39.

Ofman

Khawaja

Rahilly-Tierney

et al.

Regular physical activity and risk of atrial fibrillation: A systematic review and meta-analysis. Circ Arrhythm Electrophysiol 2013. CIRCEP.113.000147.

40.

Thompson

. Physical Fitness, physical activity, exercise training, and atrial fibrillation. J Am Coll Cardiol 2015; 66: 997–999. .

41.

Finaud

Lac

Filaire

. Oxidative stress. Sports Med 2006; 36: 327–358.

42.

Turagam

Velagapudi

Kocheril

. Atrial fibrillation in athletes. Am J Cardiol 2012; 109: 296–302.

43.

van de Schoor

Aengevaeren

Hopman

et al.

Myocardial fibrosis in athletes. Mayo Clin Proc 2016; 91: 1617–1631.

44.

Wilhelm

Roten

Tanner

et al.

Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol 2011; 108: 580–585.

45.

Dhurandhar

Schoeller

Brown

et al.

Energy balance measurement: When something is not better than nothing. Int J Obes 2015; 39: 1109.