Relation of vigorous exercise to risk of atrial fibrillation
Open accessAbstract
Limited data suggest that athletes may have a higher risk of developing atrial fibrillation (AF); however, there has been no large prospective assessment of the relation between vigorous exercise and AF. Logistic regression analyses stratified by time were used to assess the association between frequency of vigorous exercise and risk of developing AF in 16,921 apparently healthy men in the Physicians' Health Study. During 12 years of follow-up, 1,661 men reported developing AF. With increasing frequency of vigorous exercise (0, 1, 1 to 2, 3 to 4, 5 to 7 days/week), multivariate relative risks for the full cohort were 1.0 (referent), 0.90, 1.09, 1.04, and 1.20 (p = 0.04). This risk was not significantly increased when exercise habits were updated or in models excluding variables that may be in the biological pathway through which exercise influences AF risk. In subgroup analyses, this increased risk was observed only in men <50 years of age (1.0, 0.94, 1.20, 1.05, 1.74, p <0.01) and joggers (1.0, 0.91, 1.03, 1.30, 1.53, p <0.01), where risks remained increased in all analyses. In conclusion, frequency of vigorous exercise was associated with an increased risk of developing AF in young men and joggers. This risk decreased as the population aged and was offset by known beneficial effects of vigorous exercise on other AF risk factors.
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Habitual vigorous exercise is independently associated with AF, with 5-7 days/week RR 1.20 compared with non-exercisers.
“Habitual vigorous exercise 214 Non-exercisers < 1 day/week 1-2 days/week 3-4 days/week 5-7 days/week RR: 1.00 (reference) 0.90 (95% CI 0.68 -1.20) 1.09 (95% CI 0.95-1.26) 1.04 (95% CI 0.91-1.19) 1.20 (95% CI 1.02-1.41”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [214]
This results in a U-shaped relationship of physical activity and incident AF.
“This results in a U-shaped relationship of physical activity and incident AF. 214,898,902,905,906”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [214]
In men, a U-shaped association has been reported between physical activity and AF, in which sedentary lifestyle and vigorous exercise both are associated with increased AF risk, whereas moderate activity is protective.
“In men, a U-shaped association has been reported, in which sedentary lifestyle and vigorous exercise both are associated with increased AF risk,41,44,45 whereas moderate activity is protective.46”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [45]
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“We are aware of only two studies that address the association between leisure-time PA (LTPA) and risk of AF in elderly people; the Cardiovascular Health Study and the Physicians Health Study (Mozaffarian et al., 2008; Aizer et al., 2009).”
BackgroundAzarbal, F., Stefanick, M. L., Salmoirago‐Blotcher, E., Manson, J. E., Albert, C. M., LaMonte, M. J., Larson, J. C., Li, W., Martin, L. W., Nassir, R., et al. (2014) · Journal of the American Heart Association · doi:10.1161/jaha.114.001127 · Cited by 113 · see citing works
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Atrial fibrillation and atrial flutter in athletes
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“Additionally, these results were confirmed by a large prospective cohort study of apparently healthy men.(18) After adjustment for multiple potentially confounding lifestyle factors and health conditions, Aizer et al showed a 20% increased risk of developing AF among individuals with higher frequency of participation…”
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“postulated to predispose to arrhythmias, most commonly atrial fibrillation.(112,113) Twelve weeks of aggressive, exhaustive”
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Physical Activity and Risk of Atrial Fibrillation: A Nationwide Cohort Study in General Population
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Accelerometer-derived physical activity and risk of atrial fibrillation
Khurshid, S. S., Weng, L.-C. C., Al‐Alusi, M. A., Halford, J. L., Haimovich, J. S., Benjamin, E. J., Trinquart, L., Ellinor, P. T., McManus, D. D., & Lubitz, S. A. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab250 · Cited by 98 · see citing works
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Effect of Years of Endurance Exercise on Risk of Atrial Fibrillation and Atrial Flutter
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Self-citationAtrial fibrillation in endurance athletes
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“In the Physicians Health Study, the relative risk of AF increased in joggers practising more than 3 or 4 days a week.(60) Thus, limiting endurance training is the most important recommendation in athletes with AF.”
BackgroundExercise effects on cardiovascular disease: from basic aspects to clinical evidence
Sanchis‐Gomar, F., Lavie, C. J., Marín-Puyalto, J., Pérez-Quilis, C., Eijsvogels, T. M. H., O’Keefe, J. H., Perez, M. V., & Blair, S. N. (2021) · Cardiovascular Research · doi:10.1093/cvr/cvab272 · Cited by 99 · see citing works
“189,190 The association might be particularly strong in competitive athletes.”
BackgroundRun for your life … at a comfortable speed and not too far
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Central Sleep-disordered Breathing Predicts Incident Atrial Fibrillation in Older Men
May, A. M., BLACKWELL, T. L., Stone, P. H., Stone, K. L., Cawthon, P. M., Sauer, W. H., Varosy, P. D., Redline, S. S., & Mehra, R. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201508-1523oc · Cited by 91 · see citing works
Atrial fibrillation in highly trained endurance athletes — Description of a syndrome
Sanchis-Gomar, F., Perez-Quilis, C., Lippi, G., Cervellin, G., Leischik, R., Löllgen, H., Serrano-Ostáriz, E., & Lucia, A. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.10.047 · Cited by 95 · see citing works
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Kwok, C. S., Anderson, S. G., Myint, P. K., Mamas, M. A., & Loke, Y. K. (2014) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.09.104 · Cited by 89 · see citing works
The athlete’s heart is a proarrhythmic heart, and what that means for clinical decision making
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Sympathetic Nervous System Activation and Its Modulation: Role in Atrial Fibrillation
Carnagarin, R., Kiuchi, M. G., Ho, J. K., Matthews, V. B., & Schlaich, M. P. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2018.01058 · Cited by 81 · see citing works
Exercise Capacity and Atrial Fibrillation Risk in Veterans
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“There are also limited data suggesting that regular moderate-intensity exercise, as recommended by national and international guidelines on PA and health, may increase the risk of developing AF.(6,8,10) This has not been a consistent finding.”
Cardiovascular damage resulting from chronic excessive endurance exercise.
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Atrial fibrillation in athletes and the interplay between exercise and health
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“level of exertion is equivalent to jogging, then a greater prevalence of AF is appreciable in those jogging daily as compared with those jogging 1–2 times/week.(20) A reasonable ‘guestimate’ when consider-”
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The Journal of Tehran University Heart Center
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Kazemi, A., Soltani, S., Aune, D., Hosseini, E., Mokhtari, Z., Hassanzadeh, Z., Jayedi, A., Pitanga, F. J. G., & Akhlaghi, M. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01593-8 · Cited by 83 · see citing works
“Twelve cohort studies (764,640 participants, 24,642 cases) investigated the association between LTPA and risk of AF [35, 38, 42, 58, 63, 67, 87, 93, 104, 115].”
BackgroundAtrial Fibrillation in Athletes
Turagam, M. K., Velagapudi, P., & Kocheril, A. G. (2011) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.08.041 · Cited by 73 · see citing works
Novel Risk Factors for Atrial Fibrillation
Rienstra, M., McManus, D. D., & Benjamin, E. J. (2012) · Circulation · doi:10.1161/circulationaha.112.112920 · Cited by 72 · see citing works
The ambiguity of physical activity, exercise and atrial fibrillation
Morseth, B., Løchen, M., Ariansen, I., Myrstad, M., & Thelle, D. S. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318754930 · Cited by 70 · see citing works
Cardiorespiratory fitness and atrial fibrillation: A population-based follow-up study
Khan, H., Kella, D., Rauramaa, R., Savonen, K. P., Lloyd, M. S., & Laukkanen, J. A. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.024 · Cited by 69 · see citing works
“The primary outcome was incident AF.”
BackgroundInfluentialRicci, C., Gervasi, F., Gaeta, M., Smuts, C. M., Schutte, A. E., & Leitzmann, M. F. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318768026 · Cited by 66 · see citing works
Vagal atrial fibrillation: What is it and should we treat it?
Carpenter, A., Frontera, A., Bond, R., Duncan, E., & Thomas, G. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.08.108 · Cited by 65 · see citing works
“other AF risk factors [65], supporting the role of physical exercise as a positive health determinant, so long as it is practisedwithinmoderation [65].”
BackgroundExercise and Atrial Fibrillation: Prevention or Causation?
Elliott, A. D., Linz, D., Verdicchio, C. V., & Sanders, P. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.04.296 · Cited by 63 · see citing works
Life's Simple 7 and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis
Ogunmoroti, O., Michos, E. D., Aronis, K. N., Salami, J., Blankstein, R., Virani, S. S., Spatz, E. S., Allen, N. B., Rana, J. S., Blumenthal, R. S., et al. (2018) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2018.05.050 · Cited by 66 · see citing works
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Coffee Consumption and Risk of Atrial Fibrillation in the Physicians’ Health Study
Bodar, V., Chen, J., Gaziano, J. M., Albert, C. M., & Djoussé, L. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.118.011346 · Cited by 61 · see citing works
“A detailed description of the AF validation in the PHS has been published.(22)”
MethodSleep Duration and Risk of Atrial Fibrillation (from the Physicians' Health Study)
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The Impact of Diet and Lifestyle on Atrial Fibrillation
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Atrial Fibrillation in Athletes
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“Vigorous exercise was associated with an increased risk of developing AF in young men (younger than 50 years of age) and joggers (26).”
BackgroundLow heart rates predict incident atrial fibrillation in healthy middle-aged men
Grundvold, I., Skretteberg, P. T., Liestøl, K., Erikssen, G., Engeseth, K., Gjesdal, K., Kjeldsen, S. E., Arnesen, H., Erikssen, J., & Bodegard, J. (2013) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000267 · Cited by 60 · see citing works
“Vagally mediated paroxysmal AF may be particularly important in athletic men without apparent heart disease.(20) Elucidating the possible pathophysiological mechanisms of the present findings is, however, complicated.”
BackgroundKunutsor, S. K., Seidu, S., Mäkikallio, T. H., Dey, R. S., & Laukkanen, J. A. (2021) · European Journal of Epidemiology · doi:10.1007/s10654-020-00714-4 · Cited by 55 · see citing works
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Physical activity and atrial fibrillation: Data from wearable fitness trackers
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2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease
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Heidbüchel, H., Adami, P. E., Antz, M., Braunschweig, F., Delise, P., Scherr, D., Solberg, E. E., Wilhelm, M., & Pelliccia, A. (2020) · European Journal of Preventive Cardiology · doi:10.1177/2047487320925635 · Cited by 53 · see citing works
- Authors
- Aizer, A., Gaziano, J. M., Cook, N. R., Manson, J. E., Buring, J. E., & Albert, C. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Aizer, Anthony
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2009-06
- Volume
- 103
- Issue
- 11
- Pages
- 1572-1577
- ISSN
- 0002-9149 (ISSN-L)
- PMC
- PMC2687527
- OpenAlex
- W2070824750
- Cited by
- 383
- References
- 25
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 17 · 2023: 37 · 2022: 19 · 2021: 21 · 2020: 32 · 2019: 23 · 2018: 31 · 2017: 21 · 2016: 30 · 2015: 22 · 2014: 24 · 2013: 23 · 2012: 22
- FWCI
- 13.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01hl043851-10)
- National Heart, Lung, and Blood Institute (HL-34595, HL 26490, R01‐HL043851, R01HL034595)
- National Cancer Institute (R01CA040360, CA 34944, CA-097193, R01CA097193, CA 40360, R01CA047988)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- atrial fibrillation, high-intensity exercise, exercise frequency, joggers, young men, aging, risk factors, Physicians' Health Study
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Atrial Fibrillation, Humans, Life Style, Male, Middle Aged, Prospective Studies, Exercise, Effect Modifier, Epidemiologic, Body Mass Index, Logistic Models, Risk Assessment
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