Effect of Years of Endurance Exercise on Risk of Atrial Fibrillation and Atrial Flutter
Abstract
Emerging evidence suggests that endurance exercise increases the risk for atrial fibrillation (AF) in men, but few studies have investigated the dose-response relation between exercise and risk for atrial arrhythmias. Both exposure to exercise and reference points vary among studies, and previous studies have not differentiated between AF and atrial flutter. The aim of this study was to assess the risk for atrial arrhythmias by cumulative years of regular endurance exercise in men. To cover the range from physical inactivity to long-term endurance exercise, the study sample in this retrospective cohort study was based on 2 distinct cohorts: male participants in a long-distance cross-country ski race and men from the general population, in total 3,545 men aged ≥ 53 years. Arrhythmia diagnoses were validated by electrocardiograms during review of medical records. Regular endurance exercise was self-reported by questionnaire. A broad range of confounding factors was available for adjustment. The adjusted odds ratios per 10 years of regular endurance exercise were 1.16 (95% confidence interval 1.06 to 1.29) for AF and 1.42 (95% confidence interval 1.20 to 1.69) for atrial flutter. In stratified analyses, the associations were significant in cross-country skiers and in men from the general population. In conclusion, cumulative years of regular endurance exercise were associated with a gradually increased risk for AF and atrial flutter.
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A 2 to 10 times higher frequency of AF has been shown in high-intensity endurance athletes compared to individuals who do not exercise.
“Many retrospective observational studies and meta-analyses have estimated a 2 to 10 times higher frequency of AF in high-intensity endurance athletes compared to individuals who do not exercise [6,7,8,12,13,14,15,16,17].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [8]
Regular exercise of low or moderate intensity serves as a preventive strategy for cardiovascular disease and AF, while higher-intensity endurance exercise may lead to AF.
“Regular exercise of either low or moderate intensity seems serve as a preventive strategy for cardiovascular disease and AF, while higher-intensity endurance exercise may lead to AF [6,7,8,12,13,14,15,16,17,18,19,20,21].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [8]
Years of regular endurance exercise are significantly associated with an increased risk for both AF and atrial flutter, with a 1.16 (95% CI 1.06 to 1.29) times higher risk for AF and a 1.42 (95% CI 1.20 to 1.69) times higher risk for AFl per 10 years of endurance exercise.
“It was shown that years of regular endurance exercise were significantly associated with an increased risk for both arrhythmias, with a 1.16 (95% confidence interval 1.06 to 1.29) times higher risk for AF and a 1.42 (95% confidence interval 1.20 to 1.69) times higher risk for AFl per 10 years of endurance exercise [8].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [8]
Extreme exercise appears to be related to cardiac troponin release, myocardial fibrosis, and atrial fibrillation.
“These observations are in line with findings from previous studies as extreme exercise appears to be related to cardiac troponin release 33 , myocardial fibrosis 34 , and atrial fibrillation 35 .”
From Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. (2017) · cites this paper as [35]
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Self-citationAtrial fibrillation in athletes and the interplay between exercise and health
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Atrial Fibrillation in Athletes
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Self-citationAtrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature
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“Recent studies have presented a significant association between regular endurance exercise and an increased risk of AF, not only in elite athletes, but also in non-elite athletes who participate in vigorous exercise [5–8].”
BackgroundInfluential
- Authors
- Myrstad, M., Nystad, W., Graff-Iversen, S., Thelle, D. S., Stigum, H., Aarønæs, M., & Ranhoff, A. H.
- Affiliations
- Norwegian Institute of Public Health (NO)
- University of Oslo (NO)
- Diakonhjemmet Hospital (NO)
- Corresponding author
- Myrstad, Marius
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 114
- Issue
- 8
- Pages
- 1229-1233
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1995267173
- Cited by
- 104
- References
- 4
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 9 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 11 · 2019: 9 · 2018: 9 · 2017: 10 · 2016: 10 · 2015: 10
- FWCI
- 6.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- 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
- endurance exercise, atrial fibrillation, atrial flutter, atrial arrhythmias, dose-response relationship, cross-country skiing, men, physical inactivity
- MeSH terms
- Adult, Aged, Aged, 80 and over, Atrial Fibrillation, Atrial Flutter, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Norway, Physical Endurance, Surveys and Questionnaires, Retrospective Studies, Risk Factors, Skiing, Time Factors, Incidence, Risk Assessment
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