CoChat
Sign Up
Cited by 204Atrial Fibrillation Management and OutcomesPhysical Activity and HealthCardiovascular Effects of Exercise

Physical activity, resting heart rate, and atrial fibrillation: the Tromsø Study

Open access
Morseth, Bente, Graff-Iversen, Sidsel, Jacobsen, Bjarne K., Jørgensen, Lone, Nyrnes, Audhild, Thelle, Dag S., Vestergaard, Peter, Løchen, Maja-Lisa·2016·European Heart Journal
DOI 10.1093/eurheartj/ehw059PMC PMC4986028
Open this paper in CoChat — free accountOpen PDF

Abstract

AIMS: The objective was to examine the association of physical activity and resting heart rate (RHR) with hospital-diagnosed atrial fibrillation (AF) in a Norwegian cohort. METHODS AND RESULTS: This prospective study included 20 484 adults (50.3% men) who participated in the third Tromsø Study survey in 1986-87. At baseline, physical activity was assessed by a validated questionnaire, and RHR was objectively measured. Participants were followed from baseline through 2010 with respect to incident cases of hospital-diagnosed AF documented on an electrocardiogram. During a mean follow-up period of 20 years (409 045 person-years), 750 participants (70.5% men) were diagnosed with AF. Compared with the low physical activity group, moderately active individuals had a 19% lower risk of any AF [adjusted hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.68-0.97], whereas highly active had similar risk of AF. Vigorously active individuals showed a non-significantly higher risk of AF (adjusted HR 1.37, 95% CI 0.77-2.43). Risk of AF increased with decreasing RHR (adjusted HR 0.92, 95% CI 0.86-0.98 for each 10 b.p.m. increase in RHR), and RHR < 50 b.p.m. was a risk factor for AF (P < 0.05). CONCLUSION: In this prospective cohort study, leisure time physical activity was associated with AF in a J-shaped pattern. Moderate physical activity was associated with a reduced risk of AF, whereas higher activity levels attenuated the benefits of moderate activity. Low RHR was a risk factor for AF. Our results support the hypothesis that moderate and vigorous physical activity may affect AF risk via different pathophysiological mechanisms.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/eurheartj/ehw059

Cites

6 of 6 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A U-shaped relationship exists between male elite athletes and AF, suggesting both type (endurance) and dose (hours of training) of physical activity relate to AF development.

    “A U-shaped relationship between male elite athletes and AF is demonstrated through this finding, suggesting that both the type (endurance) and the dose (hours of training) of physical activity seem to relate to AF development [14,18,19,20,21].”

    From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [19]

    The Introduction (page unavailable) links endurance training to AF and notes high AF prevalence in male endurance athletes. The Physical activity and AF section (page unavailable) reports that another study found a U-shaped relationship, but this paper describes its own finding as J-shaped in a community cohort of women and men. It does not establish a U-shaped relationship specifically in male elite athletes or assess dose as hours of training. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 25

  1. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369 -2429.
  2. Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaelsson K, Sundstrom J. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J 2013;34:3624 -3631.
  3. Myrstad M, Løchen ML, Graff-Iversen S, Gulsvik AK, Thelle DS, Stigum H, Ranhoff AH. Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scand J Med Sci Sports 2014;24:e238-e244.
  4. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, Jenni R, Oechslin E, Luthi P, Scharf C, Marti B, Attenhofer Jost CH. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J 2008;29:71 -78.
  5. Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the Cardiovascular Health Study. Circulation 2008;118:800 -807.
  6. Huxley RR, Misialek JR, Agarwal SK, Loehr LR, Soliman EZ, Chen LY, Alonso A. Physical activity, obesity, weight change, and risk of atrial fibrillation: the Athero- sclerosis Risk in Communities study. Circ Arrhythm Electrophysiol 2014;7:620 -625.
  7. Azarbal F, Stefanick ML, Salmoirago-Blotcher E, Manson JE, Albert CM, LaMonte MJ, Larson JC, Li W, Martin LW, Nassir R, Garcia L, Assimes TL, Tharp KM, Hlatky MA, Perez MV. Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. J Am Heart Assoc 2014; 3:e001127.
  8. Williams PT, Franklin BA. Reduced incidence of cardiac arrhythmias in walkers and runners. PLoS ONE 2013;8:e65302.
  9. Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart 2014;100: 1037 -1042.
  10. Frost L, Frost P, Vestergaard P. 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.
  11. Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I. Cohort profile: the Tromsø Study. Int J Epidemiol 2012;41:961 -967.
  12. Anderssen SA, Engeland A, Søgaard AJ, Nystad W, Graff-Iversen S, Holme I. Changes in physical activity behavior and the development of body mass index during the last 30 years in Norway. Scand J Med Sci Sports 2008;18:309-317.
  13. Barengo NC, Nissinen A, Pekkarinen H, Halonen P, Tuomilehto J. Twenty-five-year trends in lifestyle and socioeconomic characteristics in Eastern Finland. Scand J Public Health 2006;34:437-444.
  14. Graff-Iversen S, Anderssen SA, Holme IM, Jenum AK, Raastad T. Two short ques- tionnaires on leisure-time physical activity compared with serum lipids, anthropo- metric measurements and aerobic power in a suburban population from Oslo, Norway. Eur J Epidemiol 2008;23:167 -174.
  15. Nyrnes A, Mathiesen EB, Njølstad I, Wilsgaard T, Løchen ML. Palpitations are predictive of future atrial fibrillation. An 11-year follow-up of 22,815 men and women: the Tromsø Study. Eur J Prev Cardiol 2013;20:729 -736.
  16. Gjesdal K, Grundvold I. Atrial fibrillation and exercise in women: some answers given, some questions remain. Heart 2015;101:1605 -1606.
  17. Graff-Iversen S, Gjesdal K, Jugessur A, Myrstad M, Nystad W, Selmer R, Thelle DS. Atrial fibrillation, physical activity and endurance training. Tidsskr Nor Laegeforen 2012;132:295 -299.
  18. Jensen MT, Suadicani P, Hein HO, Gyntelberg F. Elevated resting heart rate, physical fitness and all-cause mortality: a 16-year follow-up in the Copenhagen Male Study. Heart 2013;99:882 -887.
  19. Grundvold I, Skretteberg PT, Liestøl K, Erikssen G, Engeseth K, Gjesdal K, Kjeldsen SE, Arnesen H, Erikssen J, Bodegard J. Low heart rates predict incident atrial fibrillation in healthy middle-aged men. Circ Arrhythm Electrophysiol 2013;6: 726-731.
  20. Jacobsen BK, Thelle DS. The Tromsø Heart Study: responders and non-responders to a health questionnaire, do they differ? Scand J Soc Med 1988;16:101-104.
  21. Langhammer A, Krokstad S, Romundstad P, Heggland J, Holmen J. The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms. BMC Med Res Methodol 2012;12:143.
  22. Shephard RJ. Limits to the measurement of habitual physical activity by question- naires. Br J Sports Med 2003;37:197-206; discussion 206.
  23. Aadahl M, Kjær M, Jørgensen T. Associations between overall physical activity level and cardiovascular risk factors in an adult population. Eur J Epidemiol 2007;22: 369 -378.
  24. Jørgensen L, Morseth B, Andreassen M, Jacobsen B. Comments to Emaus et al. 'Does a variation in self-reported physical activity reflect variation in objectively measured physical activity, resting heart rate, and physical fitness? Results from the Tromsø study'. Scand J Public Health 2011;39:437 -438.
  25. Lip GY, Golding DJ, Nazir M, Beevers DG, Child DL, Fletcher RI. A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project. Br J Gen Pract 1997;47:285-289.

Cited by

Sorted by citations

Authors
Morseth, B., Graff-Iversen, S., Jacobsen, B. K., Jørgensen, L., Nyrnes, A., Thelle, D. S., Vestergaard, P., & Løchen, M.-L.
Affiliations
  • University Hospital of North Norway (NO)
  • UiT The Arctic University of Norway (NO)
  • Norwegian Institute of Public Health (NO)
  • Aalborg University Hospital (DK)
Corresponding author
Morseth, Bente
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2016-03-10
Volume
37
Issue
29
Pages
2307-2313
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehw059
PMC
PMC4986028
OpenAlex
W2298207690
Cited by
204
References
6
Citations by year
2026: 8 · 2025: 18 · 2024: 30 · 2023: 28 · 2022: 22 · 2021: 17 · 2020: 21 · 2019: 17 · 2018: 22 · 2017: 13 · 2016: 7 · 2012: 1
FWCI
16.20
Type
journal article
Language
en
Open access
Locations
  • European Heart Journal (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
Funders
Northern Norway Regional Health Authority (SFP1091-13)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
Keywords
atrial fibrillation, physical activity, resting heart rate, leisure-time physical activity, J-shaped association, moderate physical activity, high-intensity exercise, atrial fibrillation risk factors, Tromsø Study
MeSH terms
Atrial Fibrillation, Female, Heart Rate, Humans, Male, Norway, Prospective Studies, Risk Factors, Exercise, Incidence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review