Differential Association of Exercise Intensity With Risk of Atrial Fibrillation in Men and Women: Evidence from a Meta‐Analysis
Abstract
Background Despite widespread interest and extensive research, the association between different levels of physical activity (PA) and risk of atrial fibrillation (AF) is still not clearly defined. Therefore, we systematically evaluated and summarized the evidences regarding association of different intensity of PA with the risk of AF in this meta-analysis. Methods and results An extensive literature search was performed on databases for studies showing association of exercise with AF risk. Twenty-two studies were identified that included 656,750 subjects. Meta-analytic estimates were derived using random-effects models and pooled odds ratio estimates were obtained. Potential sources of heterogeneity were examined in sensitivity analyses, and publication biases were estimated. Pooled analysis of 7 studies with 93,995 participants reported high risk of incident AF with sedentary lifestyle (pooled OR 2.47 [95% CI 1.25-3.7], P = 0.005). In 3 trials, 149,048 women involved in moderate PA were 8.6% less likely to develop AF compared to women with sedentary life (OR 0.91 [95% CI 0.78-0.97], P = 0.002). Women performing intense exercise were found to have 28% lower risk of AF (OR 0.72 [95% CI 0.57-0.88], P Conclusion Sedentary lifestyle significantly increases and moderate amount of physical activity reduces the risk of AF in both men and women. However, intense exercise has a gender-specific association with AF risk.
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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 [17]
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 [17]
The most dominant hypothesis suggests that specific criteria in females, including smaller atria, shorter P-wave duration, differences in autonomic tone, and lower LV mass and wall thickness, may be the keys to differences in AF response between male and female elite athletes.
“The most dominant hypothesis suggests that specific criteria in females, including smaller atria, shorter P-wave duration, differences in autonomic tone, and lower LV mass and wall thickness, may be the keys to these differences [17].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [17]
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Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature
Kourek, C., Briasoulis, A., Tsougos, E., & Paraskevaidis, I. (2024) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd11100315 · Cited by 7 · see citing works
“…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 [6–8 higher frequency of AF in high-intensity endurance athletes compared to individuals who do not exercise [6–8,12–17].”
Background
- Authors
- MOHANTY, S., MOHANTY, P., TAMAKI, M., NATALE, V., GIANNI, C., TRIVEDI, C., GOKOGLAN, Y., DI BIASE, L., & NATALE, A.
- Affiliations
- St David's Medical Center (US)
- Texas Cardiac Arrhythmia (US)
- The University of Texas at Austin (US)
- University of Milan (IT)
- Texas Cardiac Arrhythmia Institute St. David's Medical Center Austin Texas
- California Pacific Medical Center (US)
- Corresponding author
- NATALE, ANDREA
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2016-07-07
- Volume
- 27
- Issue
- 9
- Pages
- 1021-1029
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2414888007
- Cited by
- 124
- References
- 9
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 12 · 2023: 8 · 2022: 18 · 2021: 11 · 2020: 17 · 2019: 11 · 2018: 16 · 2017: 8 · 2016: 3
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- 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, exercise intensity, physical activity, sedentary lifestyle, moderate physical activity, high-intensity exercise, sex differences, incident atrial fibrillation risk
- MeSH terms
- Action Potentials, Adult, Aged, Atrial Fibrillation, Female, Heart Conduction System, Heart Rate, Humans, Male, Middle Aged, Risk Factors, Sex Factors, Exercise, Incidence, Linear Models, Odds Ratio, Risk Assessment, Evidence-Based Medicine, Risk Reduction Behavior, Sedentary Behavior, Protective Factors
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