In the JournalsPerspective

Physical activity reduces AF risk, especially in women

Physically active adults, particularly women, have lower risk for atrial fibrillation and ventricular arrhythmia compared with inactive adults, according to research published in the European Heart Journal.

Using self-reported physical activity assessments from the UK Biobank (n = 402,406; 53% women; aged 40 to 69 years), researchers found that risk for incident AF was lower in those who reported 1,500 metabolic equivalent (MET) minutes per week compared with those reporting zero MET minutes per week.

The differences between the groups were more pronounced in women (HR = 0.85; 95% CI, 0.74-0.98) than men (HR = 0.9; 95% CI, 0.82-1), according to the researchers.

Moreover, researchers observed a lower risk for ventricular arrhythmias in physically active participants (HR for 1,500 MET minutes per week vs. no physical activity = 0.78; 95% CI, 0.64-0.96), which was present at all physical activity levels between 500 MET minutes per week and 2,500 MET minutes per week.

No association with bradyarrhythmias

In addition, researchers found no relationship between total or vigorous physical activity and bradyarrhythmias.

“In this comprehensive analysis of the association between physical activity and incident cardiac arrhythmias, we demonstrate that both atrial and ventricular arrhythmias are less frequent amongst physically active participants,” Adrian D. Elliott, PhD, National Heart Foundation Research Fellow and physiology lecturer at the Centre for Heart Rhythm Disorders at the University of Adelaide and Royal Adelaide Hospital, Australia, and colleagues wrote. “We did not observe any association between total physical activity habits and bradyarrhythmic events, although female participants engaging in vigorous physical activity appear to carry a lower risk of developing bradyarrhythmias. Importantly, this data supports an association between higher physical activity and reduced arrhythmia risk up to 2,500 MET minutes per week, which is higher than current physical activity guidelines.”

In other findings, researchers observed a lower risk for AF in women who engaged in moderate levels of vigorous physical activity, up to 2,500 MET minutes per week. Additionally, vigorous physical activity was also associated with reduced risk for ventricular arrhythmia.

Participants answered questions on self-reported physical activity habits, which formed the primary exposure variable, with sociodemographic factors, lifestyle habits and comorbidities as covariates. Data on clinical comorbidities including hypertension, obstructive sleep apnea, diabetes, arrhythmias, HF, valvular disease and coronary disease were also obtained by self-reported questionnaire at baseline.

“These findings suggest that low physical activity habits should be added to the list of lifestyle-based risk factors associated with the development of AF,” the researchers wrote. “Additional clinical intervention studies specifically focusing on intensive vigorous physical activity may be needed to allow clear recommendations for athletes and patients with AF who may wish to partake in these types of activity.”

Two clinical implications

“The first and foremost implication is that regular physical activity is protective against most forms of cardiac arrhythmias, including AF, and is to be encouraged,” Stanley Nattel, MD, of the department of medicine and research at the Montreal Heart Institute and Université de Montréal, wrote in a related editorial. “Secondly, regular involvement in very vigorous physical activity can promote AF, predominantly in men, and this may need to be considered in managing highly active patients with the arrhythmia. Finally, there is a lot we do not know about how sex can determine important biological responses, and much more research is needed in this area.” – by Scott Buzby

Disclosures: Elliott and Nattel report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Physically active adults, particularly women, have lower risk for atrial fibrillation and ventricular arrhythmia compared with inactive adults, according to research published in the European Heart Journal.

Using self-reported physical activity assessments from the UK Biobank (n = 402,406; 53% women; aged 40 to 69 years), researchers found that risk for incident AF was lower in those who reported 1,500 metabolic equivalent (MET) minutes per week compared with those reporting zero MET minutes per week.

The differences between the groups were more pronounced in women (HR = 0.85; 95% CI, 0.74-0.98) than men (HR = 0.9; 95% CI, 0.82-1), according to the researchers.

Moreover, researchers observed a lower risk for ventricular arrhythmias in physically active participants (HR for 1,500 MET minutes per week vs. no physical activity = 0.78; 95% CI, 0.64-0.96), which was present at all physical activity levels between 500 MET minutes per week and 2,500 MET minutes per week.

No association with bradyarrhythmias

In addition, researchers found no relationship between total or vigorous physical activity and bradyarrhythmias.

“In this comprehensive analysis of the association between physical activity and incident cardiac arrhythmias, we demonstrate that both atrial and ventricular arrhythmias are less frequent amongst physically active participants,” Adrian D. Elliott, PhD, National Heart Foundation Research Fellow and physiology lecturer at the Centre for Heart Rhythm Disorders at the University of Adelaide and Royal Adelaide Hospital, Australia, and colleagues wrote. “We did not observe any association between total physical activity habits and bradyarrhythmic events, although female participants engaging in vigorous physical activity appear to carry a lower risk of developing bradyarrhythmias. Importantly, this data supports an association between higher physical activity and reduced arrhythmia risk up to 2,500 MET minutes per week, which is higher than current physical activity guidelines.”

In other findings, researchers observed a lower risk for AF in women who engaged in moderate levels of vigorous physical activity, up to 2,500 MET minutes per week. Additionally, vigorous physical activity was also associated with reduced risk for ventricular arrhythmia.

Participants answered questions on self-reported physical activity habits, which formed the primary exposure variable, with sociodemographic factors, lifestyle habits and comorbidities as covariates. Data on clinical comorbidities including hypertension, obstructive sleep apnea, diabetes, arrhythmias, HF, valvular disease and coronary disease were also obtained by self-reported questionnaire at baseline.

“These findings suggest that low physical activity habits should be added to the list of lifestyle-based risk factors associated with the development of AF,” the researchers wrote. “Additional clinical intervention studies specifically focusing on intensive vigorous physical activity may be needed to allow clear recommendations for athletes and patients with AF who may wish to partake in these types of activity.”

PAGE BREAK

Two clinical implications

“The first and foremost implication is that regular physical activity is protective against most forms of cardiac arrhythmias, including AF, and is to be encouraged,” Stanley Nattel, MD, of the department of medicine and research at the Montreal Heart Institute and Université de Montréal, wrote in a related editorial. “Secondly, regular involvement in very vigorous physical activity can promote AF, predominantly in men, and this may need to be considered in managing highly active patients with the arrhythmia. Finally, there is a lot we do not know about how sex can determine important biological responses, and much more research is needed in this area.” – by Scott Buzby

Disclosures: Elliott and Nattel report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Seth S. Martin

    Seth S. Martin

    Physically active individuals are well known to have better health outcomes, but this has been less studied with respect to the outcome of arrhythmia, with some prior suggestion of a “U-shape relationship.” The present study addresses the association of physical activity and arrhythmia risk in a single large cohort.

    The critical gap that remains is how to better implement what we know works — that is, physical activity — in clinical practice and through public health initiatives.
    This reinforces lifestyle modification and CV risk factor management as the fourth pillar of AF care we reviewed previously (
    Miller JD, et al. J Am Coll Cardiol. 2015;doi:10.1016/j.jacc.2015.10.047).

    It is an important large-scale study that further highlights that physically active patients do better, and this is indeed the case in patients with arrhythmia.

    • Seth S. Martin, MD, MHS
    • Cardiology Today Editorial Board Member
      Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
      Johns Hopkins University School of Medicine

    Disclosures: Martin reports no relevant financial disclosures.