Relation of Physical Activity and Incident Atrial Fibrillation (from the Multi-Ethnic Study of Atherosclerosis)

      Previous studies have raised the question of whether an association exists between physical activity and atrial fibrillation (AF). We used the Multi-Ethnic Study of Atherosclerosis (MESA) database to examine the association between physical activity and AF in a diverse population without clinically recognized cardiovascular disease (CVD). MESA participants (n = 5,793) with complete baseline physical activity and covariate data were included. Cox proportional hazards models were used to calculate hazard ratios (HRs) for incident AF by levels of total intentional exercise and vigorous physical activity, independently and in combination. Multivariate models were adjusted for demographics and CVD risk factors. During a mean follow-up of 7.7 ± 1.9 years, 199 AF cases occurred. In the overall MESA population, neither vigorous physical activity nor total intentional exercise was independently associated with incident AF after adjusting for covariates. However, within the group that reported any vigorous physical activity, there was a statistically significant inverse association between total intentional exercise (modeled as a continuous variable) and incident AF. In those who reported any vigorous physical activity, the top tertile of total intentional exercise was associated with a significantly lower risk of incident AF compared with the group with no total intentional exercise in the fully adjusted model (HR 0.46, 95% confidence interval 0.22 to 0.98). In conclusion, neither total intentional exercise nor vigorous physical activity alone was associated with incident AF, but greater total intentional exercise was associated with a lower risk of incident AF in those who participated in any vigorous physical activity. As importantly, no subgroup of participants demonstrated an increased risk of incident AF with greater physical activity. The results re-emphasize the beneficial role of physical activity for cardiovascular health.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abdulla J.
        • Nielsen J.R.
        Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis.
        Europace. 2009; 11: 1156-1159
        • Elosua R.
        • Arquer A.
        • Mont L.
        • Sambola A.
        • Molina L.
        • García-Morán E.
        • Brugada J.
        • Marrugat J.
        Sport practice and the risk of lone atrial fibrillation: a case-control study.
        Int J Cardiol. 2006; 108: 332-337
        • Molina L.
        • Mont L.
        • Marrugat J.
        • Berruezo A.
        • Brugada J.
        • Bruguera J.
        • Rebato C.
        • Elosua R.
        Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study.
        Europace. 2008; 10: 618-623
        • Mont L.
        • Sambola A.
        • Brugada J.
        • Vacca M.
        • Marrugat J.
        • Elosua R.
        • Paré C.
        • Azqueta M.
        • Sanz G.
        Long-lasting sport practice and lone atrial fibrillation.
        Eur Heart J. 2002; 23: 477-482
        • Calvo N.
        • Brugada J.
        • Sitges M.
        • Mont L.
        Atrial fibrillation and atrial flutter in athletes.
        Br J Sports Med. 2012; 46: i37-i43
        • Aizer A.
        • Gaziano J.M.
        • Cook N.R.
        • Manson J.E.
        • Buring J.E.
        • Albert C.M.
        Relation of vigorous exercise to risk of atrial fibrillation.
        Am J Cardiol. 2009; 103: 1572-1577
        • Karjalainen J.
        • Kujala U.
        • Kaprio J.
        Lone atrial fibrillation in vigorously exercising middle aged men: case-control study.
        BMJ. 1998; 316: 1784-1785
        • Williams P.T.
        • Franklin B.A.
        Reduced incidence of cardiac arrhythmias in walkers and runners.
        PLoS One. 2013; 8: e65302
        • Mozaffarian D.
        • Furberg C.D.
        • Psaty B.M.
        • Siscovick D.
        Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study.
        Circulation. 2008; 118: 800-807
        • Ofman P.
        • Khawaja O.
        • Rahilly-Tierney C.R.
        • Peralta A.
        • Hoffmeister P.
        • Reynolds M.R.
        • Gaziano J.M.
        • Djousse L.
        Regular physical activity and risk of atrial fibrillation: a systematic review and meta-analysis.
        Circ Arrhythm Electrophysiol. 2013; 6: 252-256
        • Bild D.E.
        Multi-ethnic study of atherosclerosis: objectives and design.
        Am J Epidemiol. 2002; 156: 871-881
        • Cushman M.
        • Cornell E.S.
        • Howard P.R.
        • Bovill E.G.
        • Tracy R.P.
        Laboratory methods and quality assurance in the Cardiovascular Health Study.
        Clin Chem. 1995; 41: 264-270
        • Americal Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2013; 36: S67-S74
        • Ainsworth B.E.
        • Haskell W.L.
        • Whitt M.C.
        • Irwin M.L.
        • Swartz A.M.
        • Strath S.J.
        • O'Brien W.L.
        • Bassett D.R.
        • Schmitz K.H.
        • Emplaincourt P.O.
        • Jacobs D.R.
        • Leon A.S.
        Compendium of physical activities: an update of activity codes and MET intensities.
        Med Sci Sports Exerc. 2000; 32: S498-S504
        • Turkbey E.
        • Jorgensen N.
        • Johnson W.
        Physical activity and physiological cardiac remodelling in a community setting: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Heart. 2010; 96: 42-48
        • Aaron C.P.
        • Tandri H.
        • Barr R.G.
        • Johnson W.C.
        • Bagiella E.
        • Chahal H.
        • Jain A.
        • Kizer J.R.
        • Bertoni A.G.
        • Lima J.A.
        • Bluemke D.A.
        • Kawut S.M.
        Physical activity and right ventricular structure and function. The MESA-Right Ventricle Study.
        Am J Respir Crit Care Med. 2011; 183: 396-404
        • Pluim B.M.
        • Zwinderman A.H.
        • van der Laarse A.
        • van der Wall E.E.
        The athlete's heart: a meta-analysis of cardiac structure and function.
        Circulation. 2000; 101: 336-344
        • Maron B.J.
        Structural features of the athlete heart as defined by echocardiography.
        J Am Coll Cardiol. 1986; 7: 190-203
        • Qureshi W.T.
        • Alirhayim Z.
        • Blaha M.J.
        • Juraschek S.P.
        • Keteyian S.J.
        • Brawner C.A.
        • Al-Mallah M.H.
        Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford ExercIse Tesing (FIT) project.
        Circulation. 2015; 131: 1827-1834
        • Boriani G.
        • Laroche C.
        • Diemberger I.
        • Fantecchi E.
        • Popescu M.I.
        • Rasmussen L.H.
        • Sinagra G.
        • Petrescu L.
        • Tavazzi L.
        • Maggioni A.P.
        • Lip G.Y.
        Asymptomatic atrial fibrillation: clinical correlates, management and outcomes in the EORP-AF Pilot General Registry.
        Am J Med. 2014; 128: 509-518