Is exercise becoming a danger for our health? The complex relationship between exercise and atrial fibrillation

Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases

Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and nontraditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise, and AF. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and AF. Recent advances in molecular profiling technologies (ie, genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on interindividual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.

Associations between physical activity, left atrial size and incident atrial fibrillation: the Tromsø Study 1994-2016

AIMS

Left atrial (LA) enlargement is an independent risk factor for atrial fibrillation (AF). Interestingly, some athletes have increased risk of AF, which may be linked to LA enlargement; however, little is known about the relationship between LA enlargement and AF risk at moderate-level physical activity (PA). We aimed to explore the associations between PA, LA size and risk of incident AF, and if PA can attenuate the risk of AF with LA enlargement.

METHODS

This prospective study followed 2479 participants (52.4% female), free from known cardiac pathology, for median 20.2 years. Participants were followed up for hospital-diagnosed AF, confirmed by electrocardiography, from 1994-95 through 2016. At baseline, LA size was evaluated by anteroposterior LA diameter, and PA was self-reported by questionnaire.

RESULTS

We observed a U-shaped relationship between PA and AF, and moderately active had 32% lower AF risk than inactive (HRadjusted 0.68, 95% CI 0.50 to 0.93). Participants with LA enlargement had 38% higher AF risk compared with participants with normal LA size (HRadjusted 1.38, 95% CI 1.12 to 1.69). However, the increased AF risk with LA enlargement was attenuated by PA; compared with inactive participants with LA enlargement, the AF risk was 45% lower among active with LA enlargement (HRadjusted 0.55, 95% CI 0.39 to 0.79). AF risk in active participants with LA enlargement did not differ from active with normal LA size. These patterns were observed in both men and women, and in participants over/under 65 years.

CONCLUSION

Moderate PA was associated with reduced AF risk, and PA attenuated the increased risk of AF with LA enlargement in both men and women and all age groups.

Atrial Fibrillation: the Association with Physical Activity and the Effects of Cardiac Rehabilitation

The purpose of this review was to present modern studies that examine the relationship of physical activity and risk of atrial fibrillation (AF) development and the impact of cardiac rehabilitation programs in patients with all forms of AF. Data of 52 Russian and foreign scientific sources published in 1998- 2020 were presented. In our study, 48 patients with paroxysmal AF after radiofrequency ablation (RFA) were randomly assigned to a physical rehabilitation/standard therapy or control (standard therapy) group. Aerobic physical training was conducted for 6 months 3 times a week. AF is one of the most common cardiac arrhythmias. Despite modern advances, results of treatment of this disease are far from optimal. Many problems of patients with AF can be addressed through enrolment in multidisciplinary cardiac rehabilitation programs. But this question remains open. This is mainly due to the complexity of selection of physical rehabilitation program for patients with AF. It is known that physical activity can trigger an episode of AF. In the following review article, the approaches to functional capacity assessment of patient with AF are described, recommendations for prescribing safe exercise training to achieve a therapeutic effect are presented. Various aspects of the effects of physical rehabilitation are discussed, including its impact on cardiovascular risk factors, influence on atrial remodeling processes and associated biomarkers, prevention of AF progression and occurrence of cardiovascular complications. Results of our own research indicate effectiveness of physical training in patients with AF after RFA: increase in exercise duration by 18.6% (p<0.001) and load by 24.8% (p<0.01) during exercise test, increase in level of everyday physical activity by 23.8% (p=0.001); left atrium dimensions remain stable comparing with control group. That was combined with a decrease of post ablation atrial arrhythmias: after 6 months, they were registered in 4.5% of trained patients vs 17.4% of control group patients (p<0.01). Steady growth in the number of patients with AF and catheter ablation procedures around the world dictates the need for organization of multi-purpose medical rehabilitation.

Exercise and Atrial Fibrillation: Some Good News and Some Bad News

Atrial fibrillation (AF) is considered as the most common sustained arrhythmia in adults, whose incidence rate is on the rise due to the increase in the mean age of the global population. In recent years, many efforts have been made to identify effective factors in the incidence of AF to prevent them and thereby reduce the consequences of AF. Physical activity is one of the topics that attracted much attention in the last two decades. According to some findings, extreme and prolonged exercise itself can be considered as a risk factor for the onset of AF; however, other studies have shown that exercise can be regarded a protective factor against AF in the general population. The present study reviews the findings of studies on the relationship between AF and exercise and discusses possible mechanisms for this relationship. Additionally, we present some recommendations for researchers and physicians about exercise management in association with AF prevention.