Physical activity and atrial fibrillation: Where’s the balance?
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Key takeaways:
- Some studies have shown a rise in atrial fibrillation among endurance athletes, linking intense physical activity to development of AF.
- The benefits of physical activity supersede any increased risk for AF.
Atrial fibrillation is a common arrhythmia that increases risk for stroke, HF and dementia. Although AF risk increases with age, it can also occur in young people with normal hearts, sometimes called “lone AF.”
Guidelines provide strong recommendations for 75 to 150 minutes per week of moderate to vigorous exercise as part of a healthy lifestyle. Lower levels of exercise decrease the risk for AF; however, there is some suggestion that increased volume or intensity of exercise may increase risk for AF.
Data were derived from Petrungaro M, et al. J Cardiovasc Dev Dis. 2023;doi:10.3390/jcdd10050218.
Understanding factors that contribute to AF
Mattia Petrungaro, MD, and colleagues recently published a review in the Journal of Cardiovascular Development and Disease that evaluated the relationship between physical activity and AF.
In this editorial, we aim to summarize the authors’ thoughts and findings to better understand the balance between physical activity and a healthy heart.
How can physical activity cause AF? Three factors contribute to the development of AF:
- Triggers: This refers to other electrical abnormalities in the heart that cause abnormal early heart beats. Excessive exercise, dehydration, electrolyte imbalances and performance-enhancing drugs may increase these premature beats and trigger AF.
- Substrates: Structural changes that occur to the heart interfere with heart function, such as becoming too large, stretched or scarred. Although these changes do occur in both short- and long-term responses to intense physical activity, they do not seem to be related to AF occurrence in otherwise healthy athletes.
- Modulators: The amount of exercise you engage in changes the resting state of your body, including heart rate, which can change the likelihood of AF occurring. Regular intense training in endurance athletes can lead to slower heart rates at rest, which increases risk for developing arrhythmias.
Main takeaways
Regular, moderate and vigorous intensity physical activity clearly decreases the risk for death and heart disease. All patients, regardless of whether they have or are at risk for AF, should still be encouraged to engage in regular physical activity. However, some studies have noted an increased rate of AF in athletes, particularly male endurance athletes, when compared with normal populations.
It is likely that certain endurance sports and prolonged, intense physical activity can promote conditions that favor AF in these otherwise healthy populations. A U-shaped relationship between physical activity and risk for AF has been proposed — namely, that too little exercise increases risk, moderate exercise protects against AF, and excessive amounts of intense physical activity may increase risk. However, further study is required to come to more definitive conclusions.
Most people with average or above average levels of physical activity do not need to be concerned, but a select population that consistently engages in high-intensity endurance activity, such as elite or ultra-endurance athletes, should be aware of the potential increased risk for AF at prolonged intense levels of activity. However, this risk is superseded by the immense benefits of physical activity.
Exercise is one of the most important lifestyle modifications you can make to decrease your risk of heart disease.
References:
- Aizer A, et al. Am J Cardiol. 2009;doi:10.1016/j.amjcard.2009.01.374.
- Arnett DK, et al. Circulation. 2019;doi:10.1161/CIR.0000000000000678.
- CardioSmart – American College of Cardiology. Atrial Fibrillation (also known as AFib). Available at: https://www.cardiosmart.org/topics/atrial-fibrillation. Accessed Nov. 7, 2023.
- Petrungaro M, et al. J Cardiovasc Dev Dis. 2023;doi:10.3390/jcdd10050218.
- Shapero K, et al. Sports Med Open. 2016;doi:10.1186/s40798-016-0053-0.
For more information:
Nolan Fox, BS, is a medical student at Sidney Kimmel Medical College in Philadelphia; X (Twitter): @Nolan_Fox.
Nicholas Fox, BS, is a medical student at Sidney Kimmel Medical College in Philadelphia; X (Twitter): @Nick_Fox12.
Alan P. Jacobsen, MB, BCh, BAO, is a cardiology fellow at Johns Hopkins Hospital; X (Twitter): @alanpjacobsen.
Matthew W. Martinez, MD, is director of Atlantic Health System Sports Cardiology at Morristown Medical Center in New Jersey; X (Twitter): @mmartinezheart.
Roger S. Blumenthal, MD, is director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease and professor of medicine at Johns Hopkins University School of Medicine; X (Twitter): @rblument1.
Lili A. Barouch, MD, is director of the Sports Cardiology Program and associate professor of medicine at Johns Hopkins University School of Medicine, and a member of the Advanced Heart Failure and Cardiac Transplantation group at Johns Hopkins Hospital; X (Twitter): @lilibarouch.
The authors can be reached at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Halsted 560, Baltimore, MD 21827.
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