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The "J" in physical activity and atrial fibrillation

Comment by Trine Karlsen, EAPC Exercise, Basic and Translational Research Section


In a recent, population based cohort study from the Tromsø Study in Northern Norway, it was shown that participants reporting to perform moderate doses of leisure time physical activity had 19% lower risk of atrial fibrillation compared to the low physical activity group. High and vigorous levels of physical activity attenuated the risk reduction association seen with moderate physical activity. In addition, low resting heart rate was a risk factor for atrial fibrillation. The study was published in the European Heart Journal in March 2016 (1).

The study included a little above 20 000 participants, with a mean follow up time of 20 years. During follow up, 750 participants were diagnosed with atrial fibrillation, out of which 70.5% of these cases were in men. With a J-shaped association between the level of self-reported physical activity (low, moderate, high and vigorous) and hospital diagnosed atrial fibrillation, the authors discuss that the underlying causes of risk are most likely different at each end of the curve. This seems likely as a clustering of cardiovascular risk factors are prevalent in inactive, and low active individuals, while it is well documented that lifelong hard physical activity is associated with increased risk of atrial fibrillation.

The study addresses important issues for the future. One is to understand the gender differences in the prevalence of atrial fibrillation. Another is to investigate how the combined interaction between leisure time physical activity and fitness (maximal oxygen uptake) might explain the associations between resting heart rate, physical activity and atrial fibrillation in all parts of the association curve.


Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


1. Physical activity, resting heart rate, and atrial fibrillation: the Tromso Study.

Morseth B, Graff-Iversen S, Jacobsen BK, Jorgensen L, Nyrnes A, Thelle DS, Vestergaard P and Lochen ML.

Eur Heart J. 2016;37:2307-13.