Advertisement

Cardiorespiratory Fitness, Physical Activity, and Incidence of Atrial Fibrillation

  • Apostolos Tsimploulis
  • Andreas Pittaras
  • Charles Faselis
Chapter

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia with an increasing burden worldwide. Despite improvements in its management, AF is still related with increased mortality and morbidity. In this regard, considerable research was focused on assessing the risk factors of AF (hypertension, type 2 diabetes mellitus, obesity, alcohol, etc.) and the impact of modifying them. One of the most important lifestyle modifications is exercise which is proven to have beneficial effects on multiple cardiovascular diseases. Its role though on the incidence of AF is less clear. It appears that high-intensity exercise training, such as the type endured by long-distance runners, increases the risk of AF, likely due to anatomical and electrophysiological changes. However, low-to-moderate levels of physical activity are associated with decreased incidence of AF. Similarly, when cardiorespiratory fitness (CRF) is assessed by standardized exercise protocols, the CRF-AF association is inverse. In this chapter we will present the current literature related to exercise and the incidence of atrial fibrillation, the pathophysiologic mechanisms, and the role of exercise in patients who have been already diagnosed with AF.

Keywords

Atrial fibrillation Physical activity Cardiorespiratory fitness AF Cardiac arrhythmia 

References

  1. 1.
    Chugh SS, Havmoller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47.CrossRefGoogle Scholar
  2. 2.
    Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5.CrossRefGoogle Scholar
  3. 3.
    Huxley RR, Lopez FL, Folsom AR, Agarwal SK, Loehr LR, Soliman EZ, et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011;123:1501–8.CrossRefGoogle Scholar
  4. 4.
    January CT, Wann LS, Alpert JS, et al. AHA/ACC/HRS guideline for the management of patients with atrial f. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):2014.  https://doi.org/10.1016/j.jacc.2014.03.022.CrossRefGoogle Scholar
  5. 5.
    Kokkinos P, Myers J, Faselis C, Panagiotakos DB, Doumas M, Pittaras A, et al. Exercise capacity and mortality in older men: a 20-year follow-up study. Circulation. 2010;122(8):790–7.CrossRefGoogle Scholar
  6. 6.
    Kokkinos P, Myers J. Exercise and physical activity: clinical outcomes and applications. Circulation. 2010;122(16):1637–48.CrossRefGoogle Scholar
  7. 7.
    Faselis C, Doumas M, Pittaras A, Narayan P, Myers J, Tsimploulis A, et al. Exercise capacity and all-cause mortality in male veterans with hypertension aged 70 years. Hypertension. 2014;64(1):30–5.CrossRefGoogle Scholar
  8. 8.
    Kokkinos PF, Faselis C, Myers J, Panagiotakos D, Doumas M. Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study. Lancet. 2013;381(9864):394–9.CrossRefGoogle Scholar
  9. 9.
    Kokkinos P, Faselis C, Myers J, Narayan P, Sui X, Zhang J, et al. Cardiorespiratory fitness and incidence of major adverse cardiovascular events in US veterans: a cohort study. Mayo Clin Proc. 2017;92(1):39–48.CrossRefGoogle Scholar
  10. 10.
    Myers J, Kokkinos P, Chan K, Dandekar E, Yilmaz B, Nagare A, et al. Cardiorespiratory fitness and reclassification of risk for incidence of heart failure: the Veterans Exercise Testing Study. Circ Heart Fail. 2017;10:e003780.CrossRefGoogle Scholar
  11. 11.
    Kokkinos P, Myers J, Faselis C, Doumas M, Kheirbek R, Nylen E. BMI-mortality paradox and fitness in African-American and Caucasian men with type 2 diabetes. Diabetes Care. 2012;35(5):1021–7.CrossRefGoogle Scholar
  12. 12.
    Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, et al. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J. 2008;29(1):71–8.CrossRefGoogle Scholar
  13. 13.
    Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. BMJ. 1998;316(7147):1784–5.CrossRefGoogle Scholar
  14. 14.
    Mont L, Tamborero D, Elosua R, Coll-Vinent B, Sitges M, Vidal B, et al., GIRAFA (Grup Integrat de Recerca en Fibril-lació Auricular) Investigators. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace. 2008;10(1):15–20.Google Scholar
  15. 15.
    Abdulla J, Nielsen JR. Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace. 2009;11(9):1156–9.CrossRefGoogle Scholar
  16. 16.
    Heidbüchel H, Anné W, Willems R, Adriaenssens B, Van de Werf F, Ector H. Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol. 2006;107(1):67–72.CrossRefGoogle Scholar
  17. 17.
    Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, et al. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008;10(5):618–23.CrossRefGoogle Scholar
  18. 18.
    Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol. 2009;103(11):1572–7.CrossRefGoogle Scholar
  19. 19.
    Pelliccia A, Maron BJ, Di Paolo FM, Biffi A, Quattrini FM, Pisicchio C, et al. Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol. 2005;46(4):690–6.CrossRefGoogle Scholar
  20. 20.
    Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the Cardiovascular Health Study. Circulation. 2008;118:800–7.CrossRefGoogle Scholar
  21. 21.
    Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart. 2014;100:1037–42.CrossRefGoogle Scholar
  22. 22.
    Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart. 2015;101:1627–30.CrossRefGoogle Scholar
  23. 23.
    Huxley RR, Misialek JR, Agarwal SK, Loehr LR, Soliman EZ, Chen LY, et al. Physical activity, obesity, weight change and risk of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) Study. Circ Arrhythm Electrophysiol. 2014;7:620–5.CrossRefGoogle Scholar
  24. 24.
    Garg PK, O’Neal WT, Chen LY, Loehr LR, Sotoodehnia N, Soliman EZ, et al. American Heart Association’s life simple 7 and risk of atrial fibrillation in a population without known cardiovascular disease: the ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc. 2018;7:e008424.CrossRefGoogle Scholar
  25. 25.
    Azarbal F, Stefanick ML, Salmoirago-Blotcher E, Manson JE, Albert CM, LaMonte MJ, et al. Obesity, physical activity, and their interaction in incident atrial fibrillation in postmenopausal women. J Am Heart Assoc. 2014;3:17.CrossRefGoogle Scholar
  26. 26.
    Grundvold I, Skretteberg PT, Liestøl K, Gjesdal K, Erikssen G, Kjeldsen SE, et al. Importance of physical fitness on predictive effect of body mass index and weight gain on incident atrial fibrillation in healthy imaged men. Am J Cardiol. 2012;110(3):425–32.CrossRefGoogle Scholar
  27. 27.
    Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801.CrossRefGoogle Scholar
  28. 28.
    Laukkanen JA, Kurl S, Salonen R, Rauramaa R, Salonen JT. The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study. Eur Heart J. 2004;25:1428–37.CrossRefGoogle Scholar
  29. 29.
    Lee D-C, Sui X, Artero EG, Lee I-M, Church TS, McAuley PA, et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study. Circulation. 2011;124:2483–90.CrossRefGoogle Scholar
  30. 30.
    Qureshi WT, Alirhayim Z, Blaha MJ, Juraschek SP, Keteyian SJ, Brawner CA, et al. Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford ExercIse Testing (FIT) Project. Circulation. 2015;131:1827–34.CrossRefGoogle Scholar
  31. 31.
    Faselis C, Kokkinos P, Tsimploulis A, Pittaras A, Myers J, Lavie CJ, et al. Exercise capacity and atrial fibrillation risk in veterans: a cohort study. Mayo Clin Proc. 2016;91(5):558–66.CrossRefGoogle Scholar
  32. 32.
    Camm AJ, Kirchhof P, Lip GY, European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, et al. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369–429.  https://doi.org/10.1093/eurheartj/ehq278.CrossRefPubMedGoogle Scholar
  33. 33.
    Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ, et al. Pathophysiology and prevention of atrial fibrillation. Circulation. 2001;103(5):769–77.CrossRefGoogle Scholar
  34. 34.
    Wakili R, Voigt N, Kaab S, Dobrev D, Nattel S. Recent advances in the molecular pathophysiology of atrial fibrillation. J Clin Invest. 2011;121:2955–68.CrossRefGoogle Scholar
  35. 35.
    Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable risk factors and atrial fibrillation. Circulation. 2017;136:583–96.CrossRefGoogle Scholar
  36. 36.
    Nattel S, Burstein B, Dobrev D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ Arrhythm Electrophysiol. 2008;1:62–73.  https://doi.org/10.1161/CIRCEP.107.754564.CrossRefPubMedGoogle Scholar
  37. 37.
    Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659.CrossRefGoogle Scholar
  38. 38.
    Jais P, Haissaguerre M, Shah DC, Chouairi S, Gencel L, Hocini M, et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation. 1997;95:572.CrossRefGoogle Scholar
  39. 39.
    Scherf D, Romano FJ, Terranova R. Experimental studies on auricular flutter and auricular fibrillation. Am Heart J. 1948;36:241–51.CrossRefGoogle Scholar
  40. 40.
    Ehrlich JR, Cha TJ, Zhang L, Chartier D, Melnyk P, Hohnloser SH, et al. Cellular electrophysiology of canine pulmonary vein cardiomyocytes: action potential and ionic current properties. J Physiol. 2003;551:801–13.CrossRefGoogle Scholar
  41. 41.
    Lip GY, Brechin CM, Lane DA. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest. 2012;142:1489.CrossRefGoogle Scholar
  42. 42.
    Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–292.CrossRefGoogle Scholar
  43. 43.
    Kim MH, Johnston SS, Chu BC, Dalal MR, Schulman KL. Estimation of total incremental health care costs in patients with atrial fibrillation in the United States. Circ Cardiovasc Qual Outcomes. 2011;4:313–20.CrossRefGoogle Scholar
  44. 44.
    Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol. 1998;82:2N–9N.CrossRefGoogle Scholar
  45. 45.
    Miller PS, Andersson FL, Kalra L. Are cost benefits of anticoagulation for stroke prevention in atrial fibrillation underestimated? Stroke. 2005;36:360–6.CrossRefGoogle Scholar
  46. 46.
    Magnani JW, Wang N, Benjamin EJ, Garcia ME, Bauer DC, Butler J, et al. Atrial fibrillation and declining physical performance in older adults: the Health, Aging, and Body Composition Study. Circ Arrhythm Electrophysiol. 2016;9:e003525.CrossRefGoogle Scholar
  47. 47.
    Santangeli P, Di Biase L, Bai R, Mohanty S, Pump A, Cereceda Brantes M, et al. Atrial fibrillation and the risk of incident dementia: a meta-analysis. Heart Rhythm. 2012;9(11):1761–8.CrossRefGoogle Scholar
  48. 48.
    Wallace ER, Siscovick DS, Sitlani CM, Dublin S, Mitchell PH, Odden MC, et al. Incident atrial fibrillation and disability- free survival in the cardiovascular health study. J Am Geriatr Soc. 2016;64:838–43.CrossRefGoogle Scholar
  49. 49.
    Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;96:946–52.CrossRefGoogle Scholar
  50. 50.
    Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107:2920–5.CrossRefGoogle Scholar
  51. 51.
    Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995;98:476–84.CrossRefGoogle Scholar
  52. 52.
    Stewart S, Hart CL, Hole DJ, McMurray JJ. A population based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med. 2002;113:359.CrossRefGoogle Scholar
  53. 53.
    Ott A, Breteler MM, de Bruyne MC, van Harskamp F, Grobbee DE, Hofman A. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997;28:316–21.CrossRefGoogle Scholar
  54. 54.
    Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271:840–4.CrossRefGoogle Scholar
  55. 55.
    Rangnekar G. The characterisation of risk factors, substrate and management strategies for atrial fibrillation [dissertation]. School of Medicine, The University of Adelaide; 2015.Google Scholar
  56. 56.
    Jamaly S, Carlsson L, Peltonen M, Jacobson P, Sjöström L, Karason K. Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects. J Am Coll Cardiol. 2016;68:2497–504.CrossRefGoogle Scholar
  57. 57.
    Chamberlain AM, Agarwal SK, Ambrose M, Folsom AR, Soliman EZ, Alonso A. Metabolic syndrome and incidence of atrial fibrillation among blacks and whites in the Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J. 2010;159(5):850–6.  https://doi.org/10.1016/j.ahj.2010.02.005.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Bapat A, Zhang Y, Post WS, Guallar E, Soliman EZ, Heckbert SR, et al. Relation of physical activity and incident atrial fibrillation (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol. 2015;116:883–8.CrossRefGoogle Scholar
  59. 59.
    Khan H, Kella D, Rauramaa R, Savonen K, Lloyd MS, Laukkanen JA. Cardiorespiratory fitness and atrial fibrillation: a population-based follow-up study. Heart Rhythm. 2015;12:1424–30.CrossRefGoogle Scholar
  60. 60.
    Elliott AD, Maatman B, Emery MS, Sanders P. The role of exercise in atrial fibrillation prevention and promotion: finding optimal ranges for health. Heart Rhythm. 2017;14:1713–20.CrossRefGoogle Scholar
  61. 61.
    Haskell WL, Lee I-M, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1081–93.CrossRefGoogle Scholar
  62. 62.
    Kapa S, Asirvatham S. A MET a day keeps arrhythmia at bay: the association between exercise or cardiorespiratory fitness and atrial fibrillation. Mayo Clin Proc. 2016;91(5):545–50.CrossRefGoogle Scholar
  63. 63.
    Geffken DF, Cushman M, Burke GL, Polak JF, Sakkinen PA. Tracy RP Association between physical activity and markers of inflammation in a healthy elderly population. Am J Epidemiol. 2001;153(3):242–50.CrossRefGoogle Scholar
  64. 64.
    Grundvold I, Skretteberg PT, Liestøl K, Gjesdal K, Erikssen G, Kjeldsen SE, et al. Importance of physical fitness on predictive effect of body mass index and weight gain on incident atrial fibrillation in healthy middle-age men. Am J Cardiol. 2012;110(3):425–32.CrossRefGoogle Scholar
  65. 65.
    Stiles MK, John B, Wong CX, Kuklik P, Brooks AG, Lau DH, et al. Paroxysmal lone atrial fibrillation is associated with an abnormal atrial substrate: characterizing the “second factor”. J Am Coll Cardiol. 2009;53:1182–91.CrossRefGoogle Scholar
  66. 66.
    Guasch E, Benito B, Qi X, Cifelli C, Naud P, Shi Y, et al. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol. 2013;62:68–77.CrossRefGoogle Scholar
  67. 67.
    Winder WW, Hagberg JM, Hickson RC, Ehsani AA, McLane JA. Time course of sympathoadrenal adaptation to endurance exercise training in man. J Appl Physiol Respir Environ Exerc Physiol. 1978;45(3):370–4.PubMedGoogle Scholar
  68. 68.
    Chen PS, Chen LS, Fishbein MC, Lin SF, Nattel S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res. 2014;114(9):1500–15.CrossRefGoogle Scholar
  69. 69.
    Wilhelm M. Atrial fibrillation in endurance athletes. Eur J Prev Cardiol. 2014;21:1040–8.CrossRefGoogle Scholar
  70. 70.
    Kapa S, Mears JA, Asirvatham SJ. The autonomic ether; emerging electrophysiologic associations. Indian Heart J. 2011;63(4):333–40.PubMedGoogle Scholar
  71. 71.
    Elliott AD, Mahajan R, Pathak RK, Lau DH, Sanders P. Exercise training and atrial fibrillation. Further evidence of the importance of lifestyle change. Circulation. 2016;133:457–9.CrossRefGoogle Scholar
  72. 72.
    Abdul-Aziz AA, Altawil M, Lyon A, MacEachern M, Richardson CR, Rubenfire M, et al. Lifestyle therapy for the management of atrial fibrillation. Am J Cardiol. 2018;121(9):1112–7.CrossRefGoogle Scholar
  73. 73.
    Risom SS, Zwisler AD, Johansen PP, Sibilitz K, Lindschou J, Gluud C, et al. Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev. 2017;(2):CD011197.Google Scholar
  74. 74.
    Kato M, Kubo A, Nihei F, Ogano M, Takagi H. Effects of exercise training on exercise capacity, cardiac function, BMI, and quality of life in patients with atrial fibrillation: a meta-analysis of randomized-controlled trials. Int J Rehabil Res. 2017;40(3):193–201.CrossRefGoogle Scholar
  75. 75.
    Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation – A randomized controlled trial. PLoS One. 2017;12(2):e0170060.CrossRefGoogle Scholar
  76. 76.
    Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O, et al. Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial. Circulation. 2016;133:466–73.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Apostolos Tsimploulis
    • 1
  • Andreas Pittaras
    • 2
  • Charles Faselis
    • 3
  1. 1.Department of CardiologyStony Brook University HospitalStony BrookUSA
  2. 2.Department of CardiologyGW University, VAMCWashington, DCUSA
  3. 3.Veterans Affairs Medical CenterWashington, DCUSA

Personalised recommendations