Exercise Training and Atrial Fibrillation: Further Evidence for the Importance of Lifestyle Change
Atrial fibrillation (AF) is the most common clinical arrhythmia with a global burden that has increased progressively, contributing to rising hospitalizations and substantial healthcare demands1-3. Although aging is an important contributor to the rising AF prevalence, key mechanistic promoters of AF include modifiable risk factors such as obesity, hypertension, diabetes mellitus and obstructive sleep apnea.
Exercise training and physical activity improves the management of hypertension and diabetes4, assists in weight management5 and improves cardiac structure and function6. Surprisingly, despite these favorable modifications of arrhythmogenic risk factors, greater physical activity only modestly reduces incident AF rates7,8. At the extreme end of the exercise spectrum, endurance athletes who engage in the greatest volume of exercise training, encounter a risk of AF that rises significantly. Cohort studies provide estimates of AF risk in the endurance athlete population that range from a two9- to seven-fold10 elevation in incident AF risk. Until recently, the AF and exercise story has stopped here; that physically active individuals experience a small reduction in risk but doing too much increases arrhythmia risk considerably, consistent with a classic J-shaped phenomenon. Perhaps in part due to these findings and a misguided fear of promoting arrhythmias, there is a scarcity of data regarding the effects of exercise training in patients with non-permanent AF.
- Received December 20, 2015.
- Accepted December 22, 2015.