COMMENTARY

Should You Prescribe Physical Activity to Reduce A-Fib and Heart Failure Risk?

JoAnn E. Manson, MD, DrPH

Disclosures

September 18, 2014

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Hello. This is Dr. JoAnn Manson, Professor of Medicine at Harvard Medical School and Brigham and Women's Hospital, in Boston, Massachusetts. Today I want to talk about the following question: Should we be prescribing regular physical activity to help our patients reduce their risk for atrial fibrillation and heart failure?

Two recent reports published in the Journal of the American Heart Association[1] and Circulation: Heart Failure[2] in the past several weeks suggest that we should. We already know that regular physical activity is as close to a magic bullet for good health as we have come in modern medicine. Regular activity has been linked to a reduced risk for an expansive list of health conditions, including coronary heart disease; stroke; diabetes; cognitive decline and dementia; several forms of cancer, including colorectal cancer and breast cancer; depression; osteoporosis; and several other health conditions. Now, it appears from these two studies that atrial fibrillation and heart failure can be added to the list.

The first study,[1] on atrial fibrillation, was conducted in the Women's Health Initiative among more than 80,000 women. I want to acknowledge that I was a coauthor of this report. The study suggested that there is a direct dose/response relationship between increasing physical activity and reduced risk for atrial fibrillation and that increasing physical activity offset much of the excess risk for atrial fibrillation associated with obesity. Even moderate amounts of physical activity, such as 30 minutes per day or 150 minutes per week of moderate activity recommended by current guidelines, were associated with a reduced risk.

Similarly, the study on heart failure,[2] published in Circulation: Heart Failure and conducted in a Swedish cohort of about 40,000 men and women, found a dose/response gradient of increasing physical activity and reduced risk for heart failure, including total heart failure and nonischemic etiology heart failure. Again, these outcomes were related to only moderate amounts of physical activity; but with more activity than the current guidelines, such as one hour of moderate-intensity activity per day, there was an even greater risk reduction.

Both studies suggest that physical activity has these benefits. Other prospective cohort studies[3,4] have suggested regular physical activity may reduce risk for heart failure -- both preserved and reduced ejection fraction heart failure -- and we do need more research on the subject of the role of physical activity in reducing risk for atrial fibrillation and heart failure. But at the present time, we have enough reason to be getting out the prescription pad and prescribing regular physical activity to improve our patients' health. It is likely that these prescriptions will do as much as many other prescriptions we write for pharmacologic therapy, in terms of risk reduction for our patients.

Thanks so much for your attention. This is JoAnn Manson.

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