Differential Association of Exercise Intensity With Risk of Atrial Fibrillation in Men and Women

Evidence From a Meta-Analysis

Sanghamitra Mohanty, M.D., M.S., F.H.R.S.; Prasant Mohanty, M.B.B.S., M.P.H.; Megumi Tamaki, M.D.; Veronica Natale, B.S.; Carola Gianni, M.D.; Chintan Trivedi, M.D.; Yalcin Gokoglan, M.D.; Luigi Di Biase, M.D., Ph.D., F.H.R.S., F.A.C.C.; Andrea Natale, M.D., F.E.S.C., F.H.R.S., F.A.C.C.


J Cardiovasc Electrophysiol. 2016;27(9):1021-1029. 

In This Article

Abstract and Introduction


Gender-Specific Link of Exercise Intensity With AF. Background: Despite widespread interest and extensive research, the association between different levels of physical activity (PA) and risk of atrial fibrillation (AF) is still not clearly defined. Therefore, we systematically evaluated and summarized the evidences regarding association of different intensity of PA with the risk of AF in this meta-analysis.

Methods and Results: An extensive literature search was performed on databases for studies showing association of exercise with AF risk. Twenty-two studies were identified that included 656,750 subjects. Meta-analytic estimates were derived using random-effects models and pooled odds ratio estimates were obtained. Potential sources of heterogeneity were examined in sensitivity analyses, and publication biases were estimated. Pooled analysis of 7 studies with 93,995 participants reported high risk of incident AF with sedentary lifestyle (pooled OR 2.47 [95% CI 1.25–3.7], P = 0.005). In 3 trials, 149,048 women involved in moderate PA were 8.6% less likely to develop AF compared to women with sedentary life (OR 0.91 [95% CI 0.78–0.97], P = 0.002). Women performing intense exercise were found to have 28% lower risk of AF (OR 0.72 [95% CI 0.57–0.88], P < 0.001). The overall pooled estimate indicated a protective impact of moderate PA in men (pooled OR 0.8133 [95% CI 0.26–1.004], P = 0.06) whereas vigorous PA was associated with a significantly increased AF risk (pooled OR 3.30 [1.97–4.63], P = 0.0002).

Conclusion: Sedentary lifestyle significantly increases and moderate amount of physical activity reduces the risk of AF in both men and women. However, intense exercise has a gender-specific association with AF risk.


The cardiovascular benefits of physical activity (PA) are well-recognized. Additionally, regular exercise increases stamina and improves quality of life.[1] Therefore, exercise may be considered the most inexpensive and holistic therapy a physician can prescribe to reduce the risk of heart diseases.[2] For the majority of health outcomes, a dose-response relationship is believed to exist; additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration.[3] However, earlier studies have revealed conflicting associations between exercise intensity and atrial fibrillation (AF), a common form of cardiac rhythm disorder.[4] Some trials reported a J-shaped or U-shaped correlation between physical activity level and AF with increased risk in sedentary individuals and vigorously exercising men.[5,6] Others documented a linear inverse relationship between exercise intensity and AF incidence, with greater physical activity being correlated with increasingly lower rate of AF incidence.[7,8] Thus, despite widespread interest and extensive research on this topic, questions such as what level of physical activity is beneficial and could more activity have adverse consequences in AF patients lack definitive answers. Therefore, we systematically evaluated and summarized the evidences regarding association of different levels of PA with the risk of AF in this meta-analysis.