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Being more physically active could help lower the risk of experiencing a range of cardiovascular events. Antonio_Diaz/Getty Images
  • Atrial fibrillation (AFib) is an abnormal heart rhythm that can harm cardiovascular health.
  • Study findings presented at the ESC Congress 2023 found that higher levels of physical fitness were associated with decreased risk for atrial fibrillation, stroke, and major adverse cardiovascular events (MACE).
  • Further research could replicate these findings and look into specific physical fitness parameters that may be the most useful.

Heart health is critical for the body’s well-being. An essential area of research is determining factors that put people at risk for heart problems and what factors are preventive. Research in this area is ongoing.

A recent study found that participants with better exercise performance were at a lower risk for developing abnormal heart rhythm, or AFib, and at a lower risk for serious cardiovascular events.

The findings were presented at the European Society of Cardiology (ESC) Congress 2023.

The study was a retrospective, single-center study. Researchers included adults who had no previous diagnosis of AFib. However, all participants had clinical reasons for undergoing exercise treadmill testing.

Researchers analyzed participants’ fitness levels by quantifying how hard they could exercise during a treadmill test, using a measure known as metabolic equivalents (METs). A higher METs score generally indicates a higher level of physical fitness and better physical performance abilities.

Participants who were able to exercise at the highest intensity and achieved the highest MET measures during treadmill testing had an 8% lower risk of developing atrial fibrillation, a 12% decreased risk for ischemic stroke, and a 14% decreased risk for major adverse cardiovascular events (MACE).

About 15,450 participants took part in the study, and researchers followed up on them for just under eleven and a half years. Throughout the study, the researchers recorded 515 new cases of AFib. They accounted for several multi variables in their analysis, including age, hypertension, and whether or not participants were taking certain medications.

The researchers found that “better physical performance was associated with the best heart health outcomes.” They concluded that “A better exercise performance indicates a lower risk of [AFib] incidence, lower incidence of ischemic stroke and lower risk of MACE.”

Dr. Anil K. Gehi, in the division of cardiology at UNC School of Medicine, and Sewell Family-McAllister Distinguished Professor of Medicine Director and Clinical Cardiac Electrophysiology Service Program Director, who was not involved in the study, said the study emphasized the importance of regular physical activity.

“This study adds to several other studies which demonstrate a relationship between physical activity, physical fitness, and the risk for AFib. Patients who are sedentary and less physically fit tend to have a higher risk of developing atrial fibrillation and for the condition to progress.”
— Dr. Anil K. Gehi

“The reason for this is complex but likely related to structural, hormonal, and inflammatory changes that happen when we are inactive. This is similar to how physical activity can help protect against other cardiac problems such as hypertension and coronary heart disease,” he told Medical News Today.

Atrial fibrillation is a type of abnormal heart rhythm. It happens when the upper chambers of the heart beat irregularly or rapidly, which can increase the risk of blood clots and subsequent strokes.

A​ number of factors can increase someone’s risk of having AFib. For example, advanced age and particular genetics can increase risk. Lifestyle choices like drinking high levels of alcohol, smoking, or experiencing high stress levels can also increase someone’s chances of developing atrial fibrillation.

Dr. Gehi explained to MNT:

“Atrial fibrillation is a common condition that can be serious in some situations. Patients with atrial fibrillation are at an increased risk for several adverse outcomes including: stroke, hospitalization, heart failure, cognitive dysfunction (dementia), and even early mortality.”

“In addition, patients with atrial fibrillation often can have quite disabling symptoms with their atrial fibrillation episodes. However, prompt recognition and treatment of atrial fibrillation and related conditions can help mitigate the risk,” he added.

Treatment for atrial fibrillation can involve modifying certain risk factors and using medications or surgery. Researchers in the current study wanted to understand how exercise performance and physical fitness impacted the risk for atrial fibrillation.

T​he study does have certain limitations. First, it cannot establish a causal relationship between exercise and any of the health outcomes studied. It also appears that the research was collected from one center, which could indicate the need for further research in this area.

Dr. Keith C. Ferdinand, Gerald S. Berenson Endowed Chair in Preventive Cardiology and Professor of Medicine with the John W. Deming Department of Medicine at Tulane University School of Medicine, who was not involved in the study, said:

“As a retrospective, single-center study, this is a limitation versus prospective, multicenter approach, which would minimize bias. Since the subjects had some suspicion of an underlying CV concern, the exercise treadmill testing was noted as done for clinical reasons. This suggests other factors, outside of simple activity and fitness, may be important considerations.”

“Although higher exercise performance was linked to a lower [AFib] incidence and lower incidence of ischemic stroke and MACE, there are some potential confounders as demographic baseline characteristics worth further study,” added Dr. Ferdinand.

Despite these limitations, the study results appear to emphasize the importance of physical activity in reducing the risk of heart problems.

“This study, in conjunction with prior studies, highlights the importance of physical fitness for our patients who have or who are at risk for developing cardiovascular disease such as atrial fibrillation. We need to learn how to best help patients understand the importance of exercise and incorporate it into their daily lives. Interventional studies are needed next to demonstrate how best to accomplish this.”
— Dr. Anil K. Gehi