Arrhythmias and conduction disturbances
Relation of Vigorous Exercise to Risk of Atrial Fibrillation

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Limited data suggest that athletes may have a higher risk of developing atrial fibrillation (AF); however, there has been no large prospective assessment of the relation between vigorous exercise and AF. Logistic regression analyses stratified by time were used to assess the association between frequency of vigorous exercise and risk of developing AF in 16,921 apparently healthy men in the Physicians' Health Study. During 12 years of follow-up, 1,661 men reported developing AF. With increasing frequency of vigorous exercise (0, 1, 1 to 2, 3 to 4, 5 to 7 days/week), multivariate relative risks for the full cohort were 1.0 (referent), 0.90, 1.09, 1.04, and 1.20 (p = 0.04). This risk was not significantly increased when exercise habits were updated or in models excluding variables that may be in the biological pathway through which exercise influences AF risk. In subgroup analyses, this increased risk was observed only in men <50 years of age (1.0, 0.94, 1.20, 1.05, 1.74, p <0.01) and joggers (1.0, 0.91, 1.03, 1.30, 1.53, p <0.01), where risks remained increased in all analyses. In conclusion, frequency of vigorous exercise was associated with an increased risk of developing AF in young men and joggers. This risk decreased as the population aged and was offset by known beneficial effects of vigorous exercise on other AF risk factors.

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Methods

The methods of the Physicians' Health Study have been described in detail elsewhere.4 The study complies with the Declaration of Helsinki, was approved by the institutional review board of Brigham and Women's Hospital (Boston, Massachusetts), and participants gave informed consent. Briefly, 22,071 men who were physicians, 40 to 84 years old in 1982, with no history of myocardial infarction, stroke, transient ischemic attacks, or cancer were randomized to aspirin and/or β-carotene using a

Results

At 3 years, 63% of participants reported engaging in a regular program of vigorous exercise and 13% reported exercising 5 to 7 times/week (Table 1). In regular exercisers, mean total amount of time spent exercising per week was 108 ± 78 minutes (Figure 1). Frequency of vigorous exercise was inversely associated with age, BMI, smoking, diabetes, and hypertension and directly associated with alcohol, fish, multivitamin, and vitamin C and E intakes.

Frequency of vigorous exercise at 3 years was not

Discussion

In this large prospective cohort study of apparently healthy men, a complex association between exercise and development of AF was observed. After adjustment for multiple potentially confounding lifestyle factors and health conditions, higher frequency of participation in a regular program of vigorous exercise at 3 years was associated with a modestly increased risk of developing AF. This increased risk was primarily in those who exercised 5 to 7 times/week. These men had a 20% increased risk

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    This study was supported by Grants CA34944, CA40360, HL26490, HL34595, and CA097193 from the National Institutes of Health, Bethesda, Maryland.

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