Arrhythmias and Conduction Disturbances
Effect of Years of Endurance Exercise on Risk of Atrial Fibrillation and Atrial Flutter

https://doi.org/10.1016/j.amjcard.2014.07.047Get rights and content

Highlights

  • Long-term endurance exercise increased the risk for both AF and atrial flutter.

  • Years of regular endurance exercise increased the risk for atrial arrhythmias gradually.

  • Atrial arrhythmia diagnoses were validated by electrocardiography.

  • The associations were consistent between cross-country skiers and men from the general population.

  • The results were robust after adjustments for a broad range of confounding factors.

Emerging evidence suggests that endurance exercise increases the risk for atrial fibrillation (AF) in men, but few studies have investigated the dose-response relation between exercise and risk for atrial arrhythmias. Both exposure to exercise and reference points vary among studies, and previous studies have not differentiated between AF and atrial flutter. The aim of this study was to assess the risk for atrial arrhythmias by cumulative years of regular endurance exercise in men. To cover the range from physical inactivity to long-term endurance exercise, the study sample in this retrospective cohort study was based on 2 distinct cohorts: male participants in a long-distance cross-country ski race and men from the general population, in total 3,545 men aged ≥53 years. Arrhythmia diagnoses were validated by electrocardiograms during review of medical records. Regular endurance exercise was self-reported by questionnaire. A broad range of confounding factors was available for adjustment. The adjusted odds ratios per 10 years of regular endurance exercise were 1.16 (95% confidence interval 1.06 to 1.29) for AF and 1.42 (95% confidence interval 1.20 to 1.69) for atrial flutter. In stratified analyses, the associations were significant in cross-country skiers and in men from the general population. In conclusion, cumulative years of regular endurance exercise were associated with a gradually increased risk for AF and atrial flutter.

Section snippets

Methods

To cover the range from physical inactivity to long-term regular endurance exercise, the study sample was based on participants recruited from 2 independent cohorts. Altogether, 4,999 men aged 53 to 92 years were invited to participate. Figure 1 illustrates the recruitment to this retrospective cohort study.

The first cohort comprised men who had previously participated in the 54-km Birkebeiner cross-country ski race. The cohort was constructed from a list provided by the race organizer. An

Results

In all, 3,712 of 4,999 invited men (74%) participated in the study, 76% of the skiers and 72% of the men from the Oslo Health Study. One hundred sixty-seven men who had reported arrhythmias in the Oslo Health Study but did not report AF in the present study were excluded, leaving 3,545 men eligible for the analyses. Table 1 describes characteristics of the study participants by years of endurance exercise. Men with histories of long-term regular exercise were younger, taller, had lower body

Discussion

This study adds to the current knowledge by demonstrating a graded dose-response relation between cumulative years of regular endurance exercise and risk for AF in men aged ≥53 years and is the first to show a correspondingly increased risk for atrial flutter.

In a recent Swedish study, repeated participation and faster finishing time in a long-distance cross-country ski race were associated with increased risk for AF. That study was limited by the lack of a reference point in the general

Acknowledgments

The authors thank Gry Sissel Granlund and Jon Wickman at the Norwegian Institute of Public Health for assistance with collection and processing of data, Iben Hansen at Journalservice AS (Oslo University Hospital), Helge Røsjø and Jon Brynildsen at Akershus University Hospital, Anne Marit Tiller at Lovisenberg Diakonale Hospital, Sigrun Losada Eskeland, Anne Pernille Ofstad and Arnljot Tveit at Vestre Viken Health Trust, Heidi Olsen at Østfold Health Trust, Tomm Bernklev at Telemark Health

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This work was supported by Diakonhjemmet Hospital, the Kavli Research Center for Geriatrics and Dementia, the Norwegian Institute of Public Health, and the Norwegian EXTRAFoundation for Health and Rehabilitation through EXTRA FUNDS.

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