Exploring the Association Between Physical Activity and Atrial Fibrillation: A Systematic Review of Meta-Analyses

Background: Numerous studies suggest intensive and prolonged exercise is a risk factor for atrial fibrillation (AF); many other studies have shown that regular exercise can protect against AF in the general population. Meta-analyses of these studies have produced conflicting results. Thus, we performed a systematic review of meta-analyses to understand better the evidence base linking exercise and AF. Methods: We conducted a systematic review of meta-analyses that evaluated the association between physical activity (PA) and AF. A search of MEDLINE, Scopus, and Google Scholar was performed. The Assessing Methodological Quality of Systematic Reviews 2 (AMSTAR 2) measurement tool was used to evaluate the methodological quality of the included reviews. Results: A total of twelve meta-analyses met the inclusion criteria. Five meta-analyses reported consistent evidence that the risk of AF was increased among athletes compared to non-athletes. The increased risk of AF ranged from OR 1.64(1.10-2.43) to OR 5.3(3.6-7.9). The results were less consistent among studies of different degrees of PA as three reviews suggest that PA was associated with a reduction in AF, but most studies reported no difference in AF risk. Subgroup analyses suggest that individuals younger than 54-60 years and men were more likely to develop AF with PA. Conclusion: PA has a dose-dependent J-shape effect on AF risk, with increased risk at very low and very high levels of PA. This effect seems to be gender-specific and more pronounced in younger males.