Key result
High lifetime endurance exercise in middle-aged men is linked to ~116% higher AF/AFL odds.
Why the study?
Although a J-shaped relationship between exercise and AF or atrial flutter has been described, the influence of specific sport disciplines is unknown.
Does higher lifetime endurance exercise volume or specific sport discipline increase the prevalence of atrial fibrillation or flutter in middle-aged men?
Cross-Sectional (n=3,939)
Does higher lifetime endurance exercise volume or specific sport discipline increase the prevalence of atrial fibrillation or flutter in middle-aged men?
High-volume lifetime endurance exercise, particularly cycling, is associated with a progressively increased risk of atrial fibrillation and flutter in middle-aged men.
Answers are grounded in this paper and cite their sources.
High-volume endurance exercise was associated with increased AF/AFL odds; supports J-shaped relationship but leaves causality and practice change open.
Background A J-shaped relationship between exercise and atrial fibrillation (AF) or atrial flutter (AFL) has been described, but the influence of specific sport disciplines is unknown. Purpose To examine the relationship between endurance exercise and AF/AFL prevalence in middle-aged men. Methods We analysed questionnaire data from 3939 candidates for the Master@Heart study, assessing self-reported exercise history, cardiovascular risk factors and history of AF/AFL. Participants were divided into quartiles of lifetime endurance exercise hours: Q1 ≤1778, Q2 1779–5977, Q3 5978–12231, and Q4 >12231 hours. Multivariable logistic regression was performed to assess the relationship between exercise volume and type and AF/AFL. Results AF/AFL prevalence was 7.5% and increased significantly across lifetime exercise quartiles (4.8%, 7.6%, 8.0%, and 9.6% from Q1 to Q4; p < 0.001). Adjusting for age, height, and traditional risk factors, Q2 – Q4 had significantly higher odds ratios of AF/AFL compared to Q1, with the largest effect for Q4 (OR 2.16, 95% CI [1.48–3.15], p < 0.001). As sport, only cycling was independently associated with AF/AFL (OR 1.51 [1.11–2.07], p = 0.010). Conclusion In middle-aged males, greater lifetime endurance exercise volume (>1778 hours) was associated with progressively increased odds ratios of AF/AFL, with the greatest risk in the highest quartile (>12231 hours), independent of traditional risk factors. Cycling specifically was associated with AF/AFL. These findings support existing evidence that high-volume endurance exercise may increase AF/AFL risk, even in traditionally low-risk individuals, and furthermore suggest a possible sports-specific effect.
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Paepe et al. (2026) conducted a cross-sectional in Atrial fibrillation or atrial flutter (n=3,939). Lifetime endurance exercise volume vs. ≤1778 hours (Q1) was evaluated on AF/AFL prevalence (OR 2.16, 95% CI 1.48-3.15, p=<0.001). In middle-aged males, >12231 hours of lifetime endurance exercise was associated with increased odds of AF/AFL compared to ≤1778 hours.
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