Physical activity, sports and risk of atrial fibrillation: umbrella review of meta-analyses

Aims: to assess the association between physical activity (PA) or sports practice and risk of atrial fibrillation (AF). Methods: We systematically searched PubMed, SportDiscus, and the Cochrane Database of Systematic Reviews from inception to 21st October 2019 to identify systematic reviews and meta-analyses examining the relationship between PA or sport practice and the risk of AF. The methodological quality of included reviews was assessed, and we identified those associations that did not have excessive heterogeneity between studies, small study effects, and no evidence for excess significance. Results: Eleven meta-analyses were included in the umbrella review. We found evidence (with low heterogeneity and no excess significance, but with high risk of bias) that PA is not associated with AF risk, whether the former is expressed as total (n=43,672 participants, odds ratio [OR]=1.08, 95% confidence interval [CI]=0.97 to 1.21, p=0.17) or intense PA (n=152,925, OR=1.00, 95%CI=0.82 to 1.22, p=0.99), but sports practice is associated with a higher AF risk (n=9,113, OR=1.64, 95% CI=1.10 to 2.43, p=0.04). Conclusion: AF risk is independent of PA, but sports practice seems to increase AF risk. The methodological issues highlighted here, including lack of valid/objective methods for assessing AF and/or PA in most studies, no standardization of key terms such as ‘sport practice’ (with PA and sports practice used indistinctly in some reports) or ‘athletes’ (with those who are really competitive at the elite level seldom studied), should be considered in future studies to draw definite conclusions on the actual link between of PA/sports and AF risk.