Impact of Physical Activity on Stroke and Mortality in Individuals With and Without Atrial Fibrillation: The HUNT Study and the Tromsø Study

BACKGROUND: Although physical activity (PA) is associated with a reduced risk of stroke and mortality, its impact among individuals with atrial fibrillation (AF) remains insufficiently explored. Therefore, the aim of this study was to examine the impact of PA on stroke and mortality, both overall and with respect to AF diagnosis. METHODS: We included 87 340 participants, of which 6539 had AF, from 2 Norwegian population-based studies, the Tromsø Study and the HUNT (Trøndelag Health Study). Information about AF, stroke, and death were obtained from national health registries. Participants were classified as inactive (reference) or performing low, moderate, or high PA on the basis of a questionnaire. The data were analyzed using multivariable adjusted flexible parametric survival models. RESULTS: During a median follow-up of 13.5 years, 3415 strokes and 7833 deaths occurred. The respective stroke risk reduction associated with low, moderate, and high PA was 9% (95% CI, 1%-16%), 19% (95% CI, 11%-27%) and 18% (95% CI, 8%-26%). Mortality was reduced by 11% (95% CI, 7%-14%), 18% (95% CI, 14%-22%), and 22% (95% CI, 18%-27%). Similar benefits were observed for both stroke and mortality when stratifying by presence or absence of AF. Among individuals with AF, an increased life expectancy was observed, with gains of 0.50 (95% CI, 0.22-0.78), 0.66 (95% CI, 0.31-1.01) and 1.15 (95% CI, 0.77-1.53) years, respectively. CONCLUSIONS: PA was associated with a reduced risk of stroke and mortality, and similar benefits were observed irrespective of AF diagnosis. Our findings suggest that PA may complement current medical treatment strategies in individuals with AF.