Key result
Physical activity is linked to ~22% lower AF odds, but reverses at high volumes.
Why the study?
Regular physical activity may reduce atrial fibrillation risk, but the dose at which risk increases in highly active individuals remains unclear.
Does physical activity affect the risk of atrial fibrillation compared to a sedentary lifestyle?
Meta-Analysis (n=1,298,291)
Does physical activity affect the risk of atrial fibrillation compared to a sedentary lifestyle?
Physical activity exhibits a U-shaped dose-response relationship with atrial fibrillation, conferring maximum protection at 26 MET-hr/wk but increasing risk at volumes exceeding 78 MET-hr/wk.
Moderate physical activity was associated with lower atrial fibrillation odds; leaves open optimal dosing and athlete-specific risks pending prospective trials.
BACKGROUND AND AIM: Regular physical activity (PA) may reduce atrial fibrillation (AF) risk in the general population, however, contemporary data suggests individuals engaging in the highest levels of PA may exhibit a paradoxical rise in AF risk. The point at which the dose-response curve reverses remains unclear. This meta-analysis aimed to assess the association between PA and AF across the full continuum of PA exposure. METHODS: Four databases were searched (from January 1990 to June 2025). Eligible studies included those that reported PA exposure compared against a sedentary control group and assessed AF incidence or prevalence. PA exposures were standardised to metabolic equivalent of task hours per week (MET-hr/wk). Pooled odds ratios (ORs) were calculated using a weighted random-effects model. A weighted restricted cubic spline model of logarithmic odds was used to produce a dose-response curve. RESULTS: 37 studies were included (n = 1,298,291 individuals). In the general population, PA was associated with a reduction in odds of AF by 22% (22 studies; OR 0.78; 95% CI 0.68, 0.89). Athlete status was associated with an increase in the odds of AF (15 studies; OR 2.74; 95% CI 1.72, 4.39). Dose-response analysis (26 studies; n = 1,022,790 individuals) showed 26 MET-hr/wk of PA was associated with the greatest reduction in odds of AF, with doses beyond 78 MET-hr/wk associated with increased odds of AF; the equivalent of 6-7 hours per week of endurance training. CONCLUSION: PA and AF demonstrate a U-shaped relationship whereby beyond a quantitative dose threshold of 78 MET-hr/wk, the protective effect of exercise may reverse.
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Davies et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=1,298,291). Physical activity vs. Sedentary control group was evaluated on Atrial fibrillation incidence or prevalence (OR 0.78, 95% CI 0.68, 0.89). Physical activity reduced the odds of atrial fibrillation in the general population (OR 0.78; 95% CI 0.68-0.89), but the protective effect reversed beyond 78 MET-hr/wk.
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