Physical activity, cardiorespiratory fitness, and cardiovascular outcomes in individuals with atrial fibrillation: the HUNT study

Lars E Garnvik, Vegard Malmo, Imre Janszky, Hanne Ellekjær, Ulrik Wisløff, Jan P Loennechen, Bjarne M Nes, Lars E Garnvik, Vegard Malmo, Imre Janszky, Hanne Ellekjær, Ulrik Wisløff, Jan P Loennechen, Bjarne M Nes

Abstract

Aims: Atrial fibrillation (AF) confers higher risk of mortality and morbidity, but the long-term impact of physical activity (PA) and cardiorespiratory fitness (CRF) on outcomes in AF patients is unknown. We, therefore, examined the prospective associations of PA and estimated CRF (eCRF) with all-cause mortality, cardiovascular disease (CVD) mortality, morbidity and stroke in individuals with AF.

Methods and results: We followed 1117 AF patients from the HUNT3 study in 2006-08 until first occurrence of the outcomes or end of follow-up in November 2015. We used Cox proportional hazard regression to examine the prospective associations of self-reported PA and eCRF with the outcomes. Atrial fibrillation patients meeting PA guidelines had lower risk of all-cause [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41-0.75] and CVD mortality (HR 0.54, 95% CI 0.34-0.86) compared with inactive patients. The respective HRs for CVD morbidity and stroke were 0.78 (95% CI 0.58-1.04) and 0.70 (95% CI 0.42-1.15). Each 1-metabolic equivalent task (MET) higher eCRF was associated with a lower risk of all-cause (HR 0.88, 95% CI 0.81-0.95), CVD mortality (HR 0.85, 95% CI 0.76-0.95), and morbidity (HR 0.88, 95% CI 0.82-0.95).

Conclusion: Higher PA and CRF are associated with lower long-term risk of CVD and all-cause mortality in individuals with AF. The findings support a role for regular PA and improved CRF in AF patients, in order to combat the elevated risk for mortality and morbidity.

Keywords: Arrhythmias; Cardiovascular disease; Exercise; Population.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.

Figures

Figure 1
Figure 1
(A–D) Hazard ratio and 95% confidence interval for all-cause (A), cardiovascular disease mortality (B), cardiovascular disease morbidity (C), and stroke (D) across self-reported volume of physical activity, stratified by intensity. Adjusted for attained age, sex, body mass index, cardiovascular disease, smoking, alcohol, and occupational status.
Figure 2
Figure 2
(A–D) Hazard ratio and 95% confidence interval for all-cause (A), cardiovascular disease mortality (B), cardiovascular disease morbidity (C), and stroke (D) across physical activity level in individuals with and without atrial fibrillation. Adjusted for attained age, sex, body mass index, cardiovascular disease, diabetes, hypertension, smoking, alcohol, and occupational status.
Take home figure
Take home figure
Survival probabilities for all-cause and CVD mortality according to physical activity level among individuals with atrial fibrillation.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/7320825/bin/eurheartj_41_15_1467_f3.jpg

References

    1. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, Gillum RF, Kim YH, McAnulty JH Jr, Zheng ZJ, Forouzanfar MH, Naghavi M, Mensah GA, Ezzati M, Murray CJ. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation 2014;129:837–847.
    1. Jabre P, Roger VL, Murad MH, Chamberlain AM, Prokop L, Adnet F, Jouven X. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation 2011;123:1587–1593.
    1. Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail 2009;11:676–683.
    1. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, Witteman JC, Stricker BH, Heeringa J. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013;34:2746–2751.
    1. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 2013;112:1142–1147.
    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H-C, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2016;37:2893–2962.
    1. Ross R, Blair SN, Arena R, Church TS, Despres JP, Franklin BA, Haskell WL, Kaminsky LA, Levine BD, Lavie CJ, Myers J, Niebauer J, Sallis R, Sawada SS, Sui X, Wisloff U. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign. Circulation 2016;134:653–699.
    1. Lavie CJ, Arena R, Swift DL, Johannsen NM, Sui X, Lee DC, Earnest CP, Church TS, O’Keefe JH, Milani RV, Blair SN. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res 2015;117:207–219.
    1. Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 2008;118:800–807.
    1. Garnvik LE, Malmo V, Janszky I, Wisløff U, Loennechen JP, Nes BM. Physical activity modifies the risk of atrial fibrillation in obese individuals: the HUNT3 study. Eur J Prev Cardiol 2018;25:1646–1652.
    1. Khan H, Kella D, Rauramaa R, Savonen K, Lloyd MS, Laukkanen JA. Cardiorespiratory fitness and atrial fibrillation: a population-based follow-up study. Heart Rhythm 2015;12:1424–1430.
    1. Bose A, O’Neal WT, Bennett A, Judd SE, Qureshi WT, Sui X, Howard VJ, Howard G, Soliman EZ. Relation between estimated cardiorespiratory fitness and atrial fibrillation. Am J Cardiol 2017;119:1776–1780.
    1. Proietti M, Boriani G, Laroche C, Diemberger I, Popescu MI, Rasmussen LH, Sinagra G, Dan GA, Maggioni AP, Tavazzi L, Lane DA, Lip G; EORP-AF General Pilot Registry Investigators. Self-reported physical activity and major adverse events in patients with atrial fibrillation. Europace 2017;19:535–543.
    1. Malmo V, Langhammer A, Bønaa KH, Loennechen JP, Ellekjaer H. Validation of self-reported and hospital-diagnosed atrial fibrillation: the HUNT study. Clin Epidemiol 2016;8:185–193.
    1. Krokstad S, Langhammer A, Hveem K, Holmen TL, Midthjell K, Stene TR, Bratberg G, Heggland J, Holmen J. Cohort profile: the HUNT study, Norway. Int J Epidemiol 2013;42:968–977.
    1. Kurtze N, Rangul V, Hustvedt BE, Flanders WD. Reliability and validity of self-reported physical activity in the Nord-Trondelag Health Study: HUNT 1. Scand J Public Health 2008;36:52–61.
    1. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney M-T, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen M-L, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, Van Der Worp HB, Van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016;37:2315–2381.
    1. Nes BM, Janszky I, Vatten LJ, Nilsen TI, Aspenes ST, Wisloff U. Estimating V.O 2peak from a nonexercise prediction model: the HUNT study, Norway. Med Sci Sports Exerc 2011;43:2024–2030.
    1. Kokkinos P, Myers J, Franklin B, Narayan P, Lavie CJ, Faselis C. Cardiorespiratory fitness and health outcomes: a call to standardize fitness categories. Mayo Clin Proc 2018;93:333–336.
    1. Shortreed SM, Peeters A, Forbes AB. Estimating the effect of long-term physical activity on cardiovascular disease and mortality: evidence from the Framingham Heart Study. Heart 2013;99:649–654.
    1. Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol 2014;64:472–481.
    1. Nes BM, Vatten LJ, Nauman J, Janszky I, Wisloff U. A simple nonexercise model of cardiorespiratory fitness predicts long-term mortality. Med Sci Sports Exerc 2014;46:1159–1165.
    1. Khan H, Kunutsor SK, Rauramaa R, Merchant FM, Laukkanen JA. Long-term change in cardiorespiratory fitness in relation to atrial fibrillation and heart failure. Am J Cardiol 2018;121:956--960
    1. Hussain N, Gersh BJ, Gonzalez Carta K, Sydo N, Lopez-Jimenez F, Kopecky SL, Thomas RJ, Asirvatham SJ, Allison TG. Impact of cardiorespiratory fitness on frequency of atrial fibrillation, stroke, and all-cause mortality. Am J Cardiol 2018;121:41–49.
    1. Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol 2009;103:1572–1577.
    1. Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ 2016;354:4482.
    1. Svedberg N, Sundström J, James S, Hållmarker U, Hambraeus K, Andersen K. Long-term incidence of atrial fibrillation and stroke among cross-country skiers. Circulation 2019;140:910–920.
    1. Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Hendriks JM, Twomey D, Kalman JM, Abhayaratna WP, Lau DH, Sanders P. Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol 2015;66:985–996.
    1. Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O, Wisloff U, Loennechen JP. Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial. Circulation 2016;133:466–473.
    1. Keteyian SJ, Ehrman JK, Fuller B, Pack QR. Exercise testing and exercise rehabilitation for patients with atrial fibrillation. J Cardiopulm Rehabil Prev 2019;39:65–72.

Source: PubMed

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