Sex Differences in the Association Between Regular Physical Activity and Incident Atrial Fibrillation: A Meta-analysis of 13 Prospective Studies

Abstract

Several studies investigated the role of physical activity in atrial fibrillation (AF), but the results remain controversial. We aimed to estimate the association between physical activity and incident AF, as well as to determine whether a sex difference existed. We systematically retrieved relevant studies from Cochrane Library, PubMed, and ScienceDirect through December 1, 2015. Data were abstracted from eligible studies and effect estimates pooled using a random-effects model. Thirteen prospective studies fulfilled inclusion criteria. For primary analysis, neither total physical activity exposure (relative risk [RR]: 0.98, 95% confidence interval [CI]: 0.90-1.06, P = 0.62) nor intensive physical activity (RR: 1.07, 95% CI: 0.93-1.25, P = 0.41) was associated with a significant increased risk of AF. In the country-stratified analysis, the pooled results were not significantly changed. However, in the sex-stratified analysis, total physical activity exposure was associated with an increased risk of AF in men (RR: 1.18, 95% CI: 1.02-1.37), especially at age <50 years (RR: 1.58, 95% CI: 1.28-1.95), with a significantly reduced risk of AF in women (RR: 0.92, 95% CI: 0.87-0.97). Additionally, male individuals with intensive physical activity had a slightly higher (although statistically nonsignificant) risk of developing AF (RR: 1.12, 95% CI: 0.99-1.28), but there was a significantly reduced risk of incident AF in women (RR: 0.92, 95% CI: 0.86-0.98). Published literature supports a sex difference in the association between physical activity and incident AF. Increasing physical activity is probably associated with an increased risk of AF in men and a decreased risk in women.

Figure 1

Funnel plot of all included studies for a bias analysis. Abbreviations: AF, atrial fibrillation; PA, physical activity; SE, standard error.

Figure 2

Meta‐analysis of the association between total PA exposure and developing AF, with ^#estimating the association between PA and AF in men at baseline (mean age 60 years); ^&estimating the association between PA and AF in men at age 30 years; ^*estimating the association between PA and AF in women at baseline (median age 60 years); and ^$estimating the association between PA and AF in women at age 30 years. Abbreviations: AF, atrial fibrillation; CI, confidence interval; IV, inverse of the variance; PA, physical activity; SE, standard error.

Figure 3

Meta‐analysis of the association between intensive PA and developing AF, with ^#estimating the association between PA (high‐intensity exercise <2000 hours) and AF; ^&estimating the association between PA (high‐intensity exercise >2000 hours) and AF; ^*estimating the association between PA and AF in men; and ^$estimating the association between PA and AF in women. Abbreviations: AF, atrial fibrillation; CI, confidence interval; IV, inverse of the variance; PA, physical activity; SE, standard error.