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Estimated Cardiorespiratory Fitness and Risk of Atrial Fibrillation

The Nord-Trøndelag Health Study


Medicine & Science in Sports & Exercise: December 2019 - Volume 51 - Issue 12 - p 2491–2497
doi: 10.1249/MSS.0000000000002074

Purpose To investigate the association between estimated cardiorespiratory fitness (eCRF) and risk of atrial fibrillation (AF), and examine how long-term changes in eCRF affects the AF risk.

Methods This prospective cohort study includes data of 39,844 men and women from the HUNT2 (August 15, 1995 to June 18, 1997) and the HUNT3 study (October 3, 2006 to June 25, 2008). The follow-up period was from HUNT3 until AF diagnosis or November 30, 2015. The AF diagnoses were retrieved from hospital registers and validated by medical doctors. A nonexercise test based on age, waist circumference, resting heart rate and self-reported physical activity was used to estimate CRF. Cox regression was performed to assess the association between eCRF and AF.

Results The mean age was 50.6 ± 14.6 yr for men and 50.2 ± 15.2 yr for women. Mean follow-up time was 8.1 yr. One thousand fifty-seven cases of AF were documented. For men, the highest risk reduction of AF was 31% in the fourth quintile of eCRF when compared with the first quintile (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.53–0.89). For women, the highest risk reduction was 47% in the fifth quintile when compared with the first quintile (HR, 0.53; 95% CI, 0.38–0.74). One metabolic equivalent increase in eCRF over a 10-yr period was associated with 7% lower risk of AF (HR, 0.93; 95% CI, 0.86–1.00). Participants with improved eCRF had 44% lower AF risk compared with those with decreased eCRF (HR, 0.56; 95% CI, 0.36–0.87).

Conclusions The eCRF was inversely associated with AF, and participants with improved eCRF over a 10-yr period had less risk of AF. These findings support the hypothesis that fitness may prevent AF.

1Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, NORWAY

2Clinic of Cardiology, St. Olav’s Hospital, Trondheim, NORWAY

3Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, NORWAY

4Department of Neurology, Medical School, University of Pécs, Pécs, HUNGARY

5Semmelweis University, Institute of Behavioural Sciences, Budapest, HUNGARY

6School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, AUSTRALIA

Address for correspondence: Lars E. Garnvik, M.Sc., Department of Circulation and Medical Imaging, NTNU, Medisinsk Teknisk Forskningssenter, Post Box 8905, 7491 Trondheim, Norway; E-mail:

Submitted for publication February 2019.

Accepted for publication June 2019.

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Online date: June 26, 2019

© 2019 American College of Sports Medicine