Physical activity and risk of atrial fibrillation in the general population: meta-analysis of 23 cohort studies involving about 2 million participants

Abstract

Regular physical activity is well established to be associated with reduced risk of cardiovascular disease outcomes. Whether physical activity is associated with the future risk of atrial fibrillation (AF) remains a controversy. Using a systematic review and meta-analysis of published observational cohort studies in general populations with at least one-year of follow-up, we aimed to evaluate the association between regular physical activity and the risk of AF. Relevant studies were sought from inception until October 2020 in MEDLINE, Embase, Web of Science, and manual search of relevant articles. Extracted relative risks (RRs) with 95% confidence intervals (CIs) for the maximum versus the minimal amount of physical activity groups were pooled using random-effects meta-analysis. Quality of the evidence was assessed by GRADE. A total of 23 unique observational cohort studies comprising of 1,930,725 participants and 45,839 AF cases were eligible. The pooled multivariable-adjusted RR (95% CI) for AF comparing the most physically active versus the least physically active groups was 0.99 (0.93–1.05). This association was modified by sex: an increased risk was observed in men: 1.20 (1.02–1.42), with a decreased risk in women: 0.91 (0.84–0.99). The quality of the evidence ranged from low to moderate. Pooled observational cohort studies suggest that the absence of associations reported between regular physical activity and AF risk in previous general population studies and their aggregate analyses could be driven by a sex-specific difference in the associations – an increased risk in men and a decreased risk in women.Systematic review registration: PROSPERO 2020: CRD42020172814

Handgrip strength and risk of cognitive outcomes: new prospective study and meta-analysis of 16 observational cohort studies

“…For comparisons that could not be transformed into extreme tertiles, the extreme groups (i.e. maximum versus minimal value of HGS) as provided by the reports were utilised for the analyses, as used in previous reports [36,42,44,45]. This methodology is considered reliable as shown in a previous review, which showed that pooled estimates from transformed and untransformed data are qualitatively similar [10].…”

“…The role of physical activity in improving health and reducing the risk of chronic disease outcomes such as vascular disease, diabetes and cancer is well known [42,44,48,56]. The beneficial effects of physical activity on these outcomes have been reported to be modulated through its beneficial effects on risk factors such as body weight, glucose, blood pressure, lipid profiles and inflammation [41].…”

Physical activity reduces the risk of pneumonia: systematic review and meta-analysis of 10 prospective studies involving 1,044,492 participants

“…Since the risk estimates could not be transformed into consistent comparisons, the extreme groups (i.e., top versus bottom or maximum versus the minimal amount of physical activity) reported for each study were used for the analyses. This approach, which we have utilised in previous similar meta-analyses [22][23][24][25], is considered reliable as it has been shown that pooled estimates from transformed and untransformed data are qualitatively similar [26]. When a study assessed specific types of physical activity in addition to total or any physical activity, we only used risk estimates for total or any physical activity in the pooled analysis.…”

Physical activity and risk of chronic kidney disease: systematic review and meta-analysis of 12 cohort studies involving 1,281,727 participants

“…(30,31) However, to provide some consistency and enhance comparison and interpretation of the ndings, the extreme groups (i.e., the top versus bottom or maximum versus the minimal amount of physical activity) reported for each study were used for the analyses. Several previous meta-analyses have utilised this approach (12,13,32,33) and it is considered reliable as there is documented data that pooled estimates from transformed and untransformed data are qualitatively similar. (34) When a study reported speci c types of physical activity in addition to any or total physical activity, we only used risk estimates for any or total physical activity in the pooled analysis as done for previous similar reviews.…”