Abstract 11637: Physical Activity and Atrial Fibrillation: Results From the Multi-ethnic Study of Atherosclerosis (MESA)

Introduction: Prior studies have raised the question of whether an association exists between physical activity (PA) and atrial fibrillation (AF), with mixed results. We sought to use the Multi-Ethnic Study of Atherosclerosis (MESA) database to examine the association between PA and AF in a diverse population without clinically recognized prevalent cardiovascular disease (CVD). Hypothesis: Increased exercise will have a protective influence on AF incidence. Methods: MESA participants (N=5793) with a completed baseline PA survey and complete covariate data were included. Incident AF events were determined based on hospital discharge ICD-9 codes and Medicare inpatient claims. Total intentional exercise (TIE), defined as a sum of walking for exercise, dance/sport, and conditioning, was used as our independent variable of interest. The MESA population was stratified based on whether they reported participation in any vigorous physical activity (VPA), which was defined as “heavy effort” expended in household chores, lawn/yard/garden/farm work, conditioning activities, and occupational/volunteering work. Cox models, adjusted for demographics and CVD risk factors, were used to determine hazard ratios (HR) for incident AF based on total intentional exercise (TIE) for the subgroups. We performed similar analyses using TIE as a categorical variable stratified into tertiles. Results: During a mean follow-up of 7.7±1.9 years, 199 AF cases occurred. In the overall MESA population, TIE alone was not associated with incident AF. However, within the group that reported any VPA (N=1866), there was a statistically significant protective influence of increasing TIE on incident AF (HR=0.658, p=0.014). Additionally, among the same group, the top tertile of TIE was associated with a significantly lower risk of incident AF compared with the group with no TIE (HR=0.48, p=0.048). Conclusions: TIE was associated with a lower risk of incident AF among those that participated in any VPA, and this protective influence was most notable among those that performed the most TIE. Perhaps as importantly, no subgroup of participants demonstrated an increased risk of incident AF with TIE. These results re-emphasize the beneficial role of exercise for cardiovascular health.

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Abstract 047: Sedentary Behavior Increases Risk for Cardiovascular Disease in Older Women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study

Circulation ◽

10.1161/circ.137.suppl_1.047 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

John Bellettiere ◽

Michael J LaMonte ◽

Eileen Rillamas-Sun ◽

Jacqueline Kerr ◽

Kelly R Evenson ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Sedentary Behavior ◽

Older Women ◽

Cardiovascular Health ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Cvd Risk ◽

Bout Duration ◽

Increased Risk

Background: Evidence on sedentary behavior and cardiovascular disease (CVD) is largely based on self-reported sedentary time. Furthermore, how sedentary time is accumulated (in longer vs. shorter bouts) may be related to CVD risk but has not been tested. Methods: Women (n=5638, mean age=79±7) with no history of myocardial infarction or stroke wore accelerometers for 4-7 days and were followed for up to 4 years for incident CVD. Hazard ratios (HR) and 95% confidence intervals (CIs) for CVD and coronary heart disease (CHD) events were estimated across quartiles of sedentary time and mean sedentary bout duration using Cox proportional hazard models adjusting for covariates. Separate models evaluated associations after adding moderate-to-vigorous physical activity (MVPA) and possible mediators: body mass index, diabetes, hypertension, systolic blood pressure, fasting glucose, HDL-cholesterol, and triglycerides. We then tested whether mean bout duration was associated with increased risk for CVD and CHD among women with above median sedentary time (≥10hr/day). Results: Covariate-adjusted HRs for CVD and CHD increased across quartiles of both sedentary time and mean bout duration (Table). All CHD associations remained significant but attenuated after adjustment for possible mediators. After adjustment for MVPA, highest vs. lowest quartile HRs (CI) for CHD were 1.6 (0.7-3.4; p-trend = .08) for sedentary time and 1.8 (0.9-3.5; p-trend = .047) for mean bout duration. Among women with high sedentary time, the HRs (CI) comparing the 75 th vs. 25 th percentile of mean bout duration were 1.05 (0.95-1.15) for CVD and 1.16 (1.01-1.34) for CHD. Conclusions: Both sedentary time and mean bout duration showed independent, dose-response associations with increased risk of CVD and CHD events in older women. Among women with high sedentary time, longer mean bout duration was associated with higher CHD risk. Taken together, this provides evidence that both total sedentary time and the way it is accumulated are predictive of incident CHD.

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Association of Physical Activity with the Incidence of Atrial Fibrillation in Persons >65 Years Old: The Atherosclerosis Risk In Communities (ARIC) Study

10.1101/2021.12.07.21267411 ◽

2021 ◽

Author(s):

Grace Fletcher ◽

Aniqa B. Alam ◽

Linzi Li ◽

Faye L. Norby ◽

Lin Y. Chen ◽

...

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Vigorous Physical Activity ◽

Complete Information ◽

Cox Models ◽

Atherosclerosis Risk In Communities ◽

Validated Questionnaire ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Lower Hazard

ABSTRACTBackgroundThough moderate levels of physical activity (PA) seem to reduce the risk of atrial fibrillation (AF), the association of PA with AF in the elderly remains unclear.MethodsWe studied 5,166 participants of the Atherosclerosis Risk in Communities (ARIC) cohort that took part in visit 5 (2011-2013), were free of AF and had complete information on all variables. Self-reported PA was evaluated with a validated questionnaire and weekly minutes of leisure-time moderate to vigorous physical activity (MVPA) were calculated and categorized using the 2018 Physical Activity Guidelines for Americans (no activity [0 min/week], low [>0-<150 min/week], adequate [150-<300 min/week], high [≥300 min/week]). Incident AF between the visit 5 and the end of 2019 was ascertained from hospital discharges and death certificates. Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for AF by levels of physical activity adjusting for potential confounders.ResultsThe mean (SD) age for the sample was 75 (5) years; 59% were female and 22% were Black. During a mean (SD) follow-up time of 6.3 (2.0) years, 703 AF events were identified. The association of MVPA with AF incidence showed a U-shaped relationship. Compared to those not engaging in MVPA, individuals with low MVPA had a 23% lower hazard of AF (HR= 0.77; 95% CI: 0.61, 0.96), while those with adequate MVPA had a 14% lower hazard (HR 0.86; 95% CI: 0.69, 1.06). High levels of MVPA were not associated with AF risk (HR 0.97; 95% CI: 0.78, 1.20). There was no evidence of heterogeneity when stratified by race and sex.ConclusionThis study suggests that being involved in low to moderate levels of MVPA was associated with a reduced hazard of AF. There was no evidence of increased risk of AF in those with higher levels of MVPA.

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Physical activity volume in relation to risk of atrial fibrillation. A non-linear meta-regression analysis

European Journal of Preventive Cardiology ◽

10.1177/2047487318768026 ◽

2018 ◽

Vol 25 (8) ◽

pp. 857-866 ◽

Cited By ~ 16

Author(s):

Cristian Ricci ◽

Federico Gervasi ◽

Maddalena Gaeta ◽

Cornelius M Smuts ◽

Aletta E Schutte ◽

...

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Relative Risk ◽

Vigorous Physical Activity ◽

Response Analysis ◽

Metabolic Equivalents ◽

Increased Risk ◽

Non Linear ◽

Meta Regression ◽

Physical Activity Volume

Background Light physical activity is known to reduce atrial fibrillation risk, whereas moderate to vigorous physical activity may result in an increased risk. However, the question of what volume of physical activity can be considered beneficial remains poorly understood. The scope of the present work was to examine the relation between physical activity volume and atrial fibrillation risk. Design A comprehensive systematic review was performed following the PRISMA guidelines. Methods A non-linear meta-regression considering the amount of energy spent in physical activity was carried out. The first derivative of the non-linear relation between physical activity and atrial fibrillation risk was evaluated to determine the volume of physical activity that carried the minimum atrial fibrillation risk. Results The dose–response analysis of the relation between physical activity and atrial fibrillation risk showed that physical activity at volumes of 5–20 metabolic equivalents per week (MET-h/week) was associated with significant reduction in atrial fibrillation risk (relative risk for 19 MET-h/week = 0.92 (0.87, 0.98). By comparison, physical activity volumes exceeding 20 MET-h/week were unrelated to atrial fibrillation risk (relative risk for 21 MET-h/week = 0.95 (0.88, 1.02). Conclusion These data show a J-shaped relation between physical activity volume and atrial fibrillation risk. Physical activity at volumes of up to 20 MET-h/week is associated with reduced atrial fibrillation risk, whereas volumes exceeding 20 MET-h/week show no relation with risk.

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Abstract MP16: Reallocating Sedentary Behavior With Sleep or Physical Activity is Associated With Favorable Cardiovascular Health in the Multi-Ethnic Study of Atherosclerosis: MESA

Circulation ◽

10.1161/circ.141.suppl_1.mp16 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Charles German ◽

Nour Makarem ◽

Jason Fanning ◽

Susan Redline ◽

Tali Elfassy ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Blood Pressure ◽

Sedentary Behavior ◽

Diastolic Blood Pressure ◽

Cardiovascular Health ◽

Sedentary Time ◽

Vigorous Physical Activity ◽

Ethnic Study ◽

The Mean

Introduction: Sleep, sedentary behavior, and physical activity are each independently associated with cardiovascular health (CVH). However, many studies have investigated these relationships in isolation even though a change in any one given behavior will affect the time spent in the others. It is unknown how reallocating time in sedentary behavior with sleep or physical activity effects overall CVH in a diverse cohort of men and women at risk of cardiovascular disease (CVD). Hypothesis: Reallocating 30 minutes of sedentary time with sleep, light (LIPA), or moderate to vigorous physical activity (MVPA) is associated with more favorable overall CVH due to improvements in risk factors for CVD. Methods: Data for this analysis were taken from the Multi-Ethnic Study on Atherosclerosis (MESA) Sleep Ancillary Study. Eligible participants (n= 1718) wore Actiwatch accelerometers for 24 hours a day, and had at least 3 days of valid accelerometry. Time spent in sleep, sedentary behavior, LIPA, and MVPA was determined based on an established algorithm. The American Heart Association’s life simple 7 was used to represent the CVH score after excluding the physical activity component, with higher scores indicating more favorable CVH. All components were ascertained from MESA exam 5. Isotemporal substitution modeling was conducted to examine the effect of substituting 30 minutes of sedentary time for an equivalent amount of sleep, LIPA, or MVPA. Results: The mean age of participants was 68.3, 54.0% were female and 38.6% were white. The mean CVH score was 5.9 (95%CI: 5.8-6.0). On average, participants spent 499.3 minutes/day in sedentary time, 415.3 minutes/day in LIPA, 26.0 minutes/day in MVPA, and 388.2 minutes/day sleeping. Reallocating 30 minutes of sedentary time to sleep, LIPA, and MVPA was associated with a significantly higher CVH score [β(SE): 0.077(0.023), 0.039(0.017), and 0.485(0.065) respectively]. Reallocating 30 minutes of sedentary time to sleep was associated with lower BMI. Reallocating 30 minutes of sedentary time to LIPA was associated with higher diastolic blood pressure and total cholesterol, and lower BMI. Reallocating 30 minutes of sedentary time to MVPA was associated with lower systolic and diastolic blood pressure, and lower BMI. Conclusions: Our study demonstrates that sleep, LIPA, and MVPA are all positively associated with more favorable overall CVH and several key CVD risk factors. These findings underscore the importance of lifestyle modifications in improving CVH.

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Association of the combined effects of air pollution and changes in physical activity with cardiovascular disease in young adults

European Heart Journal ◽

10.1093/eurheartj/ehab139 ◽

2021 ◽

Author(s):

Seong Rae Kim ◽

Seulggie Choi ◽

Kyuwoong Kim ◽

Jooyoung Chang ◽

Sung Min Kim ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Air Pollution ◽

Young Adults ◽

Cardiovascular Health ◽

Combined Effects ◽

Cvd Risk ◽

Increased Risk ◽

High Pollution ◽

Pollution Exposure

Abstract Aims Little is known about the trade-off between the health benefits of physical activity (PA) and the potential harmful effects of increased exposure to air pollution during outdoor PA. We examined the association of the combined effects of air pollution and changes in PA with cardiovascular disease (CVD) in young adults. Methods and results This nationwide cohort study included 1 469 972 young adults aged 20–39 years. Air pollution exposure was estimated by the annual average cumulative level of particulate matter (PM). PA was calculated as minutes of metabolic equivalent tasks per week (MET-min/week) based on two consecutive health examinations from 2009 to 2012. Compared with the participants exposed to low-to-moderate levels of PM2.5 or PM10 who continuously engaged in ≥1000 MET-min/week of PA, those who decreased their PA from ≥1000 MET-min/week to 1–499 MET-min/week [PM10 adjusted hazard ratio (aHR) 1.22; 95% confidence interval (CI) 1.00–1.48] and to 0 MET-min/week (physically inactive; PM10 aHR 1.38; 95% CI 1.07–1.78) had an increased risk of CVD (P for trend <0.01). Among participants exposed to high levels of PM2.5 or PM10, the risk of CVD was elevated with an increase in PA above 1000 MET-min/week. Conclusion Reducing PA may lead to subsequent elevation of CVD risk in young adults exposed to low-to-moderate levels of PM2.5 or PM10, whereas a large increase in PA in a high-pollution environment may adversely affect cardiovascular health.

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Higher Intakes of Potassium and Magnesium, but Not Lower Sodium, Reduce Cardiovascular Risk in the Framingham Offspring Study

Nutrients ◽

10.3390/nu13010269 ◽

2021 ◽

Vol 13 (1) ◽

pp. 269

Author(s):

R. Taylor Pickering ◽

M. Loring Bradlee ◽

Martha R. Singer ◽

Lynn L. Moore

Keyword(s):

Dose Response ◽

Lower Risk ◽

Cardiovascular Health ◽

Proportional Hazards ◽

Sodium Intake ◽

Cubic Spline ◽

Cox Proportional Hazards ◽

Cvd Risk ◽

Cox Models ◽

Dietary Fiber Intake

We explored the dose-response relations of sodium, potassium, magnesium and calcium with cardiovascular disease (CVD) risk in the Framingham Offspring Study, as well as the combined effects of these minerals. Analyses included 2362 30–64 year-old men and women free of CVD at baseline. Cox proportional-hazards models were used estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for mineral intakes and incident CVD. Cox models with restricted cubic spline functions were used to examine dose-response relations, adjusting for confounding by age, sex, body mass index, dietary fiber intake, and time-varying occurrence of hypertension. Lower sodium intake (<2500 vs. ≥3500 mg/d) was not associated with a lower risk of CVD. In contrast, potassium intake ≥3000 (vs. <2500) mg/d was associated with a 25% lower risk (95% CI: 0.59, 0.95), while magnesium intake ≥320 (vs. <240) mg/d led to a 34% lower risk (95% CI: 0.51, 0.87) of CVD. Calcium intake ≥700 (vs. <500) mg/d was associated with a non-statistically significant 19% lower risk. Restricted cubic spline curves showed inverse dose-response relations of potassium and magnesium with CVD risk, but no such associations were observed for sodium or calcium. These results highlight the importance of potassium and magnesium to cardiovascular health.

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Abstract P152: Self-reported Physical Activity And Outcomes In Individuals With Chronic Kidney Disease

Circulation ◽

10.1161/circ.143.suppl_1.p152 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Jacob Bruinius ◽

Mary Hannan ◽

Jinsong Chen ◽

Julia Brown ◽

Mayank Kansal ◽

...

Keyword(s):

Physical Activity ◽

Lower Risk ◽

Cardiovascular Events ◽

Prospective Observational Study ◽

Proportional Hazards ◽

Vigorous Physical Activity ◽

Cox Proportional Hazards ◽

Physically Active ◽

Increased Risk

Background: In the general population, higher levels of physical activity are associated with lower risk for cardiovascular events and mortality. Although individuals with CKD are less physically active than individuals without CKD and at increased cardiovascular risk, the association between physical activity and outcomes has not been extensively evaluated in this population. Hypothesis: Lower levels of physical activity will be associated with an increased risk for cardiovascular events and mortality. Methods: We used data from 3935 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study, an ongoing multi-center prospective observational study of adults with CKD enrolled between 2003 and 2008. Self-reported physical activity was assessed at study entry using a self-reported survey. We evaluated two predictors: walking pace and moderate-to-vigorous physical activity (MVPA) MET-hours per week. Outcomes included physician-adjudicated myocardial infarction (MI), stroke, congestive heart failure (CHF), and cardiovascular (CV) death. Cox proportional hazards were used to assess the association of physical activity with outcomes. Results: At baseline, mean age was 57.7 years, 45.2% (1777 of 3935) were women, 33.4% (1314 of 3935) had self-reported cardiovascular disease, mean eGFR was 44.9 ml/min/m 2 , 11.7% (459 of 3914) were in the fastest walk pace group (>3 mph) and median MVPA was 39.0 MET-hours per week. During a median follow-up of 8.9 years, the number of events was 477 for MI, 230 stroke, 843 CHF, and 1022 CV deaths. In fully adjusted models, fastest walk pace was associated with lower risk for each outcome. Those in the highest MVPA quartile had lower risk for MI and CV death, but not stroke or CHF, compared to those who were least active ( Table 1 ). Conclusion: In this cohort of adults with CKD, higher physical activity was protective against cardiovascular events and cardiovascular mortality, which may have important implications for clinical practice and the design of future studies.

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Regular exercise is associated with a lower risk of developing dementia in patients with a new diagnosis of atrial fibrillation: a nationwide population-based study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0534 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.H Lim ◽

S.R Lee ◽

E.K Choi ◽

J.P Yun ◽

H.J Ahn ◽

...

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Vascular Dementia ◽

Lower Risk ◽

Alzheimer’S Dementia ◽

P Value ◽

Regular Exercise ◽

Newly Diagnosed ◽

Exercise Habit ◽

New Diagnosis

Abstract Introduction Regular exercise is known to decrease the risk of dementia. There is a paucity of information about the impact of the change of exercise habit on cardiovascular outcomes after a new diagnosis of atrial fibrillation (AF). We aimed to investigate whether regular exercise is associated with the risk of developing dementia in patients with AF. Methods Using the Korean National Health Insurance Service database, we enrolled patients with newly diagnosed AF who had undergone health screening between 2010 and 2016. The study population was divided into four groups based on the consistency of regular exercise before and after AF diagnosis: (1) persistent non-exerciser, (2) exercise starter, (3) exercise quitter, and (4) exercise maintainer. We investigated the association between exercise and the risk of dementia. Results A total of 126,555 patients were included (mean age 62.7 years, male 62.0%, and mean CHA2DS2-VASc Score 2.7). During a median follow-up duration of 3.0 years, 5,943 patients were newly diagnosed as dementia (1.57 per 100 person-years). Among patients with incident dementia, 4,410 patients had Alzheimer's dementia and 951 patients had vascular dementia (1.16 and 0.25 per 100 person-years, respectively). Persistent non-exerciser, exercise starter, quitter, and maintainer groups were 65.1%, 12.8%, 12.7%, and 9.4%, respectively. After multivariable adjustment, we found that exercise was associated with a lower risk of developing overall dementia. When compared to persistent non-exerciser, exercise starter and maintainer showed reduced risk of developing dementia (hazard ratio [HR] 0.80, 95% confidence interval [95% CI] 0.73–0.88 and HR 0.63, 95% CI 0.54–0.73, respectively, all p-value <0.0001), but exercise quitter showed no significant risk reduction (HR 0.95, 95% CI 0.88–1.03, Figure). Alzheimer's dementia showed consistent results: a 20% lower risk with exercise starter, and a 37% lower risk with exercise maintainer. Change of exercise habit, however, did not affect the risk of vascular dementia (all, p-value >0.05, Figure). Conclusions Regular exercise showed a lower risk of dementia in patients with new-onset AF. Starting exercise even after the diagnosis of AF was beneficial to patients who had little physical activity previously. These findings may support physicians to recommend that AF patients should start exercise or keep their physical activity to reduce the risk of dementia. Funding Acknowledgement Type of funding source: None

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Association of daily composition of physical activity and sedentary behaviour with incidence of cardiovascular disease in older adults

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01157-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Manasa S. Yerramalla ◽

Duncan E. McGregor ◽

Vincent T. van Hees ◽

Aurore Fayosse ◽

Aline Dugravot ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Sedentary Behaviour ◽

Cox Regression ◽

Vigorous Physical Activity ◽

Movement Behaviour ◽

Cvd Risk ◽

Daily Movement ◽

Intensity Physical Activity ◽

Current Duration

Abstract Background Moderate-to-vigorous physical activity (MVPA) is proposed as key for cardiovascular diseases (CVD) prevention. At older ages, the role of sedentary behaviour (SB) and light intensity physical activity (LIPA) remains unclear. Evidence so far is based on studies examining movement behaviours as independent entities ignoring their co-dependency. This study examines the association between daily composition of objectively-assessed movement behaviours (MVPA, LIPA, SB) and incident CVD in older adults. Methods Whitehall II accelerometer sub-study participants free of CVD at baseline (N = 3319, 26.7% women, mean age = 68.9 years in 2012–2013) wore a wrist-accelerometer from which times in SB, LIPA, and MVPA during waking period were extracted over 7 days. Compositional Cox regression was used to estimate the hazard ratio (HR) for incident CVD for daily compositions of movement behaviours characterized by 10 (20 or 30) minutes greater duration in one movement behaviour accompanied by decrease in another behaviour, while keeping the third behaviour constant, compared to reference composition. Analyses were adjusted for sociodemographic, lifestyle, cardiometabolic risk factors and multimorbidity index. Results Of the 3319 participants, 299 had an incident CVD over a mean (SD) follow-up of 6.2 (1.3) years. Compared to daily movement behaviour composition with MVPA at recommended 21 min per day (150 min/week), composition with additional 10 min of MVPA and 10 min less SB was associated with smaller risk reduction – 8% (HR, 0.92; 95% CI, 0.87–0.99) – than the 14% increase in risk associated with a composition of similarly reduced time in MVPA and more time in SB (HR, 1.14; 95% CI, 1.02–1.27). For a given MVPA duration, the CVD risk did not differ as a function of LIPA and SB durations. Conclusions Among older adults, an increase in MVPA duration at the expense of time in either SB or LIPA was found associated with lower incidence of CVD. This study lends support to public health guidelines encouraging increase in MVPA or at least maintain MVPA at current duration.

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