Abstract
Abstract Background/Introduction There is a correlation between light-to-moderate physical activity and reduced atrial fibrillation (AF) incidence and cardiovascular risk. Vigorous activities reduced the benefits and increased the risk of AF. The exact threshold at which physical activity increases the risk of cardiovascular death (CVD) in patients with AF remains to be determined. Purpose To determine the threshold of vigorous activity in patients with AF. Methods In this study, data from 23856 individuals from the Taiwan Biobank (2017) were analyzed. Physical activity levels were quantified in metabolic equivalent task (MET) hours/week and categorized into four groups based on 20 MET-hour increments. The study employed Kaplan-Meier survival analysis and an adjusted generalized additive model (GAM) to assess the impact of physical activity on CVD risk (adjusting for age, sex, diabetes, hypertension, chronic obstructive pulmonary disease, and chronic kidney disease), with follow-up data from 2017 to 2022. Results Over a median 5.51-year follow-up, 238 AF cases (cumulative rate of AF: 0.998%) were identified (48.7% female, mean age 61.7 years). The linear model indicated a lower CVD risk in participants engaging in moderate physical activity (20-40 MET-hours/week; adjusted hazard ratio [HR]: 0.38, 95% CI: 0.16-0.95) compared to the reference group (0-20 MET-hours/week). Notably, the GAM model demonstrated a significant increase in CVD risk for activities exceeding 40 MET-hours/week after multivariable adjustment. Conclusions Physical activity levels and CVD risk in AF patients are correlated in a J-shaped manner. The CVD risk of AF decreased with mild to moderate physical activity. For AF patients, it establishes a critical threshold of 40 MET-hours/week beyond which there is an increased risk of CVD, thus clarifying safe physical activity limits.Figure 1:KM sruvival curveFigure 2:Smooth model of GAM
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