AUTHOR=Wan Qin , Zhou Yue , Zhu Wengen , Liu Xiao 

TITLE=Sex-Specific Exposure–Effect Relationship Between Physical Activity and Incident Atrial Fibrillation in the General Population: A Dose–Response Meta-Analysis of 16 Prospective Studies

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.710071

DOI=10.3389/fcvm.2021.710071

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Since evidence regarding the relationship between physical activity (PA) and atrial fibrillation (AF) incidence is inconsistent among studies, we performed a dose–response meta-analysis to comprehensively evaluate the exposure–effect association between PA and incident AF and the potential sex difference in the general population.</p><p><bold>Methods:</bold> The PubMed and Embase databases were searched for eligible studies published up to July 2020 (PROSPERO: CRD42018091692). The non-linear or linear exposure–effect relationship between PA and AF was examined using the robust error meta-regression method.</p><p><bold>Results:</bold> A total of 16 prospective studies involving 1,449,017 individuals and 39,884 AF cases were included. We observed an inverse non-linear association between PA level and incident AF (<italic>I</italic><sup>2</sup> = 0%, <italic>p</italic><sub>non−linearity</sub> &lt; 0.001). In the linear model, a 5 metabolic equivalent of task (MET)-h/week increase in PA was associated with a decreased risk of AF [risk ratio (RR) = 0.992, 95% confidence interval (CI): 0.988–0.996, <italic>I</italic><sup>2</sup> = 0%]. In the sex-stratified analysis, we observed an inverse non-linear relationship between PA level and AF risk in females (<italic>I</italic><sup>2</sup> = 90%, <italic>p</italic><sub>non−linearity</sub> &lt; 0.0001) but not in males (<italic>I</italic><sup>2</sup> = 0%, <italic>p</italic><sub>non−linearity</sub> = 0.40). In the linear model, a 5 MET-h/week increase in PA was associated with a reduced risk of AF in females (RR = 0.982, 95% CI: 0.975–0.989, <italic>I</italic><sup>2</sup> = 71%) but not in males (RR = 0.998, 95% CI: 0.994–1.002, <italic>I</italic><sup>2</sup> = 0%), with a significant interaction observed between the two groups (<italic>p</italic><sub>interaction</sub> &lt; 0.0001).</p><p><bold>Conclusion:</bold> There was an inverse non-linear relationship between PA level and incident AF in the general population. The beneficial effect of PA in reducing AF risk might be predominantly observed in females.</p>