Association of Physical Activity and Cardiorespiratory Fitness with Adverse Outcomes in Atrial Fibrillation Patients: A Prospective Cohort Study

Yutong Wang ^1* Yanwen Chen ¹ Xinyang Song ² Tao Xu ³ Fang Wang ^3*

• ¹ Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, China
• ² Peking University, Beijing, China
• ³ Beijing Hospital, Beijing, China

Cardiorespiratory Fitness (CRF) and physical activity (PA) are crucial for health, gaining prominence in sports cardiology and rehabilitation medicine. This research analyzes CRF and PA's impact on atrial fibrillation (AF) patients' cardiovascular prognosis, offering insights to optimize exercise interventions and enhance the scientific use of exercise in health.Cox regression models were used to assess the associations between CRF, PA, and endpoint events, including heart failure (HF), stroke, myocardial infarction (MI), and all-cause mortality. PA was categorized into four intensity levels, while CRF was quantified using three metrics: maximal oxygen uptake, (VO₂max) resting heart rate (RHR), and maximum heart rate (HRmax). To further examine the dose-response relationship, restricted cubic spline models were employed to assess potential nonlinear associations.Increased total physical activity (TPA) (HR=0.978; 95% CI, 0.961-0.995, P = 0.011), moderate-to-vigorous PA (MVPA) (HR= 0.960; 95% CI, 0.929-0.992, P = 0.014), and moderate physical activity (MPA) (HR= 0.953; 95% CI, 0.918-0.990, P = 0.014) was significantly associated with decreased risk of major adverse cardiovascular events (MACE), respectively. All PA was significantly associated with decreased risk of cardiovascular death with HR ranging from 0.577 to 0.938 (P < 0.01). Higher RHR was significantly associated with an increased risk of adverse outcomes, but not with stroke (HR = 0.999, 95% CI 0.991-1.007, P = 0.7854) or cardiovascular death (HR = 1.004, 95% CI 0.996-1.013, P = 0.3504). Additionally, higher VO₂max was significantly associated with a lower risk of adverse outcomes, but except for cardiovascular death (HR = 0.956, 95% CI 0.888-1.030, P = 0.2376).This study shows that MPA significantly reduces cardiovascular risks in AF patients, with all PA levels lowering mortality. Any PA level is beneficial, with immediate improvements, but excessive PA may yield diminishing returns or risks. Focusing solely on intensity or duration is insufficient; scientifically designed interventions, especially those boosting CRF (e.g., VO2max), are more effective for AF prognosis.Future programs should integrate scientifically grounded strategies to maximize benefits.