Even Light Physical Activity May Lower Stroke Risk in People With AFib

• Physical activity was associated with a lower risk of stroke and death among people with atrial fibrillation (AFib), according to new research.
• Even relatively low levels of exercise were linked to meaningful benefits compared with inactivity.
• Exercise should complement, not replace, standard AFib treatments, including medications.

Even small amounts of physical activity may help reduce the risk of stroke and premature death among people with atrial fibrillation (AFib), new research suggests.

In a study involving more than 87,000 adults, researchers found that physical activity was associated with lower rates of stroke and death, regardless of whether participants had AFib.

Among those with the condition, even small amounts of activity were associated with a significantly lower adjusted risk of stroke over 15 years compared with being sedentary.

The findings were published in the Journal of the American Heart Association on August 5.

“The results support current recommendations that exercise is critically important to overall cardiovascular health and there’s a dose response showing that the more exercise the better,” said Rod Passman, MD, a professor of medicine and director of the Center for Arrhythmia Research at Northwestern University. Passman wasn’t involved in the research.

“The new data here is that in those with AF, even small amounts of exercise appear to reduce stroke risk compared to no exercise,” he told Healthline.

The findings are relevant given that some people with AFib may be hesitant to exercise due to symptoms such as heart palpitations, fatigue, dizziness, or shortness of breath. Yet as the study suggests, it may not be necessary to complete long or strenuous workouts to experience benefits. 

The results do not indicate that exercise can replace AFib treatment, including medications used to control heart rate or rhythm and anticoagulants prescribed to prevent blood clots.

Instead, physical activity should be integrated alongside treatment to improve overall cardiovascular health.

Physical activity reduced stroke risk in AFib patients

AFib is an irregular heart rhythm that can disrupt blood flow, increasing the risk of blood clots and stroke.

Physical activity is important for reducing your risk of stroke, but its effects in individuals with AFib are less established.

The study included 87,340 participants from two large population-based Norwegian research projects: the Tromsø Study and the Trøndelag Health Study, commonly known as HUNT. 

The average age of participants at the beginning of the study was approximately 51, and about half (47%) were men. A total of 6,539 participants had AFib at the beginning of the study or developed it during follow-up. 

The researchers used national health registries and hospital records to identify AFib diagnoses, strokes, and deaths. Participants were followed for a median of 13.5 years, during which 3,415 strokes and 7,833 deaths occurred. About 87% of the strokes were ischemic strokes.

Participants reported how frequently they exercised, how long their exercise sessions lasted, and how intensely they exercised. Researchers used those responses to place them into four groups:

• inactive
• low physical activity
• moderate physical activity
• high physical activity

Approximately 18% of participants were inactive, 38% reported low activity, 24% reported moderate activity, and 22% reported high activity.

Across the entire cohort, low, moderate, and high activity were associated with reductions of 9%, 19%, and 18% in stroke risk, respectively, compared with inactivity.

The corresponding reductions in the risk of death from any cause were 11%, 18%, and 22%. The benefits were similar among people with and without AFib.

“I’m particularly encouraged to see that the benefit wasn’t only limited to highly active individuals,” Denice Ichinoe, DO, an assistant professor in the department of family and community medicine at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas. Ichinoe wasn’t involved in the research. 

“Even moving from inactivity to relatively low amounts of physical activity was associated with better outcomes,” Ichinoe told Healthline.

Higher activity was also associated with longer life expectancy among people with AFib. Compared with inactivity, low activity was associated with an additional 0.50 years of life, moderate activity with 0.66 years, and high activity with 1.15 years.

However, as an observational study, it does not prove that exercise directly caused these benefits.

“The study has limitations — exercise levels are self-reported, and they do not know who was treated with anticoagulation,” Passman said. “Furthermore, the study design cannot exclude unmeasured confounders that may impact stroke risk apart from exercise.”

Still, the findings support including appropriate physical activity in a broader treatment plan.

“I would emphasize the fact that exercise is additive on top of standard of care. Neither this study nor others like it have been used to replace anticoagulant use or contemporary AF management,” said Nikhil Warrier, MD, board certified cardiac electrophysiologist and medical director of electrophysiology at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA. Warrier wasn’t involved in the study.

Getting started with exercise if you have AFib

AFib is the most common form of irregular heart rhythm.

An estimated 5 million people in the United States live with AFib, according to the American Heart Association (AHA). More than 12 million Americans are projected to have the condition by 2030.

Since exertion naturally increases heart rate, people with AFib may worry that exercise will trigger an episode or make their condition worse. However, experts interviewed by Healthline explained that such occurrences are rare.

“There is an association of atrial fibrillation with more extreme forms of endurance exercise, but most patients are not such elite endurance athletes,” said Mina Chung, MD, an AHA volunteer who co-chaired the 2023 joint guidelines for Diagnosis and Management of Atrial Fibrillation. Chung wasn’t involved in the study.

“The long-term benefits of exercise extend beyond atrial fibrillation to other cardiovascular outcomes as well,” she told Healthline.

Passman asserted that exercise-induced AFib episodes are “not the norm.”

If AFib symptoms prevent someone from exercising, Passman said clinicians may need to more aggressively control the person’s heart rhythm through lifestyle changes and medical treatment.

Ichinoe offered the following practical recommendations for beginning an exercise program with AFib:

• Start with a 5- to 10-minute walk once or twice a day if you’re currently sedentary. 
• Choose an activity you enjoy, such as walking, cycling, or swimming.
• Prioritize consistency over intensity.
• Use the “talk test” to monitor effort. At a light-to-moderate intensity, you should still be able to carry on a conversation. 
• Increase duration before intensity. For example, progress from 10 minutes of comfortable walking to 20 or 30 minutes before significantly increasing speed, resistance, or incline.

People who are new to exercise, have significant AFib symptoms, or have other cardiovascular conditions should speak with their healthcare professional before starting a new exercise regimen.

The new findings suggest that modest activity is worthwhile for improving health and reducing the risk of stroke and death, even if you can’t meet the recommended 150 minutes of physical activity per week.

“Exercise is an essential part of good heart health, including the prevention of AF and reducing the risks of adverse events even if you’ve been diagnosed,” Passman said.