Sex Differences in the Association Between Regular Physical Activity and Incident Atrial Fibrillation: A Meta‐analysis of 13 Prospective Studies

Several studies investigated the role of physical activity in atrial fibrillation ( AF ), but the results remain controversial. We aimed to estimate the association between physical activity and incident AF , as well as to determine whether a sex difference existed. We systematically retrieved relevant studies from Cochrane Library, PubMed , and ScienceDirect through December 1, 2015. Data were abstracted from eligible studies and effect estimates pooled using a random‐effects model. Thirteen prospective studies fulfilled inclusion criteria. For primary analysis, neither total physical activity exposure (relative risk [ RR ]: 0.98, 95% confidence interval [ CI ]: 0.90‐1.06, P = 0.62) nor intensive physical activity ( RR : 1.07, 95% CI : 0.93‐1.25, P = 0.41) was associated with a significant increased risk of AF . In the country‐stratified analysis, the pooled results were not significantly changed. However, in the sex‐stratified analysis, total physical activity exposure was associated with an increased risk of AF in men ( RR : 1.18, 95% CI : 1.02‐1.37), especially at age <50 years ( RR : 1.58, 95% CI : 1.28‐1.95), with a significantly reduced risk of AF in women ( RR : 0.92, 95% CI : 0.87‐0.97). Additionally, male individuals with intensive physical activity had a slightly higher (although statistically nonsignificant) risk of developing AF ( RR : 1.12, 95% CI : 0.99‐1.28), but there was a significantly reduced risk of incident AF in women ( RR : 0.92, 95% CI : 0.86‐0.98). Published literature supports a sex difference in the association between physical activity and incident AF . Increasing physical activity is probably associated with an increased risk of AF in men and a decreased risk in women.