Accelerometer Data Confirms: Increased Physical Activity Is Associated with Reduced Risk of Afib, Stroke

Physical activity has been tied to a lower risk of atrial fibrillation (Afib) in most population-based studies, but past studies typically relied on the self-reporting of exercise. Shaan Khurshid, MD, MPH, electrophysiology fellow, and Steven A. Lubitz, MD, MPH, cardiac electrophysiologist in the Telemachus & Irene Demoulas Family Foundation Center for Cardiac Arrhythmias and researcher in the Cardiovascular Research Center at Massachusetts General Hospital, and colleagues analyzed an objective measure of activity: wrist-worn accelerometer data from the UK Biobank prospective cohort study.

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In the European Heart Journal, they report that adults who met standard recommendations for moderate-to-vigorous activity had a significantly lower risk of new-onset Afib and stroke, even after adjustment for other risk factors.

Study Methods

The UK Biobank is a prospective cohort of more than 500,000 individuals who were enrolled between 2006 and 2010, when they were 40 to 69 years old. In the current study, the team analyzed data on 93,669 participants (57% female, average age 62) who were invited to wear an accelerometer on their wrists for up to one week between February 2013 and December 2015. Follow-up spanned August 2013 to March 2020.

The researchers defined moderate-to-vigorous physical activity (MVPA) as the sum of five-second time periods where average acceleration was ≥100 miligravities. For each individual, they determined whether MVPA levels met the:

• Standard recommendation of the European Society of Cardiology, American Heart Association and World Health Organization for ≥150 minutes/week of MVPA
• Extended recommendation of the World Health Organization for an additional benefit, ≥300 minutes/week of MVPA

Accelerometer Data and Afib

In models that adjusted for Afib risk factors, the risk of Afib was significantly lower for:

• Activity exceeding the standard recommendation (hazard ratio [HR], 0.82)
• Increasing MVPA decile (HR, 0.96 per one-decile increase)
• The number of days individuals met recommended MVPA levels (HR, 0.95 per day with ≥25 minutes; 0.95 per day with ≥45 minutes)

Accelerometer Data and Stroke

The risk of stroke was significantly lower for:

• Activity meeting the standard recommendation (HR, 0.76)
• Activity meeting the extended recommendation (HR, 0.78)
• Average acceleration (HR, 0.82 per one standard deviation increase)
• Increasing MVPA decile (HR, 0.94 per one decile increase)
• The number of days individuals met recommended MVPA levels (HR, 0.91 per day with ≥25 minutes; 0.90 per day with ≥45 minutes)

Other Findings

• The incidence rate ratio for Afib or stroke was approximately half among individuals meeting the standard or extended recommendation compared with those not meeting the recommendations
• Individuals who met only the standard recommendation had similar Afib risk as those who met the extended recommendation
• Men had greater Afib and stroke risk than women at every activity level
• Self-reported data on physical activity (obtained several years before this analysis) was only weakly correlated with objective measurements

Encourage More Activity in More People

Efforts to prevent Afib by promoting physical activity are warranted. Making use of objectively measured activity data may facilitate accurate measurement and counseling about physical activity interventions to prevent Afib.

Wearables that incorporate photoplethysmography and electrocardiography are becoming more common and may come to have a role in the detection of Afib as well as prevention.

Population-wide efforts to reduce Afib risk may be most effective if they aim to maximize the proportion of individuals who objectively achieve guideline-recommended levels of activity, rather than encourage higher volume or higher intensity of exercise among individuals who are already active.

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