Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice
Myrstad M, Lochen ML, Graff-Iversen SG, Gulsvik AK, THeel DS, Stigum H, and Ranhoff AH. Scan J Med Sci Sports. 2013; [Epub Ahead of Print].
Take Home Message: Older male, cross-country skiers are more likely to have atrial fibrillation than the general population, but participation in leisure time physical activity may mitigate the development of atrial fibrillation.
Atrial fibrillation (AF), the most common cardiac arrhythmia, is more prevalent among older adults and young athletes who compete in long-distance endurance races. While these races are growing in popularity amongst an older population (65 years and older), we have a poor understanding of the association between long-distance endurance training and AF among older athletes. A better understanding of this would help clinicians better inform and counsel patients on current training standards and how to maintain optimal cardiac health. Therefore, Myrstad and colleagues completed a study to investigate if long-term endurance practice is a risk factor for AF in elderly men. The researchers identified and mailed questionnaires to 658 Norwegian cross-country skiers, age 65 and older for inclusion in The Birkebeiner Ageing Study (a longitudinal study of skiers, age 65 and older who participate in Norwegian Birkebeiner cross country ski race). A total of 509 skiers completed and returned the questionnaire, and were included in the study. The authors compared the collected data with similar data from 1,867 individuals over 65 years of age in The Tromsø Study (a general population-based general health study). Both studies included questions assessing the presence of AF, participation in leisure time physical activity, age, body mass index, presence of coronary heart disease, hypertension, diabetes, educational level, health status, smoking habits, and alcohol consumption. Overall, participants who skied were less likely to consume alcohol or smoke, had lower body mass index, and had a higher level of education compared with individuals in the Tromsø Study. Individuals in the current study also reported a higher level of leisure time physical activity than those included in the Tromsø Study. Further, the authors found a higher prevalence of AF in those males who participated in long-distance cross-country ski races. Interestingly, participants who reported participating in light or moderate leisure time physical activity in the past 12 months were less likely to have AF.
Overall, the current study suggests that elderly men who regularly participate in long-distance endurance practice may have an elevated risk of AF, while participation in less strenuous, leisure time activities was associated with a lower prevalence of AF. This may be useful to clinicians who work with an older (65 years and older) population. For example, we should encourage sedentary individual to do more leisure-based physical activities. Clinicians should also be careful to monitor and educate our extreme long-distance athletes about the possible risks so that they may make a well-informed decision about their participation. While this study supports previous research we should be cautious because of certain limitations of this study. Of primary concern, is all of the data was self-reported and therefore could be less accurate than doing a proper physical examination to assess the presence of AF. It might be helpful if future research follows long-distance athletes over time to better understand when and why these athletes develop AF. Until more studies can be completed in this area, clinicians should be aware of these results because it may aid in the diagnosis of AF, it provides support for more leisure-time physical activity, and provides some evidence that we may want to begin counseling patients that there may be some risks associated with long-distance endurance activity and that they should be carefully monitored.
Questions for Discussion: Should we advise older patients who compete in long-distance endurance activities about the possible risks of AF? Do you monitor your endurance athletes for AF?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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Myrstad M, Løchen ML, Graff-Iversen S, Gulsvik AK, Thelle DS, Stigum H, & Ranhoff AH (2013). Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scandinavian Journal of Medicine & Science in Sports PMID: 24256074