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].

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

Related Posts:

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