Physical Activity and Brain Health in Patients with Atrial Fibrillation.

BACKGROUND

Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function. The role of physical activity in the prevalence of brain lesions and cognition in AF has not been investigated.

METHODS

Patients from the multicenter Swiss-AF cohort study were included in this cross-sectional analysis. We assessed regular exercise (at least once weekly) and minutes of weekly physical activity using a validated questionnaire. We studied associations with ischemic infarcts, white matter hyperintensities, cerebral microbleeds, and brain volume on brain MRI and with global cognition measured with a cognitive construct score (CoCo).

RESULTS

Among 1490 participants (mean age 72 ±9 years), 730 (49%) engaged in regular exercise. In adjusted regression analyses, regular exercise was associated with a lower prevalence of ischemic infarcts (odds ratio [OR]) 0.78, 95% CI 0.63-0.98, p=0.03) and of moderate to severe white matter hyperintensities (OR 0.78, 95% CI 0.62-0.99, p=0.04), higher brain volume (β-coefficient 10.73, 95% CI 2.37-19.09, p=0.01), and higher CoCo score (β-coefficient 0.08, 95% CI 0.03-0.12, p<0.001). Increasing weekly physical activity was associated with higher brain volume (β-coefficient 1.40, 95% CI 0.65-2.15, p<0.001).

CONCLUSION

In AF patients, regular exercise was associated with a lower prevalence of ischemic infarcts, of moderate to severe white matter disease, with larger brain volume and better cognitive performance. Prospective studies are needed to investigate if these associations are causal. Until then, our findings suggest that patients with AF should be encouraged to remain physically active.