IMR Press / RCM / Volume 26 / Issue 7 / DOI: 10.31083/RCM39200
Open Access Review
Exercise and Atrial Fibrillation: Current Evidence, Knowledge Gaps, and Future Directions
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Affiliation
1 Department of Medicine, University of Arizona, Tucson, AZ 85721, USA
2 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA
3 Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
4 Department of Internal Medicine, Ascension Saint Francis, Evanston, IL 60202, USA
5 Mayo Clinic Alix School of Medicine, Phoenix, AZ 85054, USA
6 Department of Cardiology, Sarver Heart Center, University of Arizona, Tucson, AZ 85721, USA
7 Center for Inherited Cardiovascular Diseases, WellSpan Health, York, PA 17403, USA
8 Barts Heart Centre, EC1A 7BE London, UK
9 William Harvey Research Institute, Queen Mary University of London, E1 4NS London, UK
*Correspondence: Abdelnabi.Mahmoud@mayo.edu (Mahmoud H. Abdelnabi)
Rev. Cardiovasc. Med. 2025, 26(7), 39200; https://doi.org/10.31083/RCM39200
Submitted: 22 March 2025 | Revised: 23 May 2025 | Accepted: 4 June 2025 | Published: 28 July 2025
Copyright: © 2025 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, contributing to significant morbidity and mortality worldwide. The relationship between physical exercise and AF is complex, with studies showing both beneficial and potentially adverse effects. Moreover, evidence suggests a U-shaped association between exercise intensity and AF risk. Moderate exercise has been shown to reduce AF burden by improving cardiovascular risk factors, enhancing autonomic regulation, and mitigating atrial fibrosis. In contrast, excessively high-intensity endurance exercise may increase AF risk, particularly in young athletes, due to atrial stretching, dilation, fibrosis, autonomic imbalances, and heightened inflammation. The current guidelines emphasize exercise as a core lifestyle intervention for AF management, recommending moderate-intensity aerobic activity for optimal outcomes. This review examines the current evidence on the effects of exercise on AF, identifies knowledge gaps, and proposes potential future research directions.

Keywords
atrial fibrillation (AF)
exercise intensity
moderate-intensity exercise
endurance exercise
AF burden
cardiorespiratory fitness (CRF)
cardiovascular risk
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