Physical activity changes and the risk of incident atrial fibrillation in patients with type 2 diabetes mellitus: A nationwide longitudinal follow-up cohort study of 1.8 million subjects
Objective: We investigated the association between alterations in regular physical activity (PA) and the risk of developing AF in patients with type 2 diabetes mellitus (T2DM), and the optimal PA range based on energy expenditure.
Research Design and Methods: In a nationwide database, subjects who underwent health examinations twice at a 2-year interval between 2009 and 2012 were studied. After identifying 1,815,330 type 2 DM patients without previous AF history, they were followed up until 2018. Based on regular PA alterations over time, individuals were divided into 4 groups: persistent non-exercisers (n=1,181,337), new exercisers (n=225,124), exercise dropouts (n=242,968), and exercise maintainers (n=165,401).
Results: During a mean follow-up period of 5.6±1.3 years, 46,589 cases (2.6%) of new-onset AF occurred. Compared to the persistent non-exercise group, both the exercise drop-outs group (adjusted hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.94-0.99) and new exerciser group (HR 0.95, 95% CI 0.93-0.98) had lower risks of incident AF. The exercise maintainer group showed the lowest risk (HR 0.91, 95% CI 0.89-0.94).
When we stratified T2DM patients according to energy expenditure, undergoing regular PA with ≥1500 metabolic equivalents of task (MET)-min/week in new exercisers and ≥1000 MET-min/week in exercise maintainers were associated with lower risks of incident AF than non-exercisers, respectively.
Conclusions: In patients with T2DM, starting and maintaining regular PA were both associated with lower risk of incident AF. Optimal PA ranges based on energy expenditure which were associated with lower risks of incident AF can be defined.
Key words: Type 2 diabetes mellitus, atrial fibrillation, physical activity, prognosis, energy expenditure