A large, registry-linked analysis reported that any level of physical activity was associated with lower risk of stroke and lower all-cause death compared with inactivity. In analyses of more than 87,000 adults followed for roughly 15 years, participants reporting low, moderate or high activity had lower stroke risk (9%, 19% and 18% reductions, respectively) and lower all-cause mortality (11%, 18% and 22% reductions, respectively) compared with inactive adults. The magnitude of benefit was similar for people with and without atrial fibrillation (AFib).
The analysis pooled health information from two large Norwegian population studies: the HUNT Study (survey cycles 2006–08 and 2017–19) and the Tromsø Study (survey cycles 2007–08 and 2015–16). The combined sample included 87,340 participants with an average age of about 51 years at enrollment; approximately 47% were men and more than 6,500 participants had AFib. Outcomes (AFib, stroke and death) were captured via national health registries, and participants were followed for about 15 years.
Researchers classified participants into four groups based on self-reported regular physical activity: inactive, low, moderate and high. Classification used responses on frequency (never to almost every day), duration (less than 15 minutes to more than one hour) and intensity (from taking it easy without breaking a sweat to pushing to near-exhaustion). The study also applied a multiple-records approach: participants who developed AFib during follow-up were reclassified into the AFib group to better reflect incident disease status.
Compared with inactive participants, those reporting low, moderate or high physical activity had lower adjusted risks of stroke and death. Specifically, stroke risk reductions were reported as 9% for low activity, 19% for moderate and 18% for high activity. For all-cause mortality, reductions were 11% for low activity, 18% for moderate and 22% for high activity. The largest absolute benefits were observed in the most active group, but measurable benefits were present even at low levels of activity.
The associations between activity and reduced risk of stroke and death were similar regardless of AFib status. In people with AFib, staying physically active was associated with an average increase in life expectancy of about 0.5 to 1.2 years compared with inactivity. The authors concluded that AFib does not appear to substantially alter the relationship between physical activity and the risk of stroke.
Lead study author Kristoffer Johansen, Ph.D., noted that people with AFib tend to be less active than the general population and emphasized that regular physical activity appears to be an important preventive strategy for all adults, including those with AFib. Mina Chung, M.D., FAHA, co-chair of a 2023 joint guideline for AFib diagnosis and management, commented that the study adds evidence linking physical activity with lower risks of stroke and death in people with and without AFib, while acknowledging activity may also reflect overall health. Both authors highlighted that even small increases in activity can yield health benefits.
Strengths of the analysis include a large sample size, long follow-up, linkage to national registries for outcomes, inclusion of incident AFib via reclassification, and use of two established cohort studies. Limitations include the observational, non-randomized design, which leaves the possibility of residual confounding because more active people often have healthier behaviors overall. Activity was self-reported, which can lead to misclassification if participants overestimate their exercise. The press release states that statistical adjustments were made for several factors, but the authors cannot exclude the possibility that unmeasured factors influenced results.
The study was published in the Journal of the American Heart Association. The press release indicates that co-authors, disclosures and funding sources are listed in the manuscript and that the article is peer-reviewed. Additional AHA resources cited in the release include AHA recommendations for adult physical activity and related public health materials. The press release notes that the American Heart Association does not necessarily endorse all statements in individual manuscripts and describes its funding sources and review policies.