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Exercise capacity and muscle strength and risk of vascular disease and arrhythmias: A cohort study of 1.26 million young men
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.ORCID iD: 0000-0002-6534-2613
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background:

While physical activity and exercise protects against cardiovascular disease, athletes have higher risk of atrial fibrillation and other arrhythmias. Graded independent and joint influences of exercise capacity and muscle strength on these diseases are unknown.

Methods:

All 1.26 million Swedish men who participated in mandatory military conscription between 1972 and 1995 (at a median age of 18.2 years) contributed. Multivariable-adjusted Cox proportional hazards models were used to evaluate the associations of maximal exercise capacity and muscle strength at conscription to subsequent risk of vascular disease and arrhythmias, as identified in national registries.

Results:

During a median follow-up of 26.3 years, about 26,000 hospitalizations for vascular disease events and 17,000 for arrhythmias occurred. Exercise capacity was inversely associated with risk of vascular disease (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.61-0.67]; for 5th vs. 1st quintile) and so was muscle strength (HR 0.79; 0.76-0.83; for 5th vs. 1st quintile ). Similar associations were seen across a range of major vascular disease events. Exercise capacity was associated with incidence of arrhythmias in a U-shaped fashion (HR 0.91; 0.86-0.96; for 3rd vs. 1st quintile, and 0.99; 0.94-1.04; for 5th vs. 1st quintile). Higher muscle strength was associated with lower risk of arrhythmias (HR 0.87; 0.83-0.91; for 5th vs. 1st quintile). 

Conclusion:

Exercise capacity and muscle strength in late adolescence are independently and jointly associated with long-term risk of vascular disease and arrhythmias. The lower risk of vascular events with higher exercise capacity was not outweighed by higher risk of arrhythmias.

National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Cardiology; Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-217308OAI: oai:DiVA.org:uu-217308DiVA: diva2:692766
Available from: 2014-02-01 Created: 2014-02-01 Last updated: 2016-01-18Bibliographically approved
In thesis
1. Physical Activity and Cardiovascular Disease
Open this publication in new window or tab >>Physical Activity and Cardiovascular Disease
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to investigate associations of fitness and types and levels of physical activity with subsequent risk of cardiovascular disease.

Four large-scale longitudinal cohort studies were used. The exposures were different measures related to physical activity and the outcomes were obtained through linkage to the Swedish In-Patient Register. In a cohort of 466 elderly men without pre-existing cardiovascular disease, we found that skeletal muscle morphology was associated with risk of cardiovascular events. A high amount of type I (slow-twitch, oxidative) skeletal muscle fibres was associated with lower risk of cardiovascular events and high amount of type IIx was associated with higher risk of cardiovascular events. This association was only seen among physically active men. Among 39,805 participants in a fundraising event, higher levels of both total and leisure time physical activity were associated with lower risk of heart failure. The associations were strongest for leisure time physical activity. In a cohort of 53,755 participants in the 90 km skiing event Vasaloppet, a higher number of completed races was associated with higher risk of atrial fibrillation and a higher risk of bradyarrhythmias. Further, better relative performance was associated with a higher risk of bradyarrhythmias. Among 1,26 million Swedish 18-year-old men, exercise capacity and muscle strength were independently associated with lower risk of vascular disease. The associations were seen across a range of major vascular disease events (ischemic heart disease, heart failure, stroke and cardiovascular death). Further, high exercise capacity was associated with higher risk of atrial fibrillation and a U-shaped association with bradyarrhythmias was found. Higher muscle strength was associated with lower risk of bradyarrhythmias and lower risk of ventricular arrhythmias.

These findings suggest a higher rate of atrial fibrillation with higher levels of physical activity. The higher risk of atrial fibrillation does not appear to lead to a higher risk of stroke. In contrast, we found a strong inverse association of higher exercise capacity and muscle strength with vascular disease. Further, high exercise capacity and muscle strength are related to lower risk of cardiovascular death, including arrhythmia deaths. From a population perspective, the total impact of physical activity on cardiovascular disease is positive.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 84 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 972
Keyword
Physical activity, epidemiology, cohort study, heart failure, cardiovascular disease, arrhythmias, atrial fibrillation, bradyarrhythmias, sudden cardiac death, heart failure, stroke, ischemic heart disease, cardiovascular death, maximal exercise capacity, muscle strength, skeletal muscle morphology
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology; Epidemiology
Identifiers
urn:nbn:se:uu:diva-217309 (URN)978-91-554-8871-0 (ISBN)
Public defence
2014-03-21, Enghoffsalen, Akademiska Sjukhuset, Ing 50, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2014-02-27 Created: 2014-02-01 Last updated: 2014-04-29

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Andersen, KasperHeld, ClaesSundström, Johan

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