Physical Activity May Reduce Stroke and Mortality Risk in Persons With Atrial Fibrillation

Physical activity was associated with lower risks of stroke and all-cause mortality among adults with and without atrial fibrillation (AF), according to findings from a large Norwegian cohort study published in the Journal of the American Heart Association.¹

The prospective study included 87 340 participants from 2 population-based studies, the Tromsø Study and the HUNT Study, including 6539 participants with AF. Information on AF, stroke, and death was obtained from national health registries, and participants were classified as inactive or as having low, moderate, or high physical activity based on questionnaire responses.

During a median follow-up of 13.5 years, 3,415 strokes and 7833 deaths occurred. Compared with inactivity, low, moderate, and high physical activity were associated with stroke risk reductions of 9%, 19%, and 18%, respectively. Mortality was reduced by 11%, 18%, and 22%, respectively. Similar benefits were observed regardless of AF status.

How much physical activity was associated with benefit?

Participants were categorized by estimated metabolic equivalent of task minutes per week. Inactive participants reported 0 MET min/wek; low physical activity was defined as 1 to 449 MET minutes/week; moderate physical activity as 450 to 899 MET minutes/week; and high physical activity as 900 MET minutes/week or more.

The study’s clinical perspective emphasized that even low levels of physical activity were associated with a reduced rate of stroke and increased life expectancy in individuals with AF, although the greatest benefit was seen in the most active participants.

“In general, people with AFib appear to be less active than the general population,” lead study author Kristoffer Johansen, PhD, of UiT The Arctic University of Norway, said in the American Heart Association release. “Regular physical activity is important for all and could be an important preventive strategy for people with AFib.”²

What were the findings among adults with atrial fibrillation?

Among participants with AF, the 15-year absolute risk of stroke was 19.5% in inactive participants, 15.6% in those with low physical activity, 17.1% in those with moderate physical activity, and 15.7% in those with high physical activity. Compared with inactivity, low physical activity was associated with a lower stroke risk ratio of 0.80 (95% CI, 0.67-0.95).

Mortality risk also was lower among physically active participants with AF. The 15-year absolute risk of death was 53.7% among inactive participants, compared with 49.1%, 47.2%, and 42.6% among those with low, moderate, and high physical activity, respectively.

Physical activity also was associated with longer survival among individuals with AF. Compared with inactivity, low, moderate, and high physical activity were associated with gains in life expectancy of 0.50 years, 0.66 years, and 1.15 years, respectively.

Why is this relevant to primary care?

AF is common in primary care and is a major contributor to stroke risk. Stroke prevention in AF typically centers on risk stratification, anticoagulation when indicated, blood pressure management, weight management, diabetes care, and treatment of other cardiovascular risk factors.

These findings suggest physical activity may be another practical, modifiable target to reinforce during AF care. The authors concluded that physical activity may complement current treatment strategies to prevent stroke in patients with AF and was associated with increased longevity in this population.

For clinicians, the message should remain balanced: physical activity should not be positioned as a replacement for anticoagulation or guideline-directed AF management. Instead, it may be discussed as part of comprehensive cardiovascular risk reduction, particularly for patients who are inactive or hesitant to start exercise.

Mina Chung, MD, FAHA, co-chair of the 2023 joint AF guideline from the American Heart Association and other organizations, said the study “adds important evidence linking physical activity with lower risks of stroke and death in people with and without AFib.”²

The study was observational, so the investigators could not rule out residual or unmeasured confounding. Participants were not randomly assigned to different activity levels, and physical activity was self-reported. The authors noted that the questionnaire was moderately correlated with device-measured moderate to vigorous physical activity but poorly correlated with low-intensity activity and total energy expenditure.

Anticoagulation data also were not available for the full study cohort, limiting the ability to fully adjust for this potential confounder in the main analyses. However, adjustment for anticoagulant use in a Tromsø Study subgroup did not substantially change the estimated effect of physical activity.

The authors also noted that the study was likely underpowered to detect statistically significant and clinically meaningful associations between physical activity and stroke subtypes among individuals with AF.

References

1. Johansen KR, Nes BM, Malmo V, et al. Impact of physical activity on stroke and mortality in individuals with and without atrial fibrillation: the HUNT Study and the Tromsø Study. J Am Heart Assoc. 2026;15. doi:10.1161/JAHA.126.048812
2. American Heart Association. Even light activity may lower stroke, death risk in people with atrial fibrillation. News release. Published August 5, 2026. Accessed August 27, 2026. https://newsroom.heart.org/news/even-light-activity-may-lower-stroke-death-risk-in-people-with-atrial-fibrillation