Perspective:

Benefits of regular moderate exercise are well established. Strenuous endurance exercise has previously been shown in a number of studies to be associated with greater risk of AF, but the current study suggests that this increased risk is also applicable to strength-type exercise. In this cross-sectional cohort, former NFL players had an almost sixfold increase in the risk of AF than controls, despite lower rates of traditional risk factors for AF, such as smoking, hypertension, hyperlipidemia, and diabetes mellitus. The majority of new cases of AF identified during screening were asymptomatic, perhaps in part due to exercise-induced alterations in autonomic tone and slower atrioventricular nodal conduction. It is not clear whether those alterations persist after the athletic activity abates. The report does not provide any insight into the ongoing activity level in the former NFL players. The main implications of this study are the need for heightened AF surveillance in the former NFL players given their asymptomatic status and CHA₂DS₂-VASc scores, which place them in the stroke prevention category. The current study should be considered in the context of a recent NFL survival study, which showed that overall all-cause mortality and cardiovascular mortality were lower among former NFL players than in the general population, except when playing-time body mass index of the NFL players exceeded >35 kg/m².