Physical activity and brain health in patients with atrial fibrillation.
atrial fibrillation
cerebral infarction
cerebral microbleeds
cognitive disorders and dementia
neurocognitive function
physical activity
total brain volume
white matter disease
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
revised:
25
11
2022
received:
10
10
2022
accepted:
06
12
2022
pubmed:
9
12
2022
medline:
11
2
2023
entrez:
8
12
2022
Statut:
ppublish
Résumé
Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function. The role of physical activity (PA) in the prevalence of brain lesions and cognition in AF has not been investigated. Patients from the multicenter Swiss-AF cohort study were included in this cross-sectional analysis. We assessed regular exercise (RE; at least once weekly) and minutes of weekly PA using a validated questionnaire. We studied associations with ischemic infarcts, white matter hyperintensities, cerebral microbleeds, and brain volume on brain magnetic resonance imaging and with global cognition measured with a cognitive construct (CoCo) score. Among 1490 participants (mean age = 72 ± 9 years), 730 (49%) engaged in RE. In adjusted regression analyses, RE was associated with a lower prevalence of ischemic infarcts (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.63-0.98, p = 0.03) and of moderate to severe white matter hyperintensities (OR = 0.78, 95% CI = 0.62-0.99, p = 0.04), higher brain volume (β-coefficient = 10.73, 95% CI = 2.37-19.09, p = 0.01), and higher CoCo score (β-coefficient = 0.08, 95% CI = 0.03-0.12, p < 0.001). Increasing weekly PA was associated with higher brain volume (β-coefficient = 1.40, 95% CI = 0.65-2.15, p < 0.001). In AF patients, RE was associated with a lower prevalence of ischemic infarcts and of moderate to severe white matter disease, with larger brain volume, and with better cognitive performance. Prospective studies are needed to investigate whether these associations are causal. Until then, our findings suggest that patients with AF should be encouraged to remain physically active.
Sections du résumé
BACKGROUND AND PURPOSE
Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function. The role of physical activity (PA) in the prevalence of brain lesions and cognition in AF has not been investigated.
METHODS
Patients from the multicenter Swiss-AF cohort study were included in this cross-sectional analysis. We assessed regular exercise (RE; at least once weekly) and minutes of weekly PA using a validated questionnaire. We studied associations with ischemic infarcts, white matter hyperintensities, cerebral microbleeds, and brain volume on brain magnetic resonance imaging and with global cognition measured with a cognitive construct (CoCo) score.
RESULTS
Among 1490 participants (mean age = 72 ± 9 years), 730 (49%) engaged in RE. In adjusted regression analyses, RE was associated with a lower prevalence of ischemic infarcts (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.63-0.98, p = 0.03) and of moderate to severe white matter hyperintensities (OR = 0.78, 95% CI = 0.62-0.99, p = 0.04), higher brain volume (β-coefficient = 10.73, 95% CI = 2.37-19.09, p = 0.01), and higher CoCo score (β-coefficient = 0.08, 95% CI = 0.03-0.12, p < 0.001). Increasing weekly PA was associated with higher brain volume (β-coefficient = 1.40, 95% CI = 0.65-2.15, p < 0.001).
CONCLUSIONS
In AF patients, RE was associated with a lower prevalence of ischemic infarcts and of moderate to severe white matter disease, with larger brain volume, and with better cognitive performance. Prospective studies are needed to investigate whether these associations are causal. Until then, our findings suggest that patients with AF should be encouraged to remain physically active.
Types de publication
Multicenter Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
567-577Subventions
Organisme : Swiss National Science Foundation
ID : 32003B_197524
Pays : Switzerland
Organisme : Swiss National Science Foundation
ID : 32473B_176178
Pays : Switzerland
Organisme : Swiss National Science Foundation
ID : 33CS30_177520
Pays : Switzerland
Organisme : Swiss National Science Foundation
ID : numbers 33CS30_148474
Pays : Switzerland
Investigateurs
Elena Herber
(E)
Stefanie Aeschbacher
(S)
Michael Coslovsky
(M)
Fabian Schwendinger
(F)
Elisa Hennings
(E)
Andreas Gasser
(A)
Marcello Di Valentino
(M)
Elia Rigamonti
(E)
Tobias Reichlin
(T)
Nicolas Rodondi
(N)
Seraina Netzer
(S)
Juerg H Beer
(JH)
Annina Stauber
(A)
Andreas Müller
(A)
Peter Ammann
(P)
Tim Sinnecker
(T)
Marco Duering
(M)
Jens Wuerfel
(J)
David Conen
(D)
Michael Kühne
(M)
Stefan Osswald
(S)
Leo H Bonati
(LH)
Chloé Auberson
(C)
Steffen Blum
(S)
Leo Bonati
(L)
Selinda Ceylan
(S)
Simone Evers-Doerpfeld
(S)
Ceylan Eken
(C)
Marc Girod
(M)
Vasco Iten
(V)
Philipp Krisai
(P)
Maurin Lampart
(M)
Mirko Lischer
(M)
Christine Meyer-Zürn
(C)
Pascal Meyre
(P)
Andreas U Monsch
(AU)
Christian Müller
(C)
Rebecca E Paladini
(RE)
Anne Springer
(A)
Christian Sticherling
(C)
Thomas Szucs
(T)
Gian Völlmin
(G)
Stefan Osswald
(S)
Michael Kühne
(M)
Drahomir Aujesky
(D)
Urs Fischer
(U)
Juerg Fuhrer
(J)
Laurent Roten
(L)
Simon Jung
(S)
Heinrich Mattle
(H)
Luise Adam
(L)
Carole Elodie Aubert
(CE)
Martin Feller
(M)
Axel Loewe
(A)
Elisavet Moutzouri
(E)
Claudio Schneider
(C)
Tanja Flückiger
(T)
Cindy Groen
(C)
Lukas Ehrsam
(L)
Sven Hellrigl
(S)
Alexandra Nuoffer
(A)
Damiana Rakovic
(D)
Nathalie Schwab
(N)
Rylana Wenger
(R)
Tu Hanh Zarrabi Saffari
(THZ)
Christopher Beynon
(C)
Roger Dillier
(R)
Michèle Deubelbeiss
(M)
Franz Eberli
(F)
Christine Franzini
(C)
Isabel Juchli
(I)
Claudia Liedtke
(C)
Samira Murugiah
(S)
Jacqueline Nadler
(J)
Thayze Obst
(T)
Jasmin Roth
(J)
Fiona Schlomowitsch
(F)
Xiaoye Schneider
(X)
Katrin Studerus
(K)
Noreen Tynan
(N)
Dominik Weishaupt
(D)
Simone Fontana
(S)
Corinne Friedli
(C)
Silke Kuest
(S)
Karin Scheuch
(K)
Denise Hischier
(D)
Nicole Bonetti
(N)
Alexandra Grau
(A)
Jonas Villinger
(J)
Eva Laube
(E)
Philipp Baumgartner
(P)
Mark Filipovic
(M)
Marcel Frick
(M)
Giulia Montrasio
(G)
Stefanie Leuenberger
(S)
Franziska Rutz
(F)
Jürg-Hans Beer
(JH)
Angelo Auricchio
(A)
Adriana Anesini
(A)
Cristina Camporini
(C)
Giulio Conte
(G)
Maria Luce Caputo
(ML)
Francois Regoli
(F)
Tiziano Moccetti
(T)
Roman Brenner
(R)
David Altmann
(D)
Michaela Gemperle
(M)
Mathieu Firmann
(M)
Sandrine Foucras
(S)
Martine Rime
(M)
Daniel Hayoz
(D)
Benjamin Berte
(B)
Virgina Justi
(V)
Frauke Kellner-Weldon
(F)
Brigitta Mehmann
(B)
Sonja Meier
(S)
Myriam Roth
(M)
Andrea Ruckli-Kaeppeli
(A)
Ian Russi
(I)
Kai Schmidt
(K)
Mabelle Young
(M)
Melanie Zbinden
(M)
Richard Kobza
(R)
Carlo Cereda
(C)
Alessandro Cianfoni
(A)
Maria Luisa De Perna
(ML)
Jane Frangi-Kultalahti
(J)
Patrizia Assunta Mayer Melchiorre
(PAM)
Anica Pin
(A)
Tatiana Terrot
(T)
Luisa Vicari
(L)
Giorgio Moschovitis
(G)
Georg Ehret
(G)
Hervé Gallet
(H)
Elise Guillermet
(E)
Francois Lazeyras
(F)
Karl-Olof Lovblad
(KO)
Patrick Perret
(P)
Philippe Tavel
(P)
Cheryl Teres
(C)
Dipen Shah
(D)
Nathalie Lauriers
(N)
Marie Méan
(M)
Sandrine Salzmann
(S)
Jürg Schläpfer
(J)
Alessandra Pia Porretta
(AP)
Andrea Grêt
(A)
Jan Novak
(J)
Sandra Vitelli
(S)
Frank-Peter Stephan
(FP)
Jane Frangi-Kultalahti
(J)
Augusto Gallino
(A)
Luisa Vicari
(L)
Helena Aebersold
(H)
Fabienne Foster
(F)
Matthias Schwenkglenks
(M)
Anna Altermatt
(A)
Michael Amann
(M)
Marco Düring
(M)
Petra Huber
(P)
Esther Ruberte
(E)
Vanessa Zuber
(V)
Pascal Benkert
(P)
Gilles Dutilh
(G)
Milica Markovic
(M)
Pia Neuschwander
(P)
Patrick Simon
(P)
Ramun Schmid
(R)
Informations de copyright
© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127:4-20.
Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021;16:217-221.
Mou L, Norby FL, Chen LY, et al. Lifetime risk of atrial fibrillation by race and socioeconomic status: ARIC study (atherosclerosis risk in communities). Circ Arrhythm Electrophysiol. 2018;11:e006350.
Berman JP, Norby FL, Mosley T, et al. Atrial fibrillation and brain magnetic resonance imaging abnormalities. Stroke. 2019;50:783-788.
Kalantarian S, Stern TA, Mansour M, Ruskin JN. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med. 2013;158:338-346.
Conen D, Rodondi N, Müller A, et al. Relationships of overt and silent brain lesions with cognitive function in patients with atrial fibrillation. J Am Coll Cardiol. 2019;73:989-999.
Chen LY, Lopez FL, Gottesman RF, et al. Atrial fibrillation and cognitive decline-the role of subclinical cerebral infarcts: the atherosclerosis risk in communities study. Stroke. 2014;45:2568-2574.
Alber J, Alladi S, Bae HJ, et al. White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): knowledge gaps and opportunities. Alzheimers Dement (N Y). 2019;5:107-117.
Soares-Miranda L, Siscovick DS, Psaty BM, Longstreth WT Jr, Mozaffarian D. Physical activity and risk of coronary heart disease and stroke in older adults: the cardiovascular health study. Circulation. 2016;133:147-155.
Shaaban CE, Aizenstein HJ, Jorgensen DR, et al. Physical activity and cerebral small vein integrity in older adults. Med Sci Sports Exerc. 2019;51:1684-1691.
Tan ZS, Spartano NL, Beiser AS, et al. Physical activity, brain volume, and dementia risk: the Framingham study. J Gerontol A Biol Sci Med Sci. 2017;72:789-795.
Moroni F, Ammirati E, Rocca MA, Filippi M, Magnoni M, Camici PG. Cardiovascular disease and brain health: focus on white matter hyperintensities. Int J Cardiol Heart Vasc. 2018;19:63-69.
Scarmeas N, Luchsinger JA, Schupf N, et al. Physical activity, diet, and risk of Alzheimer disease. JAMA. 2009;302:627-637.
de Bruijn RF, Schrijvers EM, de Groot KA, et al. The association between physical activity and dementia in an elderly population: the Rotterdam study. Eur J Epidemiol. 2013;28:277-283.
Gu Y, Beato JM, Amarante E, et al. Assessment of leisure time physical activity and brain health in a multiethnic cohort of older adults. JAMA Netw Open. 2020;3:e2026506.
Stephen R, Liu Y, Ngandu T, et al. Brain volumes and cortical thickness on MRI in the Finnish geriatric intervention study to prevent cognitive impairment and disability (FINGER). Alzheimers Res Ther. 2019;11:53.
Venkatraman VK, Sanderson A, Cox KL, et al. Effect of a 24-month physical activity program on brain changes in older adults at risk of Alzheimer's disease: the AIBL active trial. Neurobiol Aging. 2020;89:132-141.
Sexton CE, Betts JF, Demnitz N, Dawes H, Ebmeier KP, Johansen-Berg H. A systematic review of MRI studies examining the relationship between physical fitness and activity and the white matter of the ageing brain. Neuroimage. 2016;131:81-90.
Conen D, Rodondi N, Mueller A, et al. Design of the Swiss Atrial Fibrillation Cohort Study (Swiss-AF): structural brain damage and cognitive decline among patients with atrial fibrillation. Swiss Med Wkly. 2017;147:w14467.
Craig CL, Marshall AL, Sjöström M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381-1395.
Wanner M, Probst-Hensch N, Kriemler S, Meier F, Autenrieth C, Martin BW. Validation of the long international physical activity questionnaire: influence of age and language region. Prev Med Rep. 2016;3:250-256.
Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334-1359.
Schwendinger F, Wagner J, Infanger D, Schmidt-Trucksäss A, Knaier R. Methodological aspects for accelerometer-based assessment of physical activity in heart failure and health. BMC Med Res Methodol. 2021;21:251.
Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822-838.
Smith SM, Zhang Y, Jenkinson M, et al. Accurate, robust, and automated longitudinal and cross-sectional brain change analysis. Neuroimage. 2002;17:479-489.
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-699.
Tombaugh TN. Trail making test a and B: normative data stratified by age and education. Arch Clin Neuropsychol. 2004;19:203-214.
Morris JC, Heyman A, Mohs RC, et al. The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. clinical and neuropsychological assessment of Alzheimer's disease. Neurology. 1989;39:1159-1165.
Springer A, Monsch AU, Dutilh G, et al. A factor score reflecting cognitive functioning in patients from the Swiss atrial fibrillation cohort study (Swiss-AF). PLoS One. 2020;15:e0240167.
Jackson PA, Pialoux V, Corbett D, et al. Promoting brain health through exercise and diet in older adults: a physiological perspective. J Physiol. 2016;594:4485-4498.
Middleton LE, Corbett D, Brooks D, et al. Physical activity in the prevention of ischemic stroke and improvement of outcomes: a narrative review. Neurosci Biobehav Rev. 2013;37:133-137.
Escudero-Martínez I, Mancha F, Vega-Salvatierra Á, et al. Mediterranean diet and physical activity protect from silent brain infarcts in a cohort of patients with atrial fibrillation. J Stroke. 2019;21:353-355.
Wendel-Vos GC, Schuit AJ, Feskens EJ, et al. Physical activity and stroke. A meta-analysis of observational data. Int J Epidemiol. 2004;33:787-798.
Aeschbacher S, Blum S, Meyre PB, et al. Blood pressure and brain lesions in patients with atrial fibrillation. Hypertension. 2021;77:662-671.
Vermeer SE, Hollander M, van Dijk EJ, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam scan study. Stroke. 2003;34:1126-1129.
Landman TR, Thijssen DH, Tuladhar AM, De Leeuw FE. Relation between physical activity and cerebral small vessel disease: a nine-year prospective cohort study. Int J Stroke. 2021;16:962-971.
Bolandzadeh N, Tam R, Handy TC, et al. Resistance training and White matter lesion progression in older women: exploratory analysis of a 12-month randomized controlled trial. J Am Geriatr Soc. 2015;63:2052-2060.
Wilson D, Ambler G, Shakeshaft C, et al. Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol. 2018;17:539-547.
Vernooij MW, van der Lugt A, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam scan study. Neurology. 2008;70:1208-1214.
Erickson KI, Hillman C, Stillman CM, et al. Physical activity, cognition, and brain outcomes: a review of the 2018 physical activity guidelines. Med Sci Sports Exerc. 2019;51:1242-1251.
Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci USA. 2011;108:3017-3022.
Liu-Ambrose T, Best JR, Davis JC, et al. Aerobic exercise and vascular cognitive impairment: a randomized controlled trial. Neurology. 2016;87:2082-2090.
Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;2019(1):CD012424.
Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res. 2017;120:1501-1517.
Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation. 2011;124:2145-2154.
Tobb K. Underrepresentation of women in cardiovascular trials- it is time to shatter this glass ceiling. Am Heart J Plus Cardiol Res Pract. 2022;13:100109.