Lifestyle and Atrial Fibrillation: The Role of Obesity, Exercise, and Weight Loss in Risk Reduction and Rhythm Management

Abstract

Introduction and puropse. Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, closely associated with rising obesity rates and sedentary lifestyles. This review evaluates the evidence linking obesity, physical activity, and weight reduction with AF development, progression, and management.

Material and methods. A comprehensive literature review was conducted using PubMed and Google Scholar, prioritizing randomized trials, meta-analyses, and recent studies published within the past eight years addressing obesity, physical activity, and weight loss in AF.

Brief description of the state of knowledge. Obesity is a major risk factor for atrial fibrillation, with each 5-unit BMI increase linked to a 28–30% rise in risk. Higher BMI is associated with increased AF incidence, faster progression, and recurrence rates up to 50% after ablation in severe obesity. Moderate physical activity contributes to lower risk of AF and improved rhythm control, while high-intensity endurance exercise may elevate AF risk, particularly in middle-aged men. Sustained weight loss of at least 10% significantly reduces AF burden, recurrence rates, and symptom severity. Bariatric surgery has been shown to decrease AF incidence in severely obese patients, and long-term weight stability enhances these benefits. Anticoagulant efficacy remains stable across BMI ranges, especially rivaroxaban, which shows favorable profiles in obese patients.

Conclusions. Current evidence supports the integration of lifestyle interventions such as targeted weight loss and individualized physical activity into AF management. These strategies offer significant benefits to AF risk, arrhythmia control, and overall outcomes, supporting routine implementation in clinical practice.