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People with atrial fibrillation live longer with exercise

Four months of regular interval training reduced both the recorded flutter length and the symptoms of the disease. In addition, the exercise provided better quality of life and heart function. And last but not least: the training resulted in a marked increase in fitness.

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“Regular endurance training and good fitness seem to protect against serious cardiovascular events and early mortality for people diagnosed with atrial fibrillation,” says exercise physiologist Lars Elnan Garnvik.

Garnvik recently completed his doctorate at the Norwegian University of Science and Technology. His latest article was recently published in the prestigious European Heart Journal.

Garnvik and his colleagues in the Cardiac Exercise Research Group (CERG) have investigated how physical activity and good fitness levels are linked to future health risks for men and women who have been diagnosed with atrial fibrillation.

“The results show that people with atrial fibrillation who meet the authorities’ recommendations for physical activity generally live longer than patients who exercise less. They also have almost half the risk of dying from cardiovascular disease,” says Garnvik.

The minimum recommendation is to be physically active for 150 minutes of moderate intensity or 75 minutes of high intensity exercise each week. Moderate intensity means getting out of breath and sweaty, but still able to carry on a conversation. At high intensity you are so out of breath that you can’t speak in longer sentences.

“We found that both moderate and high intensity training are associated with significantly reduced risk,” says Garnvik.

People with atrial fibrillation have a higher health risk than same-aged individuals who do not have the disease. The new NTNU study also shows that inactive men and women with atrial fibrillation generally die earlier than inactive men and women without the condition.

“On the other hand, the risk for physically active participants with atrial fibrillation wasn’t higher than for physically inactive healthy people in the same age group,” Garnvik says.

The study includes a total of 1117 people who participated in the Trøndelag Health Study (HUNT Study) between 2006 and 2008. All had a confirmed atrial fibrillation diagnosis, and their average age was over 70. Garnvik used national health records to find out who died or was impacted by cardiovascular disease in the years leading up to and including 2015.

“It’s worth noting that this is an observational study, so the results cannot be used to establish definite causal relationships. However, we’ve tried to isolate the relationship between exercise and health risk as much as possible by adjusting the analyses for all other known differences between people who exercise a lot and a little,” he says.

In the study, the researchers calculated the condition of atrial fibrillation patients with CERG’s widely used Fitness Calculator. It was found that the participants with the lowest calculated fitness levels had the highest mortality risk during the follow-up period.

“For every 3.5 point increase in fitness score, the risk of dying dropped by 12 per cent over the next eight to nine years. In the case of cardiovascular-related deaths, this risk reduction was 15 per cent,” Garnvik says.

The fact that fitness is important is not new information.

“Both our research and other research suggests that staying in shape can be even more crucial to health than the level of physical activity. Our genes determine some of our fitness, but the vast majority of people can improve on their gene pool by exercising properly. This is also the case for individuals with atrial fibrillation,” he says.

Training in a way that actually influences your fitness level is especially important.

“Our research team has repeatedly shown that high-intensity interval training is more effective than moderate exercise for improving fitness. This is true for both healthy individuals and people with different types of lifestyle diseases,” says Garnvik.

No specific training recommendations for people with atrial fibrillation have been published yet. Last year, however, another CERG researcher completed his doctorate on the same topic. Cardiologist Vegard Malmo’s studies show that interval training using the 4 × 4 method is very effective for this group as well.

“The findings suggest that aerobic interval training has the same beneficial effect on risk factors in people with atrial fibrillation as in patients with other cardiovascular illnesses,” says Malmo.

Four months of regular interval training reduced both the recorded flutter length and the symptoms of the disease. In addition, the exercise provided better quality of life and heart function. And last but not least: the training resulted in a marked increase in fitness.

“Lifestyle changes, including exercise, should be key for treating atrial fibrillation,” Malmo says.

Biathlete Ole Einar Bjørndalen had to end his sports career due to atrial fibrillation. Cross-country ski racer Marit Bjørgen has experienced flutter episodes, and the same goes for several other high-level Norwegian and international endurance athletes.

“We know that very high levels of exercise over many years can increase the risk of developing atrial fibrillation. However, this is not something most of us need to worry about. Too little physical activity is a much greater cause of atrial fibrillation in the population than people exercising too much,” says Garnvik.

The people who exercise the most probably don’t tend to be the first to get scared and stop exercising if they have a flutter episode. A study of older people who participated in the Birkebeinerrennet – an annual long-distance cross-country ski marathon held in Norway – shows that two-thirds of these super-exercisers continue to train actively even after being diagnosed.

And they can do that with good conscience. Recently, Vegard Malmo and other Norwegian experts published an overview article on exercise and atrial fibrillation and concluded by saying: “We believe that most athletes with non-permanent atrial fibrillation can exercise without any restrictions when their heartbeat is normal. If they experience symptoms during exercise, the natural response will be to stop the activity.”

References:

Garnvik, L. E., Malmo, V., Janszky, I., Ellekjær, H., Wisløff, U., Loennechen, J. P., & Nes, B. M. (2020). Physical activity, cardiorespiratory fitness, and cardiovascular outcomes in individuals with atrial fibrillation: the HUNT study. European Heart Journal.

Malmo, V., Nes, B. M., Amundsen, B. H., Tjonna, A. E., Stoylen, A., Rossvoll, O., Wisløff, U., & Loennechen, J. P. (2016). Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial.. Circulation, 133 (5), 466-473.

Myrstad, M., Malmo, V., Ulimoen, S. R., Tveit, A., & Loennechen, J. P. (2019). Exercise in individuals with atrial fibrillation. Clinical Research in Cardiology, 108 (4), 347-354.

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Could your oral health be affecting fertility?

Chronic oral inflammation may impair female fertility by triggering a systemic immune response that affects the ovaries. A new study shows this leads to oxidative damage, reduced egg quality, disrupted follicle development and reduced live birth rate. These findings point to a potential biological link between oral health and unexplained infertility, opening new directions for future treatments.

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A new study led by Prof. Michael Klutstein at the Hebrew University of Jerusalem and Prof. Asaf Wilensky at the Hebrew University-Hadassah Medical center and spearheaded by the students Dr. Paz Kles and Stephen Ameho has uncovered a striking biological link between chronic oral inflammation and female fertility, suggesting that conditions in the mouth may have far-reaching effects on reproductive health.

Published in the Journal of Dental Research, the study shows that persistent inflammation in the oral cavity can impair ovarian function, reduce egg quality, and ultimately lower fertility rates.

Researchers examined in a mouse model inflammation associated with dental implants, a common clinical scenario, and tracked how immune signals spread throughout the body. Their findings reveal that inflammation does not remain confined to the oral cavity but triggers a systemic immune response that reaches the ovaries.

The consequences were significant. Chronic oral inflammation in the animals was linked to increased levels of inflammatory cytokines in the ovaries, along with shifts in immune cell populations. This was accompanied by oxidative damage to ovarian tissue, impaired development of follicles, and reduced quality of oocytes.

These biological changes translated into measurable reproductive outcomes, with markedly reduced birth rates observed under inflammatory conditions in the animals.

The study also identified deeper cellular effects. Oocytes exhibited DNA damage and epigenetic alterations resembling those seen in reproductive aging, pointing to a possible mechanism by which inflammation accelerates the decline in fertility.

“Inflammation is often thought of as a localized response, but our findings show that it can have systemic consequences that extend as far as the reproductive system,” said Prof. Michael Klutstein. “This work suggests that chronic oral inflammation may be an underrecognized factor in female infertility, potentially contributing to cases that currently have no clear explanation.”

The findings add to growing evidence that oral health is closely linked to overall health. Chronic oral inflammatory conditions such as periodontitis are widespread and have already been associated with a range of systemic diseases.

The researchers note that further investigation in clinical settings will be essential to determine how these findings translate to patient care. If confirmed, the work could open new avenues for diagnosis and treatment, including the use of anti-inflammatory or antioxidant approaches to improve fertility outcomes.

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Maintaining a healthy heart may require regular doses of positivity

The findings of this study further point to the importance of attending to mental and behavioral health for cardiovascular disease prevention and cardiovascular health optimization.

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Positive psychology interventions such as mindfulness, gratitude journaling and optimism training can consistently improve blood pressure, inflammation markers and other cardiovascular disease risk factors within a matter of weeks, a recent study found. However, since these benefits are associated with lifestyle changes such as eating healthier and greater physical activity, the researchers suggested that ongoing reinforcements may be needed to stay on course long term.

Rosalba (Rose) Hernandez, a professor of social work at the University of Illinois Urbana-Champaign, led a team that analyzed the findings of 18 randomized controlled trials that used positive psychological and mindfulness interventions to enhance mental or physical health.

The programs that the team reviewed included individual methods — such as structured telephone sessions, journaling with brief check-ins and digital platforms such as apps and text messaging — and interactive in-person group sessions, as well as hybrid formats that blended these with online tools and virtual meetings. Most of the programs consisted of weekly sessions and at-home activities that reinforced the skills taught, with the majority of programs lasting from six to 12 weeks, the team found.

In general, the programs included 50-200 adults with elevated cardiovascular risk factors such as uncontrolled hypertension, heart failure or other conditions. Typically, the participants were in their late 50s to mid-60s, and women comprised 35-55% of the samples across those studies that reported their participants’ gender, according to the researchers.

“In hypertension and postacute coronary syndrome cohorts, mindfulness-based programs delivered over an eight-week period reduced systolic blood pressure and lowered inflammatory markers such as high-sensitivity C-reactive protein and fibrinogen,” said Hernandez, who is a Fellow of the American Heart Association. “A 12-week spirituality-based digital intervention achieved one of the largest reductions — reducing systolic blood pressure measured with a standard cuff by 7.6 points, and central systolic pressure — which is measured in the aorta as it leaves the heart — by 4.1 points.”

In prior research on positive psychology interventions, scientists seldom defined the dose that was needed to obtain the beneficial effects, Hernandez said. She and the team members sought to clarify the frequency and duration that was most likely to improve individuals’ cardiovascular health.

Programs that had more frequent contact with their participants yielded the most consistent physiological benefits, underscoring the opportunity to embed positive psychological strategies into long-term cardiovascular care, Hernandez said.

The team found that the strongest behavioral improvements were achieved by an eight-week program delivered over WhatsApp that combined weekly sessions with daily microtasks, motivating participants to engage in greater physical activity, eat a healthier diet and take their medication as prescribed. A program that included motivational interviewing succeeded in increasing cardiac patients’ levels of physical activity by 1,800 steps a day and their medication adherence, while the mindfulness programs improved participants’ activity levels and diets only, according to the study.

“The therapeutic dose that was most consistently linked with improvements in blood pressure, inflammation and endothelial function was daily practice reinforced by weekly sessions over eight to 12-week periods,” Hernandez said. “Therapeutic dosing typically involved high-frequency dosing over this time period to obtain short-term physiologic benefits, while ongoing less-intensive contact may be needed to sustain behavioral change.”

Published in the journal Cardiology Clinics, the study was co-written by University of South Florida social work professor Soonhyung Kwon; Alyssa M. Vela, a professor of surgery and of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine; and Katharine S. Edwards, a professor of cardiovascular medicine and of psychiatry and behavioral medicine at Stanford Medicine.

“The findings of this study further point to the importance of attending to mental and behavioral health for cardiovascular disease prevention and cardiovascular health optimization,” Vela said. “This speaks to the need for routine screening and integration of cardiac behavioral medicine to allow for access to important interventions.”

The current study adds to a growing body of research linking psychological well-being — including traits such as optimism, positive affect and gratitude — with cardioprotective benefits.

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Heart disease risk may start in the womb, study finds

Young adults whose mothers had high blood pressure during pregnancy — either pregnancy-associated hypertension, pre-eclampsia or eclampsia — had more signs of early arterial injury, higher blood pressure, higher body mass index and higher blood sugar than peers.

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A child’s future heart health may be partially shaped before they are born, reports a new Northwestern Medicine study that found pregnancy complications are linked to poorer cardiovascular health in offspring more than 20 years later.

The study found that young adults whose mothers had high blood pressure during pregnancy — either pregnancy-associated hypertension, pre-eclampsia or eclampsia — had more signs of early arterial injury, higher blood pressure, higher body mass index and higher blood sugar than peers.

The authors said the study adds to growing evidence that cardiovascular risk may be transmitted across generations through a combination of biological, environmental and behavioral factors.

“That means we must make sure people maintain good health from childhood into young adulthood, so that if or when someone becomes a parent, they pass on the best opportunity for good health to their children,” said study senior author Dr. Nilay Shah, assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine.

How the study was conducted

Shah and colleagues evaluated nearly 1,350 mother-child pairs from the Future of Families and Child Well-Being Study, which enrolled mothers and children at birth between 1998 and 2000 across 20 U.S. cities. The children were then followed into adulthood.

Using delivery hospitalization records, the Northwestern scientists first identified whether mothers experienced pregnancy complications, including high blood pressure during pregnancy, gestational diabetes (high blood sugar during pregnancy) or preterm birth (before 37 weeks of pregnancy).

The three pregnancy complications are on the rise, and affect almost one in four pregnancies in the U.S.

The research team then analyzed cardiovascular health of offspring at age 22, using blood pressure measurements, blood testing, body mass index assessments and carotid artery ultrasounds to look for signs of artery injury.

Finally, the scientists compared participants with and without exposure to each pregnancy complication and adjusted for factors like income, education, difference in birth weight and smoking during pregnancy.

Key findings

At around age 22, participants whose mothers had high blood pressure during pregnancy had:

  • Higher body mass index (+2.8 BMI points)
  • Higher diastolic blood pressure (+2.3 mm Hg)
  • Higher blood sugar levels (+0.2% HbA1c)
  • Thicker artery walls (~0.02 mm)

While the difference in artery wall thickness may seem small, the study authors said it corresponds to roughly three to five years of additional vascular aging. That means arteries looked older and less healthy than expected, which raises the risk of future heart disease.

Other pregnancy complications also showed some long-term effect:

  • Exposure to gestational diabetes was linked to worse blood pressure and some evidence of artery thickening
  • Being born preterm was associated with higher blood sugar levels

‘Most heart disease is preventable’

With pregnancy complications on the rise in the U.S., Shah said the study provides compelling evidence that improving health before and during pregnancy could help reduce heart disease risk in the next generation.

“There is evidence that both parents’ health at the time of conception and during pregnancy influences a child’s health,” he said. “So, promoting health from an early age, like exercising regularly, eating healthfully, never smoking and getting enough sleep, is not just meant for an individual, but doing so may help future generations be healthier, too.”

Shah also emphasizes that risk is not destiny.

“The good news is that most heart disease is preventable,” he said. “If you experienced high blood pressure or high blood sugar during pregnancy, or your child was born early, it does not absolutely mean that your child will have worse health as adults. But I would encourage you to pay attention now to your child’s health behaviors.

“What children learn in childhood sets the stage for their health across their lives. If you are wondering whether your children’s behaviors are healthy, or are considering making a change, please speak with your child’s pediatrician for advice and guidance.”

Other Northwestern co-authors include Emily Lam, Abigail Gauen, Dr. Sadiya Khan, Alexa Freedman and Norrina Allen.

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