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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.

Patients recovering from COVID-19 often report symptoms of exhaustion, fatigue and dyspnoea and present with exercise intolerance persisting for months post-infection. Numerous studies investigated these sequelae and their possible underlying mechanisms using cardiopulmonary exercise testing. We aimed to provide an in-depth discussion as well as an overview of the contribution of selected organ systems to exercise intolerance based on the Wasserman gears. The gears represent the pulmonary system, cardiovascular system, and periphery/musculature and mitochondria. Thirty-two studies that examined adult patients post-COVID-19 via cardiopulmonary exercise testing were included. In 22 of 26 studies reporting cardiorespiratory fitness (herein defined as peak oxygen uptake—VO2peak), VO2peak was VO2peak was notably below normal even in the long-term. Given the available evidence, the contribution of respiratory function to low VO2peak seems to be only minor except for lung diffusion capacity. The prevalence of low lung diffusion capacity was high in the included studies. The cardiovascular system might contribute to low VO2peak via subnormal cardiac output due to chronotropic incompetence and reduced stroke volume, especially in the first months post-infection. Chronotropic incompetence was similarly present in the moderate- and long-term follow-up. However, contrary findings exist. Peripheral factors such as muscle mass, strength and perfusion, mitochondrial function, or arteriovenous oxygen difference may also contribute to low VO2peak. More data are required, however. The findings of this review do not support deconditioning as the primary mechanism of low VO2peak post-COVID-19. Post-COVID-19 sequelae are multifaceted and require individual diagnosis and treatment.

BACKGROUND 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 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 (at least once weekly) and minutes of weekly physical activity using a validated questionnaire. We studied associations with ischemic infarcts, white matter hyperintensities, cerebral microbleeds, and brain volume on brain MRI and with global cognition measured with a cognitive construct score (CoCo). RESULTS Among 1490 participants (mean age 72 ±9 years), 730 (49%) engaged in regular exercise. In adjusted regression analyses, regular exercise was associated with a lower prevalence of ischemic infarcts (odds ratio [OR]) 0.78, 95% 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

Background For valid accelerometer-assessed physical activity (PA) data, several methodological aspects should be considered. We aimed to 1) visualize the applicability of absolute accelerometer cut-offs to classify PA intensity, 2) verify recommendations to measure PA over 7 days by examining inter-day variability and reactivity, 3) examine seasonal differences in PA, and 4) recommend during which 10 h day period accelerometers should be worn to capture the most PA in patients with heart failure (HEART) and healthy individuals (HEALTH). Methods Fifty-six HEART (23% female; mean age 66 ± 13 years) and 299 HEALTH (51% female; mean age 54 ± 19 years) of the COmPLETE study wore accelerometers for 14 days. Aim 1 was analyzed descriptively. Key analyses were performed using linear mixed models. Results The results yielded poor applicability of absolute cut-offs. The day of the week significantly affected PA in both groups. PA-reactivity was not present in either group. A seasonal influence on PA was only found in HEALTH. Large inter-individual variability in PA timing was present. Conclusions Our data indicated that absolute cut-offs foster inaccuracies in both populations. In HEART, Sunday and four other days included in the analyses seem sufficient to estimate PA and the consideration of seasonal differences and reactivity seems not necessary. For healthy individuals, both weekend days plus four other days should be integrated into the analyses and seasonal differences should be considered. Due to substantial inter-individual variability in PA timing, accelerometers should be worn throughout waking time. These findings may improve future PA assessment. Trial registration The COmPLETE study was registered at clinicaltrials.gov (NCT03986892). Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01350-6.

Additional file 1: Table 1. Linear mixed model results with estimates of daily physical activity (min) �� SE for patients with heart failure and healthy individuals. Table 2. Linear mixed model results with estimates of daily physical activity (min) �� SE for patients with heart failure and healthy individuals. Figure 1. Cardiorespiratory response in % of $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak to exercising at 2, 3, and 6 METs across the cardiorespiratory fitness spectrum ( $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak range = 10.2 ��� 65.1 mL.kg-1.min-1) including patients with heart failure (HEART) and healthy individuals (HEALTH). The $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak of all participants is displayed on the x-axis. The relative intensity in % of the subjects��� $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak that would be required to exercise at the three absolute intensities (2, 3, and 6 METs) is depicted on the y-axis. Intensity categories are marked by the dashed lines. LPA is defined as 0 to < 46% of $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak , MPA as 46 to < 64% of $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak , and VPA as 64 to 100% of $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak . 2 The hatched area symbolizes the intensity that cannot be maintained for a prolonged time, as it exceeds the individual���s cardiorespiratory fitness. Abbreviations: LPA, light physical activity; MPA, moderate physical activity; VPA, vigorous physical activity; $$\overset{.}{\mathrm{V}}\mathrm{O}_{2\text{peak}}$$ V . O 2 peak , peak oxygen uptake.

Additional file 1. Completed PRISMA-P Checklist.

Additional file 2. Full search strategy for Medline (on Ovid), Web of Science (core collection), Scopus, L.OVE Coronavirus disease by Epistemonikos, and ProQuest Dissertations & Theses A&I (on proquest.com ).