IJCS | Volume 32, Nº4, July/August 2019

386 Figure 1 - Selection process of studies. Garlipp et al. Physical activity and atrial fibrillation Int J Cardiovasc Sci. 2019;32(4):384-390 Original Article The combined analysis of the studies did not suggest a significant increase in AF in subjects submitted to exercise (RR=0.914, 95%CI =0.833 – 1.003, heterogeneity: p<0.001). Discussion Although the benefits of physical exercise on cardiovascular diseases are well described, the same does not occur in relation to AF. In this sense, the results of this meta-analysis, based on the studies analyzed, indicate that individuals who exercise are less likely to have AF. Mozaffarian et al., 10 suggest that mild and moderate activities, especially leisure activities such as walking, are associated with a significantly lower incidence of AF. On the other hand, Drca et al., 15 observed an increased risk of the development of AF in men under 30 years of age submitted to high levels of exercise, and this does not occur at older ages. In this sense, Larsson et al., 16 suggest that maintaining a body mass index (BMI) of less than 25 kg/m 2 , doing more than 20 minutes of exercise daily, not consuming or consuming alcohol in a mild to moderate manner (≤ 2 drinks/day for men and ≤ 1 drink/day for women) and not smoking reduce the risk of developing AF by half. Bapat et al., 6 from the Multiethnic Atherosclerosis Study (MESA), associated physical activity and AF in a diverse population without clinically recognized cardiovascular disease. The results showed that neither vigorous physical activity nor total intentional exercise were independently related to AF, when adjusted for some covariates. It has even been shown that the greater the relationship of the individual with vigorous activities,