Exercise lowers severity and recurrence of atrial fibrillation (AF)
Exercise-based rehabilitation reduces the severity, frequency, and recurrence of the heart condition atrial fibrillation (AF), according to meta-analysis published online in the British Journal of Sports Medicine.
AF occurs when the heart's upper chambers (atria) don’t contract properly and instead twitch, disrupting the electrical signals to the lower chambers (ventricles). Symptoms include palpitations, chest pain, dizziness and shortness of breath.
Associated with a heightened risk of stroke and heart failure, it will affect an estimated 18 million people in Europe by 2060.
While current treatment is effective, trials of exercise-anchored rehab have seen symptom severity cut by 39%, frequency and length of AF episodes by 43% and 42%, respectively, and risk of recurrence by 32%.
Lead researcher Dr Ben Buckley, a senior lecturer in cardiovascular physiology, at Liverpool John Moores University, said: “The ability of patients to manage their condition themselves may help minimise impact on their quality of life.”
Exercise rehabilitation is used for patients who have had a heart attack, or had a stent fitted but is not currently included in international AF treatment guidelines nor is it part of routine care in the NHS.
The ability of patients to manage their condition themselves may help minimise impact on their quality of life.
Previous systematic reviews on the subject, published in 2017 and 2018, provided inconclusive evidence for its broader benefits. But since then, several relevant clinical trials have been published, so the researchers set out to update the evidence.
Dr Buckley and collaborators scoured research databases and found 20 relevant clinical trials carried out between 2006 and 2024 that involved 2,039 patients, monitored for an average of 11 months.
Five trials assessed comprehensive exercise rehabilitation, which included educational and/or psychological components; the remainder assessed exercise only rehabilitation.
The exercise interventions ranged from 8 to 24 weeks, involving 1–7 weekly sessions of 15–90 minutes in length. Most trials included moderate intensity interventions and aerobic exercise-based training.
Compared with those in the comparison groups, it reduced symptom severity by 39%, frequency and length of AF episodes by 43% and 42%, respectively, and risk of recurrence by 32%.
It also significantly improved exercise capacity, as measured by maximal oxygen intake.
More research needed
The researchers acknowledge some limitations; most trials were relatively small and had a short monitoring period. The number of reported deaths and serious side effects was small, which substantially reduced the ability to reliably detect any true effect. And most participants were men.
Dr Buckley noted: “While improvements in traditional cardiovascular risk factors likely account for a substantial proportion of the benefit, additional mechanisms may directly impact AF burden and recurrence.
“Exercise training promotes favourable atrial remodelling, including reduced atrial stiffness and fibrosis, which may help limit [conditions favourable for AF], although further research is needed.”
Drs Sarandeep Marwaha and Sanjay Sharma of the Institute of Cardiovascular and Cell Sciences, London, say the findings “provide further compelling evidence that [exercise based cardiac rehabilitation] significantly benefits patients with AF.”
They add: “Exercise is widely recognised as an important management tool, and it is crucial to highlight that it remains one of the most cost-effective, readily available, and manageable interventions for improving cardiovascular health.”
Research: Exercise based cardiac rehabilitation for atrial fibrillation: Cochrane systematic review, meta analysis, meta-regression and trial sequential analysis Doi: 10.1136/bjsports-2024-109149
