A six-month exercise program helps maintain a normal heart rhythm and reduces the severity of symptoms in patients with atrial fibrillation, according to late-breaking research presented at ESC 2021.1
“The ACTIVE-AF trial demonstrates that some patients can control their arrhythmia through physical activity, without the need for complex interventions such as ablation or drugs to keep their hearts at a normal rate,” said the study author Dr Adrian Elliott of the University of Adelaide. , Australia.
Atrial fibrillation (AF) is a heart rhythm disorder that causes the heart to beat quickly and irregularly. The most common symptoms are palpitations, shortness of breath, dizziness, and fatigue, which can have a dramatic impact on quality of life. Patients are at high risk for stroke and heart failure. The global prevalence of AF is increasing rapidly and is estimated at over 30 million people,2 while the lifetime risk of the disorder for people over 55 can be as high as one in three.3
Exercise rehabilitation is recommended for patients with coronary artery disease and heart failure, but few studies have examined the benefits of AF. An observational study found that patients who acquired cardiorespiratory fitness during a five-year follow-up were significantly less likely to have recurrence of AF.4 A randomized controlled trial showed that 12 weeks of aerobic interval training reduced the time spent in AF compared to usual care, but the study enrolled only 51 patients and the follow-up was only four weeks.5
The ACTIVE-AF trial evaluated the impact of a six-month exercise program combining supervised and home aerobic exercise on AF recurrence and symptom severity – during the procedure and after six additional months of follow-up. The study included patients with either short episodes of AF (paroxysmal AF) or longer episodes requiring intervention to restore normal rhythm (persistent AF). Patients whose normal heart rhythm cannot be restored (permanent AF) were excluded.
The trial randomly assigned 120 patients with symptomatic AF to an exercise intervention or usual care for six months. The intervention included supervised exercises (weekly for three months then fortnightly for three months) and an individualized weekly plan to be followed at home. Over the six months, the goal was to increase aerobic exercise up to 3.5 hours per week. Supervised sessions were generally of higher intensity to improve cardiorespiratory fitness, while home exercise was generally a moderate-intensity aerobic activity of the patient’s choice (eg, walking, indoor cycling, swimming). The usual care group received exercise counseling, but no active intervention. All patients received usual medical care from their cardiologist who was blinded for study group assignment.
The co-primary outcomes were the AF symptom severity score and the proportion of patients with recurrent AF at 12 months. Recurrent AF was defined as episodes lasting longer than 30 seconds, undergoing ablation procedure or requiring continued antiarrhythmic drug therapy.
The mean age of the patients in the study was 65 years and 43% were female. At 12 months, the AF recurrence rate was significantly lower in the exercise group (60%) compared to the control group (80%), with a relative risk of 0.50 (95% confidence interval 0, 33-0.78; p = 0.002). Dr Elliott said: “Simply put, this means that more patients in the exercise group could maintain normal heart rhythms without the need for invasive procedures or continued use of medications.”
Patients in the exercise group also had a significant reduction in the severity of their symptoms at 12 months compared to the control group. “This means that patients have reported less severe palpitations, shortness of breath and fatigue,” Dr. Elliott said.
He concluded: “Our study provides evidence that aerobic exercise should be integrated into the treatment of patients with symptomatic AF. General guide, patients should strive to accumulate up to 3.5 hours per week of aerobic exercise and incorporate higher intensity activities to improve cardiorespiratory fitness.
1Abstract Title: An Exercise and Physical Activity Program in Patients with Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial.
2Chugh SS, Havmoeller R, Narayanan K, et al. Global Epidemiology of Atrial Fibrillation: A 2010 Global Burden of Disease Study. Circulation. 2014; 129: 837-847.
3Staerk L, Wang B, Preis SR, et al. Lifetime risk of atrial fibrillation by optimal, borderline, or elevated risk factor levels: a cohort study based on longitudinal data from the Framingham Heart Study. BMJ. 2018; 360: k1453.
4Pathak RK, Elliott A, Middeldorp ME, et al. Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese people with atrial fibrillation. J Am Coll Cardiol. 2015; 66: 985-996.
5Malmö V, Nes BM, Amundsen BH, et al. Aerobic interval training reduces the burden of atrial fibrillation in the short term. Circulation. 2016; 133: 466-473.