Exercise-based cardiac rehabilitation significantly improves health outcomes without increasing risk of adverse events or mortality.
Atrial fibrillation symptom severity can be reduced by nearly 40%, according to meta-analysis of exercise-based cardiac rehabilitation.
Across 20 clinical trials, exercise was also found to reduce AF recurrence by more than a third, and episode frequency and duration by more than 40% when compared to controls.
Trials were conducted between 2006 and 2024 of more than 2000 patients across Australia, Europe, Asia, Canada, Brazil and Russia.
The study found that exercise also increased physical activity capacity and improved mental health.
All improvements were independent of AF subtype, ‘dose’ of rehab and how exercise was delivered (remote, in-centre or a combination of both).
They did not find any association between exercise-based cardiac rehabilitation and serious adverse events or all-cause mortality, indicating that exercise is safe for AF patients when appropriately supervised and tailored to the individual.
Researchers said that AF management guidelines should be updated to recommend exercise-based cardiac rehabilitation for patients alongside drug and ablation therapies.
Current Australian clinical guidelines make limited mention of exercise, suggesting that its role is to reduce burden by improving aerobic capacity and is only recommended for individuals with symptomatic AF.
The exercise interventions ranged from eight to 24 weeks duration and involved between one and seven supervised or remotely delivered sessions per week, lasting between 15 and 90 minutes each.
The average follow-up period was 11 months, with individual trials ranging from eight weeks to five years in duration. The average participant age was 63 years and nearly three quarters of participants were male.
AF subtypes included paroxysmal, persistent and permanent, with seven trials focused specifically on symptomatic AF.
Most studies involved moderate-intensity aerobic exercise programs, and a small number looked at the combination of aerobic exercise and resistance training. Only three trials looked at the impact of vigorous intensity exercise.
One trial involved inspiratory muscle training, two were yoga-based exercise and one was of Qi Gong, a practice known as “moving meditation” which consists of slow movements and a focus on breathing.
Most trials evaluated exercise-only programs, while five included educational and psychological support. Some trials did not cease standard care for controls, including medication, education and procedures. However, in all trials, control groups received no formal exercise training.
Exercise was delivered either remotely or in centre for most of the trials, but five were a combination of both settings. Intensity was assessed using percentage heart rate max, percentage peak exercise capacity and rating of perceived exertion.
AF recurrence was mostly tracked using Holter monitors, which showed that exercise participants were 32% less likely to experience AF recurrence compared to those in the control groups.
Related
Symptom severity and AF burden were patient-reported metrics, which showed fewer, shorter and less severe episodes associated with exercise-based cardiac rehabilitation.
Overall, there was a severity reduction of 39%, frequency reduction of 43% and episode length reduction of 42%.
Exercise capacity, assessed by VO₂ peak and the six-minute walk test, also improved with exercise. The mean pooled VO₂ of 3.18 mL/kg/min was both statistically and clinically significant, given that a 1 mL/kg/ min improvement has traditionally been accepted as a clinically meaningful change, researchers explained.
The majority of trials included a quality-of-life assessment using validated questionnaires such as the SF-36, which indicated that exercise reduced anxiety, stress and the emotional burden of AF.
Researchers proposed that beyond the known improvements in cardiovascular risk factors and mental wellbeing, a possible mechanism of exercise was to remodel the atria, reducing stiffness and fibrosis that contribute to AF.
