Daily cardio cuts rates of AF

5 minute read

And half an hour of exercise a day lessens the severity of symptoms too, new research suggests.

Exercising for half an hour a day halves the incidence of atrial fibrillation and reduces symptoms, an Australian study has shown.

The prospective, randomised controlled trial of 120 patients with paroxysmal or persistent symptomatic atrial fibrillation also found that 210 minutes of moderate exercise a week was safe.

After 12 months, 40% of people in the exercise group were free from arrhythmia, compared with 20% of patients in the control group. The study also found that, by six months, symptom severity was lower in the exercise group, and that difference persisted at 12 months.

“These findings support the recommendation of exercise prescription within the medical care of patients with atrial fibrillation to improve atrial fibrillation-related symptoms and reduce arrhythmia recurrence,” the authors wrote in JACC: Clinical Electrophysiology.

The research showed there were meaningful clinical benefits of an exercise program for patients with atrial fibrillation, said Professor Jamie Vandenberg, Victor Chang Cardiac Research Institute co-deputy director, who was not involved in the research.

The key to rolling out an exercise program on a larger scale was to find a balance between an effective exercise intervention that patients continued in the long term and ensuring it was accessible and affordable, Professor Vandenberg told TMR.

“The biggest challenge is how do we take that knowledge and implement it in a feasible patient acceptable, clinically actionable way?” said Professor Vandenberg.

Professor Vandenberg said the study included people who had not yet progressed to permanent atrial fibrillation and who were good candidates for non-surgical interventions, potentially saving them from having atrial fibrillation ablation procedures.

“Even if you could save only half of them from having to have an ablation, then that would save the healthcare system a huge amount of money.”

Professor Vandenberg said there was strong evidence for GPs to recommend exercise for patients with atrial fibrillation.

“If you had a patient who had any episodes of atrial fibrillation and anyone who’s got any sort of heart disease, as a GP, I think you should be recommending that they do half an hour of moderate exercise every day.

“The biggest issue is getting people to get into the habit of doing that every day.”

Senior investigator Professor Prash Sanders, cardiologist and electrophysiologist at the University of Adelaide and Royal Adelaide Hospital, said the results were good news for patients who could do something to improve their atrial fibrillation.

“We’ve thought that treating just one risk factor may not be enough to achieve an outcome in terms of atrial fibrillation, so this is really super exciting in that context of a single intervention that’s made a big difference,” Professor Sanders told TMR.

“From a patient’s perspective, it’s one thing they can have input into in terms of improving their own health.”

Professor Sanders said all the participants had been referred to a clinic for atrial fibrillation ablation, so were symptomatic enough to want to have an invasive procedure.

Those in the intervention group had supervised, one-on-one exercise sessions every week for three months, and then fortnightly for another three months.

They were also encouraged to exercise at home, such as brisk walking, cycling, swimming and light jogging, increasing their weekly activity time until they reached 210 minutes a week.

Participants in the control group were given individual educational sessions about the benefits of exercise and encouraged to do 150 minutes of moderate exercise a week, but were not given any individual training plans or supervision.

Study lead Dr Adrian Elliott, a physiologist and research scientist, said they found that improvement in atrial fibrillation occurred independently of weight loss and blood pressure control.

“There’s something that happens when you exercise and become fitter. You develop some of the cardiopulmonary capacity that helps control the atrial fibrillation, but it doesn’t matter necessarily where you’ve lost weight or not.

“There are changes that happen with exercise that we hypothesise would contribute to better control of AF.”

Professor Elliott told TMR they set the exercise recommendation above the national guidelines of 150 minutes of exercise a week.

“As we see from the results, it’s making a difference,” said Dr Elliott, senior lecturer in physiology at the Adelaide Medical School and a National Heart Foundation future leader fellow.

Dr Elliott said some patients with atrial fibrillation might be concerned about potential risks of exercising.

“If the AF is frequent enough, there’s a hesitation about exercising. Traditionally in AF, exercise hasn’t been front and centre of the recommendation as it is for somebody who might have had a heart attack, for example.

“One of the main take-homes from this study is that in the future the recommendations could be that within the range of exercise that we’ve studied, it appears safe – and we certainly didn’t see any complications from exercise – and it will contribute to helping manage the atrial fibrillation alongside all the other things that would typically be done with this group of patients.”

Previous research led by Professor Sanders has shown that lifestyle modifications and risk factor management – including weight, physical activity, blood pressure, type two diabetes and sleep apnoea – reduced the recurrence, duration and symptoms of atrial fibrillation.

JACC: Clinical Electrophysiology 2023, online 18 January

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