Exercise maintains normal heart rhythm in patients with atrial
fibrillation

Date:
August 23, 2021
Source:
European Society of Cardiology
Summary:
A six-month exercise program helps maintain normal heart rhythm
and reduces the severity of symptoms in patients with atrial
fibrillation, according to new research.



FULL STORY ==========================================================================
A six-month exercise programme helps maintain normal heart rhythm
and reduces the severity of symptoms in patients with atrial fibrillation,according to late breaking research presented at ESC
Congress 2021.1

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"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 medications to keep their heart in
normal rhythm," said study author Dr. Adrian Elliott of the University
of Adelaide, Australia.

Atrial fibrillation (AF) is a heart rhythm disorder that makes the heart
beat fast and irregularly. The most common symptoms are palpitations,
shortness of breath, light headedness, and fatigue, which can dramatically impact quality of life. Patients have significant risks of stroke and
heart failure. The global prevalence of AF is increasing rapidly and is estimated to be over 30 million people,2 while the lifetime risk of the disorder for individuals over the age of 55 may be as high as one in
three.3 Exercise-based rehabilitation is recommended for patients with
coronary heart disease and heart failure, but few studies have examined
the benefits in AF. An observational study found that patients who gained cardiorespiratory fitness over a five-year follow-up were significantly
less likely to have recurrences of AF.4 A randomised controlled trial
showed that 12 weeks of aerobic interval training reduced the time spent
in AF compared to usual care but the study enrolled just 51 patients and follow-up was only four weeks.5 The ACTIVE-AF trial assessed the impact of
a six-month exercise programme combining supervised and home-based aerobic exercise on AF recurrence and symptom severity -- during the intervention
and after a further six months of follow-up. The study included patients
with short AF episodes (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 allocated 120 patients with symptomatic AF to an
exercise intervention or usual care for six months. The intervention
included supervised exercise (weekly for three months then fortnightly for three months) and an individualised weekly plan to follow at home. Over
the six months the target was to increase aerobic exercise up to 3.5 hours
per week. Supervised sessions were typically higher intensity to raise cardiorespiratory fitness, while home- based exercise was typically a
moderate intensity aerobic activity of the patient's choice (e.g. walking, indoor cycling, swimming). The usual care group received exercise advice
but no active intervention. All patients received usual medical care
from their cardiologist who was blinded to study group allocation.



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The co-primary outcomes were 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 an ablation intervention, or requiring ongoing anti-arrhythmic drug therapy.

The average age of patients in the study was 65 years and 43% were
women. At 12 months, the AF recurrence rate was significantly lower in the exercise group (60%) compared to the control group (80%), with a hazard
ratio of 0.50 (95% confidence interval 0.33-0.78; p=0.002). Dr. Elliott
said: "Put simply, this means a larger number of patients in the exercise
group could maintain a normal heart rhythm without needing invasive interventions or continued use of drugs." 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
reported less severe palpitations, shortness of breath and fatigue,"
said Dr. Elliott.

He concluded: "Our study provides evidence that aerobic exercise should
be incorporated into the treatment of patients with symptomatic AF. This
should sit alongside the use of medications, as guided by a cardiologist,
and management of obesity, hypertension and sleep apnoea. As a general
guide, patients should strive to build up to 3.5 hours per week of aerobic exercise and incorporate some higher intensity activities to improve cardiorespiratory fitness." References 1Abstract title: An exercise
and physical activity program in patients with atrial fibrillation:
the ACTIVE-AF randomised controlled trial.



========================================================================== 2Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology
of atrial fibrillation: A Global Burden of Disease 2010
study. Circulation. 2014;129:837- 847.

3Staerk L, Wang B, Preis SR, et al. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors:
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 individuals with atrial
fibrillation.

J Am Coll Cardiol. 2015;66:985-996.

5Malmo 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.

========================================================================== Story Source: Materials provided by European_Society_of_Cardiology. Note: Content may be edited for style and length.


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Link to news story: https://www.sciencedaily.com/releases/2021/08/210823110330.htm

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