Exercise Reduces the Burden of Atrial Fibrillation

Study Questions:

What is the effect of aerobic interval training (AIT) on the burden of atrial fibrillation (AF)?


Fifty-one patients with either paroxysmal (n = 29) or persistent AF (n = 22) were randomized to AIT or conventional care. AIT consisted of walking or running on a treadmill 3 times a week for 12 weeks. Each session consisted of a 10-minute warm up at 60-70% of peak heart rate (HR), followed by four 4-minute intervals at 85-95% of peak HR, and concluded with a 3-minute recovery, and 5-minute cool down phase. After randomization, baseline data (including AF burden as determined via an implantable loop recorder, AF symptoms, exercise capacity [VO2peak], cardiac volumes, quality of life [QoL], lipid status, cardioversions, and hospitalizations) were obtained.


Patients in the exercise group were younger (56 vs. 62 years, p < 0.05). AF burden decreased in the AIT group (8.1% to 4.8%), whereas it increased in the control group (10.4% to 14.6%) (p = 0.001). VO2peak, some QoL measures, left atrial and ventricular ejection fraction, lipid status, and weight/body mass index also improved in the AIT group. There was a trend toward fewer cardioversions and hospital admissions in the exercise group.


Exercise training was associated with an improvement in arrhythmia burden, and other parameters in patients with paroxysmal and persistent AF.


Results from epidemiological studies suggest that persistent high-intensity exercise training is associated with a higher risk of incident AF. However, in this randomized study, short-term interval training was associated with improvement in arrhythmia burden in patients with AF. The differences between these studies include the fact that individuals in the current study already had AF, and likely as importantly, performed moderate-intensity (as opposed to vigorous) exercise for a short-term period. The current study adds to an emerging evidence base demonstrating the importance of exercise and weight loss in reducing the AF burden. This study should also exhort clinicians in more vigorously recommending such measures in patients with AF, especially those patients in whom a rhythm strategy is chosen. Antiarrhythmic medications and catheter ablation cannot undo the structural and electrical remodeling that led to AF in the first place. Maintaining a healthy lifestyle seems to be salutary not only in terms of arrhythmia burden, but also in a host of other cardiometabolic measures.

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