An Exercise and Physical Activity Program in Patients With Atrial Fibrillation - ACTIVE-AF

Apr 26, 2023
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Author/Summarized by Author:
Dharam J. Kumbhani, MD, SM, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Heart Foundation of Australia
Date Published:
04/24/2023
Date Updated:
04/26/2023
Original Posted Date:
04/26/2023
References

Contribution To Literature:

The ACTIVE-AF trial shows that a supervised exercise and home-based physical activity intervention reduces AF recurrence and symptom severity among patients with paroxysmal or persistent AF.

Description:

The goal of the trial was to assess the safety and efficacy of exercise and physical activity intervention among patients with symptomatic paroxysmal or persistent atrial fibrillation (AF).

Study Design

Patients were randomized in a 1:1 fashion to either exercise intervention (combining home and supervised aerobic exercise; n = 60) or usual care (n = 60) for 6 months. The exercise intervention was tailored for each patient according to baseline exercise capacity and current physical activity levels and preferences and delivered by clinical exercise physiologists. This consisted of one-on-one exercise sessions on a weekly basis for the first 3 months, and then fortnightly from 3-6 months. Participants in the control group were given two one-on-one educational sessions with a clinical exercise physiologist on the benefits of physical activity participation and appropriate guidance on exercise for patients with AF. They were encouraged to achieve 150 minutes of moderate-intensity exercise per week.

  • Total screened: 369
  • Total number of enrollees: 120
  • Duration of follow-up: 12 months
  • Mean patient age: 65 years
  • Percentage female: 43%

Inclusion criteria:

  • Symptomatic paroxysmal or persistent AF
  • Age 18-80 years
  • Referred for rhythm management and consideration for AF ablation

Exclusion criteria:

  • The absence of AF lasting >30 seconds in the past 3 months documented by 12-lead electrocardiogram or Holter monitoring
  • AF ablation within past 12 months
  • Permanent AF
  • Myocardial infarction or cardiac surgery within past 12 months
  • Autoimmune or systemic inflammatory disease
  • Left ventricular ejection fraction <45%
  • Moderate to severe valvular disease
  • Inability to participate in structured exercise program due to musculoskeletal condition

Other salient features/characteristics:

  • Paroxysmal AF: 61%
  • Previous AF ablation: 21%
  • Permanent pacemaker: 14%

Principal Findings:

The primary endpoint, freedom from arrhythmia at 12 months for exercise intervention vs. usual care, was: 40% vs. 20% (p = 0.002).

  • AF symptom severity (using AF Symptom Severity [AFSS] questionnaire) at 12 months: 5.6 vs. 8.2; difference: -2.3 points (95% confidence interval -4.5 to -0.1, p = 0.041)

Secondary endpoints for exercise intervention vs. usual care:

  • Total symptom burden at 12 months: 12.6 vs. 14.9, difference -1.7 (-3.6 to 0.2)
  • AF frequency: 2.9 vs. 4.1 (p > 0.05)
  • Peak VO2 max: 20.6 vs. 19.9 mL/kg/min (p < 0.05)

Interpretation:

The results of this trial indicate that a supervised exercise and home-based physical activity intervention reduces AF recurrence and symptom severity among patients with paroxysmal or persistent AF. This is an important trial. Similar exercise programs have been shown to be beneficial for other chronic conditions such as coronary artery disease and peripheral artery disease. Scalability and utility of home-based vs. supervised training will need to be ascertained in future studies.

References:

Elliott AD, Verdicchio CV, Mahajan R, et al. An Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial. JACC Clin Electrophysiol 2023;9:455-65.

Editorial Comment: Beatty AL, Marcus GM. Time to Get Moving: Exercise for Atrial Fibrillation. JACC Clin Electrophysiol 2023;9:466-7.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise

Keywords: Arrhythmias, Cardiac, Arrhythmia, Sinus, Atrial Fibrillation, Catheter Ablation, Exercise, Pacemaker, Artificial, Patient Care Team, Secondary Prevention


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