Exercise-based intervention tied to reduced AF recurrence, symptom severity

A six-month intervention with supervised exercise and home-based physical activity was associated with reduced atrial fibrillation (AF) recurrence and symptom severity among patients with symptomatic AF, according to the ACTIVE-AF* trial.

At final follow-up of 12 months, 40 percent of the patients in the exercise group were free from AF recurrence, while only 20 percent of those in the control group achieved this outcome (hazard ratio for risk of recurrence, 0.50; p=0.002). [J Am Coll Cardiol EP 2023;doi:10.1016/j.jacep.2022.12.002]

AF symptom severity was lower in the exercise group than in the control group at 6 months (mean difference, -2.3; p=0.033), which persisted through 12 months (mean difference, -2.3; p=0.041).

“These findings support the recommendation of exercise prescription within the medical care of patients with AF to improve AF-related symptoms and reduce arrhythmia recurrence,” said the researchers.

This study enrolled 120 patients (mean age 65 years) with symptomatic paroxysmal or persistent AF who were randomized to receive exercise intervention, which combined supervised aerobic exercise and home-based physical activity (exercise group, n=60), or usual medical care (control group, n=60) for 6 months and were then followed up for an additional 6 months.

Using the symptom severity domain of the University of Toronto Atrial Fibrillation Symptom Severity Questionnaire, the total AF symptom burden was lower in the exercise group vs the control group at both 6 months (12.8 vs 15.6 points; mean difference, -2.0 points) and 12 months (12.8 vs 14.9 points; mean difference, -1.7 points).

Moreover, only 10 patients in the exercise group underwent AF ablation compared with 12 patients in the control group (p=0.60), though this finding did not reach statistical significance.

With regard to cardiopulmonary exercise testing, patients in the exercise group achieved a higher peak oxygen consumption (VO_2peak) at 6 and 12 months (mean difference, 1.6 and 1.8 mL/kg per minute, respectively) compared with the control group.

There were no between-group differences in cardiac structure or function, body mass index, or blood pressure at both 6 and 12 months.

“Overall, we found that a tailored aerobic-based exercise and physical activity programme among patients with symptomatic, nonpermanent AF leads to a reduction in self-reported AF symptom severity and improved maintenance of sinus rhythm without antiarrhythmic medication or AF ablation,” said the researchers.

“This study reaffirms the role of lifestyle modification for patients in the management of AF,” they noted.