Dr Adrian Elliott

Exercise could be key to maintaining normal heart rhythm and reducing symptom severity in atrial fibrillation (AF) patients, an Australian study suggests.

Research findings presented at European Society of Cardiology (ESC) Congress 2021 show a six-month exercise program significantly reduced AF recurrence rates, severe palpitations, shortness of breath and fatigue, according to study author, Dr Adrian Elliott (PhD) from the University of Adelaide

The study randomised 120 paroxysmal or persistent AF patients to usual care alone or with a six-month supervised and home-based exercise program, designed to increase aerobic activity to up to 3.5 hours per week.

Supervised sessions were typically high-intensity to raise cardiorespiratory fitness, while home-based exercise often included moderate-intensity activities such as walking, indoor cycling or swimming.

At 12 months’ follow-up, the AF recurrence rate was 60% in the exercise group, versus 80% in the control group (hazard ratio [HR]: 0.5, 95% CI: 0.33–0.78, P = 0.002).

“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,” said Dr Elliott, a a Senior Lecturer in Physiology at the Adelaide Medical School and Centre for Heart Rhythm Disorders, Royal Adelaide Hospital.

There was also a “significant reduction in the severity of symptoms at 12 months compared to the control group”, according to a press release from the ESC meeting.

“Exercise-based rehabilitation is recommended for patients with coronary heart disease and heart failure, but few studies have examined the benefits in AF,” it said.

The statement noted that  previous observational study found that patients who gained cardiorespiratory fitness over a five-year follow-up were less likely to have AF recurrences, while a randomised controlled trial showed that 12 weeks of aerobic interval training reduced the time spent in AF versus usual care, though the study only enrolled 51 patients and followed up at four weeks, the media release noted.

“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,” concluded Dr Elliott.

“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.”