Aerobic Exercise Can Reduce AF Frequency, Severity: ACTIVE-AF

In the ACTIVE-AF randomized controlled study with 120 patients

Patients with atrial fibrillation (AF) benefited significantly from a 6-month program of supervised and unsupervised moderate exercise compared to usual treatment, new randomized study results show.

Among 120 AF patients in the ACTIVE-AF study, those randomized to the exercise arm had significantly less frequent AF recurrences and less severe symptoms over a period of one year, said Adrian Elliott, PhD, who based this latest research on the Congress of the European Society of Cardiology (ESC) 2021.

The study “shows that some patients can control their arrhythmias through physical activity without the need for complex procedures such as ablation or medication to keep their heart in a normal rhythm,” Elliott of the University of Adelaide, Australia, said in one Statement from the ESC.

This is “the largest randomized controlled trial examining the value of exercise prescription in patients with symptomatic paroxysmal or persistent AF,” he told | Medscape Cardiology in an email.

The results “really provide the necessary evidence that recommending aerobic exercise in patients with symptomatic atrial fibrillation can reduce the severity of symptoms and prevent recurrence of atrial fibrillation in many patients,” he said. Aerobic exercise should be incorporated into patient care, he added, “alongside taking medication led by a cardiologist and treating obesity, high blood pressure and sleep apnea.”

Mina K. Chung, Dr.

The “results support AHA’s scientific statement that we should encourage our patients with AF to include regular moderate exercise to prevent AF, reduce AF exposure, and improve AF-related symptoms and quality of life,” Chung, Cardiologist at Cleveland Clinic in Ohio, summarized in an email to | Medscape cardiology.

“Our recommendation is to encourage atrial fibrillation patients to at least pursue the AHA physical activity guidelines for the general population, who recommend 150 minutes of moderate exercise every week,” said Chung.

This is a “reasonable” goal, but “some might argue that a slightly higher exercise duration goal could be considered,” commented Elliott.

ACTIVE-AF, he noted, suggests that “as a general patient guide [with AF] should aim to build up to 3.5 hours of aerobic exercise per week and incorporate some higher intensity activities to improve cardiorespiratory fitness. “

Aim for 3.5 hours a week

A previous observational study showed that patients who improved their cardiorespiratory fitness over a period of 5 years had significantly less atrial fibrillation.

And in a randomized study of 51 patients, 12 weeks of aerobic interval training during a 4 week follow-up reduced the time spent on AF compared to usual treatment.

ACTIVE-AF aimed to investigate the value of exercise in AF in a larger, longer randomized study.

The researchers enrolled 120 patients, mean age 65, of whom 43% were women.

The patients in the treatment group received individually guided exercise from an exercise physiologist in the cardiology clinic once a week for 3 months and then every other week for the following 3 months, along with a physical activity plan for the other days at home – with the goal of up to to build up 3.5 hours of physical activity per week.

The supervised sessions, Elliott explained, were typically higher-intensity to improve cardiorespiratory fitness, while the home exercise was a moderate-intensity aerobic activity of the patient’s choice, such as exercise. B. walking, indoor cycling or swimming.

“We have certainly warned against going well beyond that level,” he added.

Patients in the standard care group received exercise recommendations, but no active intervention.

All patients received the usual medical care from their cardiologist, who was blinded to the study group classification.

The co-primary endpoints were AF symptom severity and the percentage of patients with recurrent AF at 12 months, defined as an AF episode lasting more than 30 seconds or undergoing ablation or requiring ongoing antiarrhythmic drug therapy.

After 12 months, the percentage of patients with AF relapse in the training group was significantly lower than in the control group (60% vs. 80%; hazard ratio 0.50; 95% CI 0.33-0.78; P = 0.002) .

This means that more patients in the training group had normal heart rhythms without the need for invasive surgery (ablation) or continued medication, Elliott said.

Patients in the exercise group also had significantly fewer severe symptoms – palpitations, shortness of breath, and fatigue – than patients in the control group.

“On average, the patients lasted almost 180 minutes [of physical activity] per week to 6 months after the intervention and attended 18 supervised sessions in the clinic, “Elliott said.

Cost wasn’t an obstacle as the sessions with an exercise physiologist were free.

Lack of time was the most common reason for missing physical activity goals, especially among those with work and family responsibilities.

Most of the patients liked the variety of physical activity options.

The researchers plan to determine all gender differences in ACTIVE-AF.

More research is needed, Elliott added, to determine what type of exercise is best, whether exercise and weight loss are synergistic, and whether exercise leads to better long-term freedom from arrhythmias, reduced hospital stays, and improved survival.

The study was supported in part by the National Heart Foundation of Australia through a postdoctoral fellowship to Elliott. The researchers and Chung have not disclosed any relevant financial relationships.

Congress of the European Society of Cardiology (ESC) 2021: ACTIVE-AF: A randomized controlled study on exercise training in AF patients. Presented on 08/27/2021.

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