Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation

Abstract

ImportancePatients with atrial fibrillation (AF) experience poor functional capacity and quality of life (QOL). High-intensity interval training (HIIT) has been shown to elicit greater improvements in functional capacity and QOL compared with moderate to vigorous intensity continuous training (MICT) in other cardiovascular populations, yet HIIT remains understudied in AF.ObjectiveTo compare the effects of 12 weeks of HIIT and MICT-based cardiovascular rehabilitation (CR) on functional capacity and general QOL in patients with persistent and permanent AF. Disease-specific QOL, resting heart rate (HR), time in AF, and physical activity (PA) levels were also assessed.Design, Setting, and ParticipantsThis randomized clinical trial, conducted between November 17, 2015, and February 4, 2020, at a tertiary-care cardiovascular health center in Ottawa, Canada, recruited 94 patients with persistent and permanent AF.InterventionsHigh-intensity interval training (23 minutes: two 8-minute interval training blocks of 30-second work periods at 80%-100% of peak power output interspersed with 30-second recovery) or CR (60 minutes: continuous aerobic conditioning within 67%-95% of peak HR and 12-16 of 20 ratings of perceived exertion) twice weekly for 12 weeks.Main Outcomes and MeasuresThe primary outcomes were changes in functional capacity (6-minute walk test [6MWT] distance) and general QOL (Short Form 36) from baseline to 12 weeks’ follow-up. Secondary outcomes included changes in disease-specific QOL (Atrial Fibrillation Severity Scale), resting HR, time in AF, and PA levels. An intention-to-treat analysis was used to compare changes between groups.ResultsOf the 94 patients who consented, 86 participated (mean [SD] age, 69 [7] years; 57 [66.3%] men). No significant differences in improvements in 6MWT distance (mean [SD], 21.3 [34.1] vs 13.2 [55.2] m; P = .42) and general QOL (Physical Component Summary, 0.5 [6.1] vs 1.1 [4.9] points; P = .87) between HIIT and CR were observed. No significant differences in improvements in disease-specific QOL (AF symptoms: −1.7 [4.3] vs −1.5 [4] points, P = .59), resting HR (−3.6 [10.6] vs −2.9 [12.4] beats per minute, P = .63), and moderate to vigorous PA levels (37.3 [93.4] vs 14.4 [125.7] min/wk; P = .35) between HIIT and CR were detected. Participants attended a mean (SD) of 18.3 (6.1) (75.1%) HIIT sessions and 20.0 (4.5) (83.4%) CR sessions (P = .36).Conclusions and RelevanceIn this randomized clinical trial, twice-weekly 23-minute HIIT was as efficacious as twice-weekly 60-minute CR in improving functional capacity, general and disease-specific QOL, resting HR, and PA levels in patients with persistent and permanent AF.Trial RegistrationClinicalTrials.gov Identifier: NCT02602457

High-intensity interval training versus moderate-intensity continuous training on patient quality of life in cardiovascular disease: a systematic review and meta-analysis

“…The characteristics of the included studies are summarized in Table 1 . The included studies were from 12 different countries, with Canada 25 , 29 , 39 , 47 and Norway 27 , 38 , 44 , 45 dominating the origin of articles. All articles were written in English, except for one published in China that was written in Chinese 35 .…”

“…The study participants were predominantly (11/25 studies) patients with coronary heart disease. The remaining studies involved patients with HF 24 , 26 , 38 , 43 , tetralogy of Fallot 12 , heart transplantation 27 , 36 , coronary artery bypass grafting 44 , atrial fibrillation 47 , myocardial infarction 34 , stroke 37 , and hypertension 35 , 41 . Most of the studies reported the registration numbers, while eight did not 25 , 26 , 32 , 34 , 42 – 44 , 46 .…”

“…Table 2 shows the characteristics of the HIIT and MICT exercise programs. The narrative summaries of the exercise interventions are as follows: With the exception of 5 studies that did not mention the intervention sites 12 , 25 , 27 , 35 , 40 , 3 were conducted at home 31 , 34 , 44 , 14 at the hospital and rehabilitation center 24 , 26 , 28 , 29 , 33 , 36 – 39 , 42 – 44 , 46 , 47 , and the remaining studies were conducted the firm, university, or indoor tennis court 30 , 32 , 41 . Exercise was conducted under supervision in all studies except two 34 , 41 , and three studies did not report information regarding supervision 12 , 28 , 33 .…”

“…Two studies did not report data on adherence to exercise 34 , 41 , while in the remaining studies, exercise adherence ranged 67.1–99.0% 12 , 24 – 33 , 35 – 40 , 42 – 46 . Adverse events during the exercise interventions were reported in 19 studies 12 , 24 , 27 , 29 , 31 – 34 , 36 , 38 – 40 , 42 – 47 and of the two reported adverse exercise events 29 , 31 . In all but two studies 26 , 31 , warm-up or relaxation exercises were involved in the exercise program.…”

Atrial fibrillation: comorbidities, lifestyle, and patient factors

“… 9 High-intensity interval training improves functional capacity and quality of life in AF, similar to moderate-to-vigorous continuous training. 10 …”