Effects of Supervised Exercise Training on Atrial Fibrillation

Oesterle, Adam; Giancaterino, Shaun; Noord, Megan Van; Pellegrini, Cara N.; Ding, Fan; Srivatsa, Uma N.; Amsterdam, Ezra A.

doi:10.1097/hcr.0000000000000665

Cited by 18 publications

(6 citation statements)

References 41 publications

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“…This review demonstrated that incorporating CR for patients with AF following RFCA either diminished or did not alter the risk of AF recurrence. This finding stands in contrast to prior systematic reviews [ 22 ]. The preceding review reported a reduction in AF recurrence; however, only three studies were included in the meta-analysis that examined AF recurrence.…”

Section: Reviewcontrasting

confidence: 99%

“…There is no conclusive evidence that moderate-intensity CR increases the incidence of AF, and its role in AF recurrence after RFCA has not been determined. Previously, a systematic review was conducted examining the prevention of AF recurrence with exercise [ 22 ]. However, the results are uncertain because fewer than three studies were included in that review, and exercise intensity was not standardized.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Kurasawa,

Maeda,

Tamaru

et al. 2023

Cureus

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Despite the potential of cardiac rehabilitation (CR) to reduce atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA), its prescription is not routine. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of CR in this setting. Inclusion criteria comprised randomized controlled trials (RCTs) comparing CR with usual care in patients with AF following RFCA. We performed a comprehensive search of six databases up to August 17, 2023, and conducted a thorough risk of bias assessment. We synthesized safety outcomes using AF recurrence rates to calculate relative risks (RR). Furthermore, we conducted a meta-analysis on peak oxygen uptake (VO 2 peak) and the six-minute walk test (6MWT) to gauge efficacy, utilizing mean differences (MD) for comparison. The GRADE framework was employed to determine the certainty of evidence, with two independent reviewers completing all processes. Our analysis encompassed eight studies with 772 participants aged 55-70 years engaged in moderate-intensity CR for a median of six months. Results showed no significant difference in AF recurrence after CR (RR = 0.69 (0.41-1.14)), with low evidence certainty due to heterogeneity. Subgroup analyses suggested a poor risk reduction effect in patients with obesity and persistent AF. Significant improvements were observed in VO 2 peak and 6MWT outcomes (VO 2 peak; MD = 2.53 (0.78-4.28), 6MWT; MD = 38.81 (0.65-76.97)), with moderate-certainty evidence. While CR may decrease AF recurrence after RFCA, its effectiveness varies, potentially diminishing in patients with obesity or persistent AF. Moderate gains in physical performance were achieved with minimal adverse events. Further RCTs are warranted to confirm these findings.

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Section: Reviewcontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Kurasawa,

Maeda,

Tamaru

et al. 2023

Cureus

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“…Recommendation-Specific Supportive Text In patients with nonpermanent AF, aerobic exercise training may contribute to a reduction in AF burden and improve maintenance of sinus rhythm. 2–5 Aerobic exercise interventions reduce severity of AF symptoms, increase functional capacity, and improve health-related QOL among patients with both nonpermanent and permanent AF. 1,3,6 Initiation of or continuing regular exercise after development of AF was associated with a lower risk of HF and mortality in a population-based cohort study.…”

Section: Lifestyle and Risk Factor Modification (Lrfm) For Af Managementmentioning

confidence: 99%

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Joglar,

Chung,

Armbruster

et al. 2024

Circulation

566

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AIM The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

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“…Randomized studies examining the impact of lifestyle modification and cardiac rehabilitation on secondary prevention of AF have been limited in size and duration, with few evaluating sustainability. 4 , 5 , 8 The ACTIVE-AF trial demonstrated that a tailored aerobic-based exercise program reduced AF symptom severity and improved maintenance of sinus rhythm. 9 These benefits were achieved in the absence of weight loss.…”

Section: Discussionmentioning

confidence: 99%

A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: Introductory Findings

Ashburner,

Carmichael,

Bhattacharya

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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Effects of Supervised Exercise Training on Atrial Fibrillation

Cited by 18 publications

References 41 publications

Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: Introductory Findings

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