Efficacy of Physical Exercise on the Quality of Life, Exercise Ability, and Cardiopulmonary Fitness of Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Objective: Physical exercise is recommended to help prevent lifestyle diseases. The present study was designed to quantify the efficacy of physical exercise on the quality of life (QoL), exercise ability and cardiopulmonary fitness of patients with atrial fibrillation (AF). Method: A comprehensive systematic literature search was performed in Medline, Embase, Cochrane Library, Web of Science and PubMed databases (from 1970 to December 1st, 2019) for randomized controlled trials (RCTs) comparing physical exercise combined with AF routine treatments to routine treatments alone. The meta-analysis was conducted following PRISMA guidelines. Our main outcomes were QoL (measured by the Short-Form 36 scale, SF-36), exercise ability (measured by the 6-min walk test, 6MWT) and cardiopulmonary fitness (measured by peak oxygen uptake and resting heart rate). Quality assessments were conducted using the Cochrane Collaboration tool. Results: Twelve trials involving 819 patients met the criteria for analysis. The results showed that physical exercise improved the QoL by enhancing physical functioning [standardized mean difference (SMD) = 0.63, 95%CI: 0.18–1.09; p = 0.006], general health perceptions (SMD = 0.64, 95%CI: 0.35–0.93; p < 0.001) and vitality (SMD = 0.51, 95%CI: 0.31–0.71; p < 0.001); increased exercise ability by improving the 6MWT performance (SMD = 0.69, 95%CI: 0.19–1.119; p = 0.007); and enhanced peak VO 2 (SMD = 0.37, 95%CI: 0.16–0.57; p < 0.001) while reducing resting heart rate (SMD = −0.39, 95%CI: −0.65 to −0.13; p = 0.004). In addition, meta-regression analysis showed that training mode ( p physicalfunctioning = 0.012, p generalhealthperceptions = 0.035) and training duration ( p = 0.047) were the main factors of an intervention that influenced the effect size. Following sub-group analysis, we found that aerobics, Yoga and longer training durations (≥60 min) showed larger improvements. Conclusion: In summary, our meta-analysis shows that physical exercise has a positive effect on the QoL, exercise ability and cardiopulmonary fitness in AF patients. When physicians offer exercise recommendations to AF patients, they should consider both the training mode and training duration to achieve maximum results.

Reabilitação cardiovascular aumenta qualidade de vida e capacidade de exercício após ablação cardíaca de pacientes com fibrilação atrial

“…While one carried out the evaluation in the 1st, 4th, 6th month [18] after the intervention, the other [16] applied the SF-36 questionnaire adapted for his study only once [34], which may have interfered in the QoL analysis. Therefore, as in other studies, positive effects of CR were observed on QOL, exercise capacity and cardiopulmonary fitness in individuals with AF, highlighting the findings of this review [35].…”

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

“…Both groups fared similarly despite the 336-minute difference in total exercise conditioning volume (CR: 720 minutes vs HIIT: 384 minutes). A recent meta-regression analysis in patients with AF reported that exercise sessions of at least 60 minutes could significantly increase 6MWT distance, yet the patients in the HIIT group of our study demonstrated significant increases after a program duration of only 23 minutes. A meta-analysis showed, however, superior increases of 47 m in 6MWT distance following MICT-based CR compared with control (ie, usual care) in patients with paroxysmal, persistent, and permanent AF .…”

Effects of different exercise types on quality of life for patients with atrial fibrillation: a systematic review and meta-analysis

“…During our search, similar exercise-related systematic reviews on patients with AF were identified 33–36 . The first systematic review 33 investigated the benefits of physical activity in AF patients with 1056 participants from 36 articles.…”

“…The most recent systematic review and meta-analysis (12 studies, n = 819 participants) 36 also reported a significant improvement in vitality [SMD: 0.51 (95% CI: 0.31–0.71)], physical functioning [SMD: 0.63 (95% CI: 0.18–1.09)] and general health [SMD: 0.64 (95% CI: 0.35–0.93)], although the heterogeneity was high in the last two domains ( I 2 = 85.6%, and I 2 = 66.2% respectively). V̇O 2peak and 6MWT were also significantly improved [SMD: 0.37 (95% CI: 0.16–0.57), SMD: 0.69 (95% CI: 0.19–1.19) respectively] but heterogeneity was high in the 6MWT ( I 2 = 70.6%) owing to the training duration.…”