Exercise Training and Atrial Fibrillation

Elliott, Adrian D.; Mahajan, Rajiv; Pathak, Rajeev K.; Lau, Dennis H.; Sanders, Prashanthan

doi:10.1161/circulationaha.115.020800

Cited by 25 publications

(6 citation statements)

References 21 publications

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“…These interactions suggest atrial fibrillation to beget HFpEF and vice versa and suggest efforts to restore sinus rhythm could be included in a HFpEF treatment strategy. Similar to HFpEF, atrial fibrillation reacts favorably to exercise training and weight loss 155 . To restore sinus rhythm, only cardioversion is recommended as catheter ablation of atrial fibrillation had limited long term success in HFpEF with single- and multiple-procedure drug-free success rates of respectively 27 and 45% 156 .…”

Section: Phenotypic Treatment Strategymentioning

confidence: 99%

Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction

Shah¹,

et al. 2016

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Heart failure (HF) with preserved ejection fraction (EF) (HFpEF) accounts for 50% of HF cases and its prevalence relative to HF with reduced EF (HFrEF) continues to rise. In contrast to HFrEF, large trials testing neurohumoral inhibition in HFpEF failed to reach a positive outcome. This failure was recently attributed to distinct systemic and myocardial signaling in HFpEF and to diversity of HFpEF phenotypes. In this review, a HFpEF treatment strategy is proposed which addresses HFpEF-specific signaling and phenotypic diversity. In HFpEF, extracardiac comorbidities such as metabolic risk, arterial hypertension and renal insufficiency drive left ventricular (LV) remodeling and dysfunction through systemic inflammation and coronary microvascular endothelial dysfunction. The latter affects LV diastolic dysfunction through macrophage infiltration resulting in interstitial fibrosis and through altered paracrine signaling to cardiomyocytes, which become hypertrophied and stiff because of low nitric oxide (NO) and cyclic guanosine monophosphate (cGMP). Systemic inflammation also affects other organs such as lungs, skeletal muscle and kidneys leading respectively to pulmonary hypertension, muscle weakness and sodium retention. Individual steps of these signaling cascades can be targeted by specific interventions: metabolic risk by caloric restriction, systemic inflammation by statins, pulmonary hypertension by phosphodiesterase (PDE) 5 inhibitors, muscle weakness by exercise training, sodium retention by diuretics and monitoring devices, myocardial NO bioavailability by inorganic nitrate-nitrite, myocardial cGMP content by neprilysin or PDE 9 inhibition and myocardial fibrosis by spironolactone. Because of phenotypic diversity in HFpEF, personalized therapeutic strategies are proposed, which are configured in a matrix with HFpEF presentations in the abscissa and HFpEF predispositions in the ordinate.

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Section: Phenotypic Treatment Strategymentioning

confidence: 99%

Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction

Shah¹,

et al. 2016

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“…Concerns about damaging the heart are unfounded, indeed studies have shown physical exercise reduces AF burden and improves quality of life. 36 Food was seen as a source of comfort during times of anxiety caused by AF symptoms, provoking resistance to weight management through calory-restriction alone. Several participants spoke of postponing weight-loss attempts until an anticipated future time when treatment would restore sinus rhythm.…”

Section: Discussionmentioning

confidence: 99%

“…The experience of AF symptoms impacted on participants’ willingness to engage in regular exercise that might contribute to weight management. Concerns about damaging the heart are unfounded, indeed studies have shown physical exercise reduces AF burden and improves quality of life 36. Food was seen as a source of comfort during times of anxiety caused by AF symptoms, provoking resistance to weight management through calory-restriction alone.…”

Section: Discussionmentioning

confidence: 99%

‘Out of sync’: a qualitative investigation of patients’ experiences of atrial fibrillation and perceptions of weight management

2022

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ObjectivesTo explore ways to enhance the design of risk factor management and weight-loss services for people with overweight/obesity and atrial fibrillation (AF).BackgroundAF is the most common cardiac arrhythmia, with serious consequences for health and quality of life. Some evidence indicates weight reduction in people with AF and overweight/obesity may improve symptoms. This population may require additional support with weight management due to factors associated with ageing and health.DesignQualitative investigation based on semi-structured interviews.Methods12 adult participants (4 female, 8 male) with diagnosed AF and a current or previous body mass index >27 kg/m2were recruited at a large tertiary cardiac referral centre in southern England between September 2020 and January 2021. Participants completed quality of life and AF symptom questionnaires using Think-Aloud technique and semi-structured interviews relating to their weight management experiences, needs and preferences. Interviews were audio recorded and analysed thematically using the Capability, Opportunity and Motivation-Behaviour model as a theoretical framework.ResultsThree main themes were identified.Being out of rhythmexplores the psychological and physical impact of AF on weight management;doing the right thingdiscusses participants’ weight management experiences andbroaching the subjectexplores participants’ perspectives on weight management conversations with clinicians.ConclusionsThere was dissatisfaction with the weight management advice received from healthcare professionals including cardiologists. Participants wanted open, non-judgemental discussion of cardiac health implications of overweight/obesity supported by referral to weight management services. Improved communication including research findings regarding the benefits of weight loss as a factor in AF management might increase motivation to adhere to weight-loss advice in this population.

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“…The proposed mechanism behind the association between PA and lower AF risk is that PA can have a beneficial effect on several AF risk factors, including improving the management of hypertension and diabetes mellitus, 26 , 27 assisting in weight management 28 and improving cardiac structure and function. 29 , 30 Conversely, PA might increase AF risk when individuals engage in frequent exercise (i.e. 5–7 times per week) and with high intensity.…”

Section: Discussionmentioning

confidence: 99%

Physical activity types and atrial fibrillation risk in the middle-aged and elderly: The Rotterdam Study

Albrecht

Koolhaas

Schoufour

et al. 2018

Eur J Prev Cardiolog

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BackgroundThe association between physical activity and atrial fibrillation remains controversial. Physical activity has been associated with a higher and lower atrial fibrillation risk. These inconsistent results might be related to the type of physical activity. We aimed to investigate the association of total and types of physical activity, including walking, cycling, domestic work, gardening and sports, with atrial fibrillation.DesignProspective cohort study.MethodsOur study was performed in the Rotterdam Study, a prospective population-based cohort. We included 7018 participants aged 55 years and older with information on physical activity between 1997–2001. Cox proportional hazards models were used to examine the association of physical activity with atrial fibrillation risk. Models were adjusted for biological and behavioural risk factors and the remaining physical activity types. Physical activity was categorised in tertiles and the low group was used as reference.ResultsDuring 16.8 years of follow-up (median: 12.3 years, interquartile range: 8.7–15.9 years), 800 atrial fibrillation events occurred (11.4% of the study population). We observed no association between total physical activity and atrial fibrillation risk in any model. After adjustment for confounders, the hazard ratio and 95% confidence interval for the high physical activity category compared to the low physical activity category was: 0.71 (0.80–1.14) for total physical activity. We did not observe a significant association between any of the physical activity types with atrial fibrillation risk.ConclusionOur results suggest that physical activity is not associated with higher or lower risk of atrial fibrillation in older adults. Neither total physical activity nor any of the included physical activity types was associated with atrial fibrillation risk.

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Exercise Training and Atrial Fibrillation

Cited by 25 publications

References 21 publications

Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction

Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction

‘Out of sync’: a qualitative investigation of patients’ experiences of atrial fibrillation and perceptions of weight management

Physical activity types and atrial fibrillation risk in the middle-aged and elderly: The Rotterdam Study

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