Atrial Fibrillation Specific Exercise Rehabilitation: Are We There Yet?

Abstract

Regular physical activity and exercise training are integral for the secondary prevention of cardiovascular disease. Despite recent advances in more holistic care pathways for people with atrial fibrillation (AF), exercise rehabilitation is not provided as part of routine care. The most recent European Society of Cardiology report for AF management states that patients should be encouraged to undertake moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. The aim of this review was to collate data from primary trials identified in three systematic reviews and recent real-world cohort studies to propose an AF-specific exercise rehabilitation guideline. Collating data from 21 studies, we propose that 360-720 metabolic equivalent (MET)-minutes/week, corresponding to ~60-120 min of exercise per week at moderate-to-vigorous intensity, could be an evidence-based recommendation for patients with AF to improve AF-specific outcomes, quality of life, and possibly prevent long-term major adverse cardiovascular events. Furthermore, non-traditional, low-moderate intensity exercise, such as Yoga, seems to have promising benefits on patient quality of life and possibly physical capacity and should, therefore, be considered in a personalised rehabilitation programme. Finally, we discuss the interesting concepts of short-term exercise-induced cardioprotection and 'none-response' to exercise training with reference to AF rehabilitation.

Keywords: atrial fibrillation; atrial health; cardiovascular disease; exercise; physical activity; preventive cardiology; rehabilitation medicine; secondary prevention; vascular health.

Figure 1

Proposed mechanisms explaining the long-term AF protection from regular exercise training. We propose atrial health has a direct impact on AF recurrence/burden and an indirect impact on AF morbidity whereas vascular health has a direct impact on AF morbidity and an indirect impact on AF recurrence/burden. Dark blue arrows represent a direct relationship. Light blue arrows represent an indirect relationship.