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Randomized Controlled Trial
. 2023 Apr;9(4):455-465.
doi: 10.1016/j.jacep.2022.12.002. Epub 2023 Jan 18.

An Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial

Adrian D Elliott  1 , Christian V Verdicchio  2 , Rajiv Mahajan  3 , Melissa E Middeldorp  4 , Celine Gallagher  4 , Ricardo S Mishima  4 , Jeroen M L Hendriks  5 , Rajeev K Pathak  6 , Gijo Thomas  2 , Dennis H Lau  4 , Prashanthan Sanders  7
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Free article
Randomized Controlled Trial

An Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial

Adrian D Elliott et al. JACC Clin Electrophysiol. 2023 Apr.
Free article

Abstract

Background: There are limited data on the effect of exercise interventions on atrial fibrillation (AF) recurrence and symptoms.

Objectives: The aim of this study was to determine the efficacy of an exercise and physical activity intervention on AF burden and symptoms among patients with symptomatic AF.

Methods: This prospective, randomized controlled trial included 120 patients with paroxysmal or persistent, symptomatic AF, randomized 1:1 to receive an exercise intervention, combining home and supervised aerobic exercise over 6 months, or to receive usual care. The coprimary outcomes were: 1) AF recurrence, off antiarrhythmic medications and without catheter ablation; and 2) symptom severity assessed by using a validated questionnaire.

Results: By 12 months, freedom from AF was achieved in 24 (40%) of 60 patients in the exercise group and 12 (20%) of 60 patients in the control group (HR: 0.50: 95% CI: 0.33 to 0.78). At 6 months, AF symptom severity was lower in the exercise group compared with the control group (mean difference -2.3; 95% CI: -4.3 to -0.2; P = 0.033). This difference persisted at 12 months (-2.3; 95% CI: -4.5 to -0.1; P = 0.041). Total symptom burden was lower at 6 months in the exercise group but not at 12 months. Peak oxygen consumption was increased in the exercise group at both 6 and 12 months. There were no between-group differences in cardiac structure or function, body mass index, or blood pressure.

Conclusions: Participation in an exercise-based intervention over 6 months reduced arrhythmia recurrence and improved symptom severity among patients with AF. (A Lifestyle-based, PhysiCal AcTIVity IntErvention for Patients With Symptomatic Atrial Fibrillation [the ACTIVE-AF Study]; ACTRN12615000734561).

Keywords: arrhythmia; cardiorespiratory fitness; exercise; risk factors.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported by funding from the National Heart Foundation of Australia through a postdoctoral fellowship to Dr Elliott. Dr Mahajan is supported by a mid-career fellowship from The Hospital Research Foundation. Drs Middeldorp and Gallagher are supported by postdoctoral fellowships from the University of Adelaide. Dr Hendriks is supported by a Future Leader Fellowship from the Australian Heart Foundation. Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia. The University of Adelaide has received on behalf of Dr Mahajan lecture and/or consulting fees from Medtronic, Abbott, Pfizer, and Bayer; and the University of Adelaide has also received on behalf of Dr Mahajan research funding from Medtronic, Abbott, and Bayer. Flinders University has received on behalf of Dr Hendriks lecture and/or consulting fees from Biotronik. The University of Adelaide has received on behalf of Dr Lau lecture and/or consulting fees from Abbott Medical, Boehringer Ingelheim, Bayer, and Pfizer. Dr Sanders has served on the advisory board of Boston Scientific, CathRx, Medtronic, Abbott Medical, and PaceMate. The University of Adelaide has received on behalf of Dr Sanders lecture and/or consulting fees from Medtronic, Boston Scientific, Abbott Medical, PaceMate, and CathRx; the University of Adelaide has also received on behalf of Dr Sanders research funding from Medtronic, Abbott Medical, Boston Scientific, PaceMate, and MicroPort. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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