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Exercise to Maintain Normal Heart Rhythm and Ease Symptoms―But Doesn’t Cure A-Fib

In a study from Australia (ACTIVE-AF), a six-month exercise program helped maintain normal heart rhythm and reduced the severity of symptoms in patients with atrial fibrillation.

In the ACTIVE-AF study, 120 symptomatic paroxysmal or persistent A-Fib patients were randomly assigned to a six-month exercise program or a program of usual care (control group). The average age of patients in the study was 65 years and 43% were women.

The exercise program included supervised exercise weekly for three months, then every two-weeks for three months.

The exercise group also had an individualized weekly exercise plan to follow at home. The goal was to increase aerobic exercise up to 3.5 hours a week. The six-month exercise program was followed up by another six months of observation.

Study Results

According to lead author was Dr. Adrian Elliott of the University of Adelaide, Adelaide, Australia, the A-Fib recurrence rate was significantly lower in the exercise group (60%) vs the control group (80%).

Patients in the exercise group also had a significant reduction in the severity of their symptoms at 12 months compared to the control group (less severe palpitations, shortness of breath, and fatigue).

ACTIVE-AF Conclusions

“The ACTIVE-AF trial demonstrates that some patients can control their arrhythmia through physical activity, without the need for complex interventions such as ablation or medications to keep their heart in normal rhythm,” said study author Dr. Adrian Elliott.

Recommendations for patients with symptomatic paroxysmal or persistent A-Fib:

• Aerobic exercise should part of the treatment plan, alongside the use of medications and the management of obesity, hypertension, and sleep apnea;
• Patients should strive to build up to 3.5 hours per week of aerobic exercise;
• Some higher intensity activities should be incorporated to improve cardiorespiratory fitness.

Editor’s Comments

Editor's Comments about Cecelia's A-Fib story

We know from many other studies that exercise is recommended for patients with coronary heart disease and heart failure, but also for overall heart fitness and health.
This small study shows that exercise is good for A-Fib patients as well. Though sometimes it just isn’t possible with symptomatic A-Fib. (e.g., When I had A-Fib years ago, my heart rate would get very high when I’d try to jog. I’d have to stop and walk home.)
Relying on exercise to “cure” A-Fib is probably a false hope. Exercise alone won’t eliminate your A-Fib. But for those who are symptomatic, exercise can improve your A-Fib symptoms and reduce “recurrence” of your A-Fib (i.e., after being symptom-free for a period of time).

Take Away for A-Fib Patients: Aerobic exercise to improve cardiorespiratory fitness should become a regular habit. Even after one is cured of A-Fib (i.e., by catheter ablation, etc.) because exercise helps prevent recurrence of A-Fib.

• Exercise maintains normal heart rhythm in patients with atrial fibrillation. European Society of Cardiology. August 23, 2021.

• ESC 2021: ACTIVE-AF finds benefits for exercise programme in AF patients. Cardiac Rhythm News. 23rd August 2021.

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