Exercise in patients with atrial fibrillation. Risks in check, rhythms in balance.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and affect >33 million people worldwide. AF relates strongly to higher age, hypertension, obesity, diabetes, physical inactivity and underlying cardiovascular disease (CVD). AF prevalence is therefore expected to more than double the next 30 years, due to ageing of the population, increased prevalence of obesity, and improved survival from other CVD. AF patients suffer from reduced quality of life (QoL) and symptom burden, increased mortality and few treatment options. They have a high burden of cardiovascular risk factors and events. Exercise can become an important part of lifestyle changes in AF treatment, but has not been implemented due to limited evidence and fear of increased AF burden and high heart rates during exercise. Specific guidelines for exercise do not exist for AF patients. In this project, we seek to close the knowledge gaps that have impeded structured use of exercise in AF management. To achieve this, we initiate a large-scale study including 500 AF patients. These will be divided into two groups; an exercise group vs. a control group, to determine the feasibility and safety of exercise, effects on AF burden, heart rate during exercise, QoL and symptoms, cardiorespiratory fitness, cardiac function, cognitive function and overall cardiovascular risk. All participants will undergo continuous rhythm monitoring by an implantable heart rhythm recorder, enabling assessment of duration, frequency and total time of AF episodes.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and affect >33 million people worldwide. AF relates strongly to higher age, hypertension, obesity, diabetes, physical inactivity and underlying cardiovascular disease (CVD). AF prevalence is therefore expected to more than double the next 30 years, due to ageing of the population, increased prevalence of obesity, and improved survival from other CVD. AF patients suffer from reduced quality of life (QoL) and symptom burden, increased mortality and inappropriate treatment options. They have a high burden of cardiovascular risk factors and events. Exercise can become an important part of lifestyle changes in AF treatment, but has not been implemented due to limited evidence and fear of increased AF burden and high ventricular rate during exercise. Guidelines for exercise do not exist for AF patients. In this project, we seek to close the knowledge gaps that have impeded structured use of exercise in AF management. To achieve this, we propose a large-scale multicenter RCT including 360 AF patients across three participating hospitals in Norway. These will be randomized 1:1 to a one-year e-health based exercise intervention vs. control, to determine the feasibility and safety of exercise, effects on AF burden, heart rate during exercise, QoL and symptoms, cardiorespiratory fitness, cardiac function, cognitive function and overall cardiovascular risk. All patients will undergo continuous rhythm monitoring by an implantable loop recorder, enabling assessment of duration, frequency and total time of AF episodes. The size and quality of the trial will ensure high impact and lay foundation for evidence based exercise guidelines for the growing number of AF patients.