Introduction and purpose: Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increasing prevalence with advancing age. It is associated with dyspnea, exercise intolerance, and increased risk for clinical events, especially stroke and heart failure. This article provides a concise review of exercise testing and rehabilitation in patients with persistent or permanent AF.
Clinical considerations: The first goal in the treatment of AF is to reduce symptoms (eg, palpitations) and a fast ventricular rate. The second goal is to reduce the risk of a stroke. Exercise testing and rehabilitation may be useful once these goals are achieved. However, there are no large, randomized exercise training trials involving patients with AF, and what data are available comes from single-site trials, secondary analyses, and observational studies.
Exercise testing and training: There are no specific indications for performing a graded exercise test in patients with AF; however, such testing may be used to screen for myocardial ischemia or evaluate chronotropic response during exertion. Among patients with AF, exercise capacity is 15% to 20% lower and peak heart rate is higher than in patients in sinus rhythm. Exercise rehabilitation improves exercise capacity, likely improves quality of life, and may improve symptoms associated with AF. Whole-body aerobic exercise is recommended.
Summary: Atrial fibrillation is a common cardiac condition and in these patients, exercise rehabilitation favorably improves exercise capacity. However, prospective randomized controlled trials are needed to better define the effects of exercise training on safety; quality of life; clinical outcomes; and central, autonomic, and peripheral adaptations.
Conflict of interest statement
Conflicts of interests: Dr. Keteyian is a technical consultant with Nimble Heart, Inc. and the remaining authors declare no conflicts.
Exercise-based Cardiac Rehabilitation for Adults With Atrial FibrillationSS Risom et al. Cochrane Database Syst Rev 2 (2), CD011197. PMID 28181684. - ReviewDue to few randomised patients and outcomes, we could not evaluate the real impact of exercise-based cardiac rehabilitation on mortality or serious adverse events. The ev …
Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: Association With Exercise Capacity, Left Ventricular Filling Pressures, Natriuretic Peptides, and Left Atrial VolumeCS Lam et al. JACC Heart Fail 5 (2), 92-98. PMID 28017355.AF is independently associated with greater exertional intolerance, natriuretic peptide elevation, and left atrial remodeling in HFpEF. These data support the application …
Impact of Atrial Fibrillation on Exercise Capacity in Heart Failure With Preserved Ejection Fraction: A RELAX Trial Ancillary StudyR Zakeri et al. Circ Heart Fail 7 (1), 123-30. PMID 24162898. - Randomized Controlled TrialAF identifies an HFpEF cohort with more advanced disease and significantly reduced exercise capacity. These data suggest that evaluation of the impact of different rate o …
Exercise Training in Patients With Chronic Heart Failure and Atrial FibrillationN Luo et al. J Am Coll Cardiol 69 (13), 1683-1691. PMID 28359513. - Randomized Controlled TrialAF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential …
Exercise Training in Heart Failure Patients With Persistent Atrial Fibrillation: A Practical ApproachJ Cornelis et al. Card Fail Rev 4 (2), 107-111. PMID 30206486. - ReviewPersistent AF is present in at least 20 % of patients with chronic heart failure (CHF) and is related to a poor prognosis and more severe cardiac arrhythmias. CHF and AF …