ACTIVE-AF – exercise and its role in AF symptom burden

By Dr Jonathan Shurlock

Recurrence of arrhythmia and symptom severity are important patient centred outcomes for individuals with symptomatic atrial fibrillation (AF). A research group led by Dr Prashanthan Sanders have explored the role of supervised exercise and home based physical activity in reducing recurrent arrhythmia and symptom severity. The work first presented at the ESC 2021 congress is now published in JACC: Clinical Electrophysiology. 

The authors randomised 120 patients with symptomatic AF (paroxysmal or persistent) 1:1 to an exercise intervention group and a usual standard care group. Those with permanent AF were excluded. The average age of participants was 65 years.

The two primary outcomes were: 

  1. Recurrent AF (defined as any episodes lasting longer >30 seconds), undergoing an ablation, or requiring ongoing anti-arrhythmic medication
  2. Self-reported symptom severity (Measured by AFSS Questionnaire)

The intervention group underwent supervised exercise (weekly for three months then fortnightly for three months) and an individualised home-based physical activity plan. The aim was to increase to and then maintain up to 3.5 hours per week of aerobic exercise. Supervised sessions were higher intensity in an effort to raise cardiorespiratory fitness, and home-based exercise was moderate intensity self-selected aerobic activity. The usual standard care group received exercise advice and no additional intervention.

At 12 months follow-up, 40% of the exercise intervention group (24/60) achieved freedom from AF, compared with 20% (12/60) in the control group (HR: 0.50: 95% CI: 0.33 to 0.78). Reported symptoms were less severe in the exercise group compared to the usual standard care group at both 6 months (mean difference –2.3; 95% CI: –4.3 to –0.2; P = 0.033) and 12 months (–2.3; 95% CI: –4.5 to –0.1; P = 0.041). Total symptom burden was lower in the exercise group at 6 months, though this difference did not persist over 12 months.

The authors conclude that their study provides evidence for incorporating aerobic exercise into the treatment of patients with symptomatic AF, alongside current usual management, including other lifestyle interventions.

See the full study here: