Patients with atrial fibrillation (AF) can exercise, and it is often recommended as part of their management plan. However, the type and intensity of exercise should be tailored to the individual's condition and monitored by healthcare professionals.
Exercise recommendations for AF patients
- Moderate-to-vigorous exercise: The ACC/ACCP/AHA/HRS 2024 guidelines recommend moderate-to-vigorous exercise training to a target of 210 minutes per week to reduce AF symptoms and burden, increase maintenance of sinus rhythm, increase functional capacity, and improve quality of life (QoL) in patients with AF
- Tailored exercise program: The EACTS/ESC 2024 guidelines recommend offering a tailored exercise program to patients with paroxysmal or persistent AF to improve cardiorespiratory fitness and reduce AF recurrence
Exercise and AF outcomes
- Exercise capacity: Exercise-based rehabilitation has been shown to increase exercise capacity more than no exercise, as measured by VO₂ peak and the six-minute walking test
- AF symptoms and burden: Aerobic interval training (AIT) for 12 weeks has been shown to reduce the time in AF in patients with nonpermanent AF, followed by significant improvements in AF symptoms, peak oxygen uptake (VO₂ peak), left atrial and ventricular function, lipid levels, and QoL
- Cardiovascular outcomes: A nationwide population-based cohort study found that new exercisers and exercise maintainers were associated with a lower risk of heart failure compared to persistent non-exercisers
Considerations for high-intensity exercise
- High-intensity, long-duration endurance activity: The CCS/CHRS 2020 guidelines suggest offering a period of decreased exercise intensity (detraining) as a possible management strategy for patients engaged in high-intensity, long-duration endurance activity, taking into account their values and preferences
- Catheter ablation for athletes: For athletes developing AF, the ACC/ACCP/AHA/HRS 2024 guidelines suggest considering catheter ablation with pulmonary vein isolation for rhythm control due to its effectiveness and low risk of detrimental effects on exercise capacity
In conclusion, exercise is generally beneficial for patients with AF, but the type and intensity should be individualized. High-intensity endurance exercise may increase the risk of AF, and in such cases, a period of decreased exercise intensity or catheter ablation may be considered. Regular follow-up and monitoring are essential to ensure the safety and effectiveness of the exercise program.