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Clinical Research in Cardiology

Published in:

01-04-2019 | Review

Exercise in individuals with atrial fibrillation

Authors: Marius Myrstad, Vegard Malmo, Sara Reinvik Ulimoen, Arnljot Tveit, Jan Pål Loennechen

Published in: Clinical Research in Cardiology | Issue 4/2019

Abstract

Background

Despite the high prevalence of atrial fibrillation (AF), there is a lack of recommendations for physical activity and exercise in individuals with AF, including athletes with AF.

Methods

With the aim to review studies that have investigated effects and safety of exercise in individuals with AF, we conducted a literature search in Pubmed using the key words atrial fibrillation AND exercise OR physical activity OR exercise/adverse effects OR adverse outcome.

Results

Observational data from one registry suggest that regular exercise is associated with reduced mortality in AF patients. Three randomized controlled trials (RCTs) have demonstrated that 12-week exercise interventions might reduce the burden of AF and improve exercise capacity by 10–16% in patients with paroxysmal or persistent AF. Three small RCTs suggest that exercise might improve exercise capacity with 15–41% in patients with permanent AF. Exercise might improve quality of life in patients with AF. Data on safety of exercise are sparse. No studies have evaluated the effect of exercise in athletes with AF.

Conclusions

Despite weak evidence, we suggest that individuals with AF should exercise regularly after evaluation of underlying conditions. Recommendations should be individualized. There is a lack of data to support exercise recommendations in athletes with AF.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962CrossRefPubMed

Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al (2014) Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation 129:837–847CrossRefPubMed

Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A et al (2013) Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 34:2746–2751CrossRefPubMedPubMedCentral

Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD et al (2015) 50 Year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386:154–162CrossRefPubMedPubMedCentral

Mohanty S, Mohanty P, Tamaki M, Natale V, Gianni C, Trivedi C et al (2016) Differential association of exercise intensity with risk of atrial fibrillation in men and women: evidence from a meta-analysis. J Cardiovasc Electrophysiol 27:1021–1029CrossRefPubMed

Gorenek Chair B, Pelliccia Co-Chair A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI et al (2017) European heart rhythm association (EHRA)/European association of cardiovascular prevention and rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the heart rhythm society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Eur J Prev Cardiol 24:4–40CrossRef

Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM et al (2007) Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 115:2675–2682CrossRefPubMed

Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS et al (2014) 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:S76–S99CrossRefPubMed

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al (2016) 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for cardiovascular prevention and rehabilitation (EACPR). Eur J Prev Cardiol 23:Np1–Nnp96CrossRefPubMed

10.

Grimsmo J, Grundvold I, Maehlum S, Arnesen H (2010) High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors—a 28–30 years follow-up study. Eur J Cardiovasc Prev Rehabil 17:100–105CrossRefPubMed

11.

Myrstad M, Lochen ML, Graff-Iversen S, Gulsvik AK, Thelle DS, Stigum H et al (2014) Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scand J Med Sci Sports 24:e238–e244CrossRefPubMed

12.

Myrstad M, Nystad W, Graff-Iversen S, Thelle DS, Stigum H, Aaronaes M et al (2014) Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter. Am J Cardiol 114:1229–1233CrossRefPubMed

13.

Myrstad M, Aaronaes M, Graff-Iversen S, Nystad W, Ranhoff AH (2015) Does endurance exercise cause atrial fibrillation in women? Int J Cardiol 184:431–432CrossRefPubMed

14.

Sanchis-Gomar F, Perez-Quilis C, Lippi G, Cervellin G, Leischik R, Lollgen H et al (2017) Atrial fibrillation in highly trained endurance athletes—description of a syndrome. Int J Cardiol 226:11–20CrossRefPubMed

15.

Wernhart S, Halle M (2015) Atrial fibrillation and long-term sports practice: epidemiology and mechanisms. Clin Res Cardiol 104:369–379CrossRefPubMed

16.

Perez-Quilis C, Lippi G, Cervellin G, Lollgen H, Sanchis-Gomar F (2017) Exercising recommendations for paroxysmal AF in young and middle-aged athletes (PAFIYAMA) syndrome. Ann Transl Med 5:24CrossRefPubMedPubMedCentral

17.

Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O et al (2016) Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial. Circulation 133:466–473CrossRefPubMed

18.

Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U (2017) Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation—a randomized controlled trial. PLoS One 12:e0170060CrossRefPubMedPubMedCentral

19.

Risom SS, Zwisler AD, Rasmussen TB, Sibilitz KL, Madsen TL, Svendsen JH et al (2016) Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: Results of the randomized CopenHeartRFA trial. Am Heart J 181:120–129CrossRefPubMed

20.

Mertens DJ, Kavanagh T (1996) Exercise training for patients with chronic atrial fibrillation. J Cardiopulm Rehabil 16:193–196CrossRefPubMed

21.

Vanhees L, Schepers D, Defoor J, Brusselle S, Tchursh N, Fagard R (2000) Exercise performance and training in cardiac patients with atrial fibrillation. J Cardiopulm Rehabil 20:346–352CrossRefPubMed

22.

Hegbom F, Sire S, Heldal M, Orning OM, Stavem K, Gjesdal K (2006) Short-term exercise training in patients with chronic atrial fibrillation: effects on exercise capacity, AV conduction, and quality of life. J Cardiopulm Rehabil 26:24–29CrossRefPubMed

23.

Hegbom F, Stavem K, Sire S, Heldal M, Orning OM, Gjesdal K (2007) Effects of short-term exercise training on symptoms and quality of life in patients with chronic atrial fibrillation. Int J Cardiol 116:86–92CrossRefPubMed

24.

Plisiene J, Blumberg A, Haager G, Knackstedt C, Latsch J, Norra C et al (2008) Moderate physical exercise: a simplified approach for ventricular rate control in older patients with atrial fibrillation. Clin Res Cardiol 97:820–826CrossRefPubMed

25.

Osbak PS, Mourier M, Henriksen JH, Kofoed KF, Jensen GB (2012) Effect of physical exercise training on muscle strength and body composition, and their association with functional capacity and quality of life in patients with atrial fibrillation: a randomized controlled trial. J Rehabil Med 44:975–979CrossRefPubMed

26.

Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R et al (2015) Impact of CARDIOrespiratory fitness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol 66:985–996CrossRefPubMed

27.

Proietti M, Boriani G, Laroche C, Diemberger I, Popescu MI, Rasmussen LH et al (2017) Self-reported physical activity and major adverse events in patients with atrial fibrillation: a report from the EURObservational research programme pilot survey on atrial fibrillation (EORP-AF) general registry. Europace 19:535–543CrossRefPubMed

28.

Luo N, Merrill P, Parikh KS, Whellan DJ, Pina IL, Fiuzat M et al (2017) Exercise training in patients with chronic heart failure and atrial fibrillation. J Am Coll Cardiol 69:1683–1691CrossRefPubMedPubMedCentral

29.

Rienstra M, Hobbelt AH, Alings M, Tijssen JGP, Smit MD, Brugemann J et al (2018) Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial. Eur Heart J. https://doi.org/10.1093/eurheartj/ehx739 CrossRefPubMed

30.

Hoogsteen J, Schep G, Van Hemel NM, Van Der Wall EE (2004) Paroxysmal atrial fibrillation in male endurance athletes. A 9-year follow up. Europace 6:222–228CrossRefPubMed

31.

Myrstad M, Aaronaes M, Graff-Iversen S, Ariansen I, Nystad W, Ranhoff AH (2016) Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation. Clin Res Cardiol 105:154–161CrossRefPubMed

32.

Risom SS, Zwisler AD, Johansen PP, Sibilitz KL, Lindschou J, Gluud C et al (2017) Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev 2:Cd011197PubMed

33.

Borjesson M, Urhausen A, Kouidi E, Dugmore D, Sharma S, Halle M et al (2011) Cardiovascular evaluation of middle-aged/ senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 18:446–458CrossRefPubMed

34.

Riebe D, Franklin BA, Thompson PD, Garber CE, Whitfield GP, Magal M et al (2015) Updating ACSM’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc 47:2473–2479CrossRefPubMed

35.

Heidbuchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P et al (2006) Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil 13:475–484CrossRefPubMed

36.

Morseth B, Lochen ML, Ariansen I, Myrstad M, Thelle DS (2018) The ambiguity of physical activity, exercise and atrial fibrillation. Eur J Prev Cardiol 25:624–636CrossRefPubMed

37.

Atwood JE, Myers J, Sullivan M, Forbes S, Friis R, Pewen W et al (1988) Maximal exercise testing and gas exchange in patients with chronic atrial fibrillation. J Am Coll Cardiol 11:508–513CrossRefPubMed

38.

Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA et al (2013) Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 20:442–467CrossRefPubMed

39.

Helgerud J, Hoydal K, Wang E, Karlsen T, Berg P, Bjerkaas M et al (2007) Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 39:665–671CrossRefPubMed

40.

Kemi OJ, Wisloff U (2010) Mechanisms of exercise-induced improvements in the contractile apparatus of the mammalian myocardium. Acta Physiol (Oxf) 199:425–439CrossRef

41.

Guasch E, Benito B, Qi X, Cifelli C, Naud P, Shi Y et al (2013) Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol 62:68–77CrossRefPubMed

42.

Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME et al (2013) Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA 310:2050–2060CrossRefPubMed

43.

Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NA et al (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 132:e315–e325CrossRefPubMed

44.

Shen MJ, Choi EK, Tan AY, Lin SF, Fishbein MC, Chen LS et al (2011) Neural mechanisms of atrial arrhythmias. Nat Rev Cardiol 9:30–39CrossRefPubMed

Title: Exercise in individuals with atrial fibrillation
Authors: Marius Myrstad
Vegard Malmo
Sara Reinvik Ulimoen
Arnljot Tveit
Jan Pål Loennechen
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 4/2019
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1361-9

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