Buckley, B, van Hout, L, Fitzhugh, C, Lip, GYH, Taylor, RS and Thijssen, DHJ Exercise-based Cardiac Rehabilitation for Patients with Atrial Fibrillation: A Narrative Review. European Heart Journal Open. ISSN 2752-4191 (Accepted)

Text EHJ-Open_review_R1 CLEAN.pdf - Accepted Version Restricted to Repository staff only Download (610kB)

Abstract

Importance: The role of physical activity (i.e., any bodily movement that requires energy expenditure) and exercise (i.e., planned, structured and repetitive physical activity to improve/maintain fitness) in the primary and secondary prevention of atrial fibrillation (AF) is increasingly recognised. Physical activity has been associated with lower risks to develop AF and associated complications (e.g., stroke, heart failure, myocardial infarction). Exercise-based Cardiac Rehabilitation (ExCR) is increasingly examined in the treatment of AF and sometimes combined with rhythm control strategies (e.g., catheter ablation). Nonetheless, several important clinical, practical and mechanistic questions remain not fully understood. Observations: This state-of-the-art review first provides a contemporary update on the evidence base for the clinical effects of ExCR in AF. Despite the ongoing need for high-quality studies, existing randomised controlled trials and cohort studies suggest ExCR reduces AF-burden, lowers risks for major adverse cardiovascular events, and improves health-related quality of life. Second, to facilitate implementation of ExCR, we have observed comparable effects of distinct exercise protocols (e.g., type of training, centre-/home-based) and discussed similarity of effectiveness across patient characteristics (e.g., age, sex, AF subtype). Critically, we have discussed potential barriers that may prohibit the uptake of ExCR for patients with AF, categorised at clinician- (e.g., referral, training), patient- (e.g., motivation, transportation, psychosocial factors), and system-levels (e.g., insurance, resources). Third, we have summarised the potential mechanisms underlying these effects of ExCR, classified by their potential role in reducing AF burden (e.g., atrial/ventricular function, autonomic balance, inflammation) and lowering risks for adverse events (e.g., modifiable risk factors, vascular function, thrombogenesis). Conclusions and Relevance: Based on the increasing evidence for clinical benefits, e.g., improved health-related quality of life and better clinical outcomes, we advocate stronger focus on regular physical activity and referral to multidisciplinary ExCR for sustainable lifestyle changes within the ESC AF-CARE pathway for the prevention and treatment of AF

Item Type:	Article
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Public and Allied Health Sport and Exercise Sciences
Publisher:	Oxford University Press
SWORD Depositor:	A Symplectic
Date Deposited:	03 Mar 2025 10:57
Last Modified:	03 Mar 2025 11:00
URI:	https://researchonline.ljmu.ac.uk/id/eprint/25761

View Item