How Exercise Can Reduce Atrial Fibrillation: ACTIVE-AF Study

In 2021, a team of Australian researchers teased us with initial results of ACTIVE-AF. Their findings suggested their treatment doubles the number of AF patients who were free from it after 1 year.

This was the chart presented in 2021. Whereas 20% of the control arm were free of AF episodes at 1 year, 40% were free in the exercise group

For those of you who read the title you may have guessed that that treatment was exercise and we finally got the full results of this study last month.

The ACTIVE-AF Study

The study involved 120 patients with symptomatic AF. They were randomized to receive an exercise intervention or usual care, with some additional exercise education only. After 12 months, 40% of those in the exercise intervention group were free from AF compared to 20% of patients in the control group. 'Free from AF' means no AF ablation or anti-arrhythmic drug treatments were used either. In addition, those in the exercise group reported lower symptom severity and improved exercise capacity compared to the control group (who weren't prescribed exercise plans).

The Exercise Program

Getting into the specifics- what was the exercise? Importantly, it wasn't a one-size fits all. The programme was tailored to an individual patient based on their fitness. An exercise physiologist would spend the first couple of weeks just supervising their exercise and then would try to create a cardiovascular exercise regimen that would get the heart rate to 85-90% of their maximum for 4 minutes at a time. The sessions were scaled up to try and reach 210 minutes per week.

We all probably accept deep down that exercise is good for us, but what this study does is that it gives us good evidence to suggest it can be beneficial in reducing AF for people who have the condition. It also gives physicians, physiologists and their patients a target of what 'exercise' looks like. The barriers are often around the amount of time doctors can spend with patients in clinic and how to implement it. So we now have numbers and intensity levels to base any guidance around and it is important we create a way this advice can be replicated but in a personalised way- because that's what is shown to work.

Should exercise be 'prescribed'? It isn't something that is routinely done for AF patients. What would a programme like this do when combined with other AF treatments...i.e. would it improve a patient's chances of success after an AF ablation?

Whilst we figure that out, get moving and start building up your fitness from this weekend! For patients using a heart rate tracker or in the active arm of the AFFU-AW study, you can use your device to calculate your max heart rate and set your targets based on that. Enjoy!