Effect of patient education and physical training on quality of life and physical exercise capacity in patients with paroxysmal or persistent atrial fibrillation: A randomized study

Abstract

Atrial fibrillation is the most common cardiac arrhythmia and the number of atrial fibrillation patients is growing worldwide. In addition to an increase in risk of stroke and heart failure patients with atrial fibrillation also experience decrease in fitness and quality of life. In our study 58 atrial fibrillation patients draw lots to participate or not in a rehabilitation program with education and exercise training in addition to usual treatment. We measured fitness by a bicycle test at the beginning of the study and after 3 and 6 months, moreover participants filled out questionnaires on quality of life at the beginning of the study and after 3, 6 and 12 months. We found that our rehabilitation program may have a short term (but no long term) effect on quality of life and fitness in atrial fibrillation patients. Objective: To examine the effect of a rehabilitation programme on quality of life and physical capacity in patients with atrial fibrillation. Methods: Patients with paroxysmal or persistent atrial fibrillation were randomized to either a 12week rehabilitation programme with education and physical training (intervention group) or standard care (control group). At baseline, after 3, 6 and 12 months participants completed 5 different quality of life questionnaires (Quality of Life in patients with Atrial Fibrillation (AF-QoL-18), Atrial Fibrillation Effect on QualiTy of Life (AFEQT), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7) and EuroQol 5D (EQ-5D)), and physical exercise tests. Differences in mean] scores between groups were analysed by repeated measures analysis of variance (ANOVA). Results: Fifty-eight patients (age range 43-78 years, 31% female) were included. In the intervention group the AF-QoL-18 score increased from baseline (48.4 (standard deviation (SD) 22.8)) to 6 months (68.0 (SD 15.2)) compared with the control group (baseline 51.6 (SD 22.3), 6 months 59.2 (SD 27.3)). After 12 months, there was no difference. Similar patterns were found for the other questionnaires. Maximum exercise capacity improved in the intervention group from baseline (176 W (SD 48)) to 6 months (190 W (SD 55)). There was no change in the control group. Conclusion: Education and physical training may have a short-term (but no long-term) beneficial effect on quality of life and physical exercise capacity in patients with atrial fibrillation.

Efficacy of Physical Exercise on the Quality of Life, Exercise Ability, and Cardiopulmonary Fitness of Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…The effect of physical exercise on cardiopulmonary fitness was measured by the peak VO 2 and resting heart rate. Four RCTs (Malmo et al, 2016 ; Risom et al, 2017 ; Joensen et al, 2019 ; Kato et al, 2019 ) reported peak VO 2 values, which were improved after physical exercise in AF patients (SMD = 0.37, 95%CI: 0.16–0.57; p < 0.001) ( Figure 7 ) with low heterogeneity ( I 2 = 0.0%, p = 0.597). Five RCTs (Osbak et al, 2012 ; Malmo et al, 2016 ; Wahlstrom et al, 2017 ; Wahlström et al, 2020 ; Kato et al, 2019 ) reported resting heart rates, which were reduced after physical exercise in AF patients (SMD = −0.39, 95%CI: −0.65 to −0.13; p = 0.004) ( Figure 8 ) with low heterogeneity ( I 2 = 23.5%, p = 0.265).…”

“…The 12 RCTs included 819 patients (408 allocated to experimental groups and 411 allocated to control groups). Four RCT exercise interventions were aerobic (Osbak et al, 2012 ; Malmo et al, 2016 ; Joensen et al, 2019 ; Nourmohammadi et al, 2019 ), one was anaerobic (Zeren et al, 2016 ), three were aerobic combined with anaerobic (Hegbom et al, 2007 ; Risom et al, 2016 ; Kato et al, 2019 ), one was Qigong (Pippa et al, 2007 ), and three were Yoga (Lakkireddy et al, 2013 ; Wahlstrom et al, 2017 ; Wahlström et al, 2020 ). The details of all included studies are shown in Table 2 .…”

“…The effect of physical exercise on exercise ability was measured by the 6MWT. Five RCTs (Pippa et al, 2007 ; Osbak et al, 2012 ; Zeren et al, 2016 ; Joensen et al, 2019 ; Kato et al, 2019 ) reported the results of 6MWTs, which were improved after physical exercise in AF patients (SMD = 0.69, 95%CI: 0.19–1.19; p = 0.007) ( Figure 6 ) with high heterogeneity ( I 2 = 70.6%, p = 0.009). After meta-regression analysis, the training duration was selected as the heterogeneity factor ( p = 0.047) from the possible factors (training period, training mode, training duration and exercise intensity) that may cause heterogeneity.…”

Association of income and educational attainment in hospitalization events in atrial fibrillation

“…More research is needed to target interventions for high- patients, thereby addressing disparities. Targeted rehabilitation programs, including group education and physical training for patients with AF, significantly diminished the risk of mortality and cardiovascular hospitalizations [ 39 , 40 ]. These structured care programs have enhanced patient outcomes among patients with AF Reinforced, targeted, in-person education can improve quality of life, symptoms improvement, and medication adherence [41] .…”

Sex differences in the change in cardiorespiratory fitness and additional physical and mental health outcomes after exercise training in adults with atrial fibrillation: a systematic review protocol

“…Several research trials implementing exercise training have reported improvements in cardiorespiratory fitness (CRF) in patients with AF (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). CRF independently predicts AF recurrence (17) and prognosis (18,19); every 1 metabolic equivalent (MET; i.e.…”