Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials

Abstract

ObjectiveThe aim of this study was to undertake a contemporary review of the impact of exercise-based cardiac rehabilitation (CR) targeted at patients with atrial fibrillation (AF).MethodsWe conducted searches of PubMED, EMBASE and the Cochrane Library of Controlled Trials (up until 30 November 2017) using key terms related to exercise-based CR and AF. Randomised and non-randomised controlled trials were included if they compared the effects of an exercise-based CR intervention to a no exercise or usual care control group. Meta-analyses of outcomes were conducted where appropriate.ResultsThe nine randomised trials included 959 (483 exercise-based CR vs 476 controls) patients with various types of AF. Compared with control, pooled analysis showed no difference in all-cause mortality (risk ratio (RR) 1.08, 95% CI 0.77 to 1.53, p=0.64) following exercise-based CR. However, there were improvements in health-related quality of life (mean SF-36 mental component score (MCS): 4.00, 95% CI 0.26 to 7.74; p=0.04 and mean SF-36 physical component score: 1.82, 95% CI 0.06 to 3.59; p=0.04) and exercise capacity (mean peak VO2: 1.59 ml/kg/min, 95% CI 0.11 to 3.08; p=0.04; mean 6 min walk test: 46.9 m, 95% CI 26.4 to 67.4; p<0.001) with exercise-based CR. Improvements were also seen in AF symptom burden and markers of cardiac function.ConclusionsExercise capacity, cardiac function, symptom burden and health-related quality of life were improved with exercise-based CR in the short term (up to 6 months) targeted at patients with AF. However, high-quality multicentre randomised trials are needed to clarify the impact of exercise-based CR on key patient and health system outcomes (including health-related quality of life, mortality, hospitalisation and costs) and how these effects may vary across AF subtypes.

Lifestyle interventions after ablation for atrial fibrillation: a systematic review

“…41 In addition, it has been observed that patients with anxiety or depression often participate in more unhealthy behaviours as possible coping strategies (such as smoking, alcohol, high calorie food intake, sleep disturbances and sedentary behaviour). [42][43][44][45] The results of this review are comparable to the literature on patients with AF, in which positive effects are found for patients participating in exercise-based cardiac rehabilitation 46 and for patients participating in educational programmes consisting of interventions addressing lifestyle and risk factor management, 7,8,[47][48][49] but only one of those studies was able to reduce mortality among patients. 8 The studies included in this review differed in design, sample size and type of risk factor and lifestyle intervention, and reported a variety of primary outcomes, making the number of patients included in the analysis relatively small.…”

“…Designing complex interventions and testing them in trials is challenging and low to moderate risk of bias is observed in other reviews gathering trials testing, for example, complex rehabilitation interventions for patients with AF. 46,50 In qualitative studies, patients have described how they are living with anxiety about when another AF episode will occur, the consequences of the symptoms, and what interventions to use to prevent or manage further episodes. 8,44 Few studies have investigated patient perspectives of life after AF ablation, but one study found that patients described managing symptoms and self-care as more challenging than they had expected, especially in the first 3 months after ablation.…”

Educational interventions to improve outcomes in patients with atrial fibrillation—a systematic review

“…It has also been found that patients often are unaware of the necessary precautions they need to take in everyday life because of the disease, like stroke prevention and patients lack knowledge about treatment options and effects for AF 6 . Furthermore, many patients with AF experience decreased physical capacity 7 and lower quality of life compared with the general population, but also compared with patients with, for example, ischemic heart disease, 8,9 some patients also report of high levels of anxiety and depression 10…”

Cardiac Rehabilitation for Patients Treated for Atrial Fibrillation With Ablation Has Long-Term Effects: 12-and 24-Month Follow-up Results From the Randomized CopenHeartRFA Trial

“…To our knowledge there are no trials that include a physical exercise component for patients diagnosed with AF that have longer exercise capacity follow-up than 20 weeks (31). A sub-study to the HF-ACTION trial (32) included 382 patients with AF and chronic heart failure and tested a supervised aerobic exercise training program (12 weeks, 3 sessions per week), followed by home-based exercise training for an additional 2 years had a mean 2.6 years follow-up (33).…”