Some of our patients with rate-controlled atrial fibrillation complain about shortness of breath, fatigue, and palpitations. In the absence of other etiologies, we may second-guess our rate-control approach and consider rhythm control hoping to recapture that elusive “atrial kick” that will magically melt their complaints away. However, this approach exposes our patients to additional expense and risk. What other recommendations could we provide to our patients?
Recently, the American Heart Journal published a clinical trial assessing the potential beneficial effect of exercise for patients with atrial fibrillation. In this study, patients with atrial fibrillation were identified by chart review and excluded if they had NYHA Class III-IV CHF, refractory hypertension (HTN), previous heart valve surgery, moderate or severe pulmonary disease, short life expectancy, or inability to exercise. After an ECG and echocardiogram, 49 patients with age of 70 years and a BMI of 30 were randomized to exercise training or a control condition. Exercise training consisted of ergometer cycling, walking on stairs, running, fitness training, and interval training. Total exercise duration was 60 minutes, 3 times weekly for 12 weeks, of which a minimum of 30 minutes was at 70% of maximal exercise capacity. Patients randomized to training were encouraged to engage in additional light exercise for 30 minutes daily, while control patients were advised to engage in a regular physical activity.
The investigators observed that patients randomized to exercise had significantly improved maximal exercise capacity and walking capacity compared to controls. Exercise patients had significantly improved emotional well-being and perceived physical functioning, health perception, and vitality compared to baseline. Interestingly and importantly, exercise was associated with a decreased resting heart rate. No changes were observed in natriuretic peptides and no adverse events were identified.
Atrial fibrillation is associated with inherent hemodynamic instabilities that may undermine a clinician’s motivation to recommend exercise for patients with presumed deconditioning. This evidence suggests that we should feel comfortable encouraging physical activity in selected patients. While we may not be able to realistically provide the exact intervention provided in this study, we can perhaps more reassuredly encourage our patients with atrial fibrillation to “get up and get moving” to improve symptoms.