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Exercise with Atrial Fibrillation

Comment by Martin Halle, EACPR Exercise, Basic and Translational Research Section


Excessive endurance sports can lead to pathological adaptation by the heart, with disproportionate expansion of the atria and scarring, which increases the rate of atrial fibrillation among these athletes. On the other hand, it is known that obesity associated with diabetes and hypertension frequently leads to impaired diastolic function of the myocardium, which is a significant risk factor for an increased rate of atrial fibrillation. Some studies show that physical training can improve cardiovascular risk factors as well as impaired diastolic function in these patients [1]. It remains unclear whether lifestyle modification -- especially with an increase in physical activity -- can reduce the probability of a new event in overweight, non-active patients with newly occurring atrial fibrillation.

In the current study from Australia [2], 308 patients with BMI>27 kg/m2 were enrolled in a supplementary physical training program to optimise cardiovascular risk factors. After 4 years of follow-up, it could be seen that in the beginning, 17% of participants in the group of patients with low cardiorespiratory fitness were free of atrial fibrillation, while this figure was already 76% in the moderate fitness group, and in the high fitness group, 84% of participants experienced no recurrence of atrial fibrillation. In addition, those who continued to improve their cardiopulmonary fitness in the course of the study benefitted further. Each additionally attained MET (Metabolic Equivalent Task) induced a 20% reduction in recurrences. This marked reduction remained in place even when the effects of reduced body weight and fitness at the beginning of the study, medication or procedures like ablation were taken into account as possible disrupting factors. Those in whom diastolic function of the myocardium improved at the same time benefitted especially.

This study underscores the significance of lifestyle with weight reduction and physical training in patients with atrial fibrillation and signs of impaired diastolic function. Therefore, this therapeutic principle should be integrated along with optimal drug therapy of risk factors for patients with atrial fibrillation.


The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology