Exercise Training for Atrial Fibrillation

(Exercise-AF Trial)

Recruiting at 1 trial location

Overseen By Matheus Mistura, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ottawa Heart Institute Research Corporation

Disqualifiers: Routine exercise, Unstable angina, Severe stenosis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

132 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how two different exercise programs can help people with atrial fibrillation (a heart condition causing an irregular heartbeat) feel better and improve their exercise capacity. It compares high-intensity interval training (HIIT) and moderate-intensity continuous exercise (MICE) to standard care. The goal is to determine which approach more effectively enhances exercise capacity and quality of life. Individuals with persistent or permanent atrial fibrillation who have a steady heart rate and can perform a symptom-limited exercise test might be suitable candidates for this study. As an unphased trial, this study offers participants a unique opportunity to contribute to understanding how exercise can improve life quality for those with atrial fibrillation.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that these exercise training methods are safe for patients with atrial fibrillation?

Research has shown that both high-intensity interval training (HIIT) and moderate-intensity continuous exercise (MICE) are generally safe for people with atrial fibrillation.

For HIIT, studies have found it effective and safe, with a low risk of serious heart problems. It can enhance heart health, physical fitness, and mental well-being. Some research even suggests HIIT might better reduce atrial fibrillation symptoms and improve quality of life.

MICE has also been shown to lower the risk and symptoms of atrial fibrillation. It improves heart health by reducing inflammation and other risk factors. Studies suggest that regular moderate exercise can lead to fewer heart-related issues over time.

Both types of exercise are well-tolerated by patients, making them good options for improving health in those with atrial fibrillation. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using exercise training for atrial fibrillation because it offers a non-drug approach to managing this heart condition. Unlike standard treatments that often rely on medication or invasive procedures, high-intensity interval training (HIIT) and moderate-intensity continuous exercise training (MICE) focus on improving heart function through physical activity. HIIT pushes the heart with short bursts of intense exercise followed by recovery periods, potentially enhancing cardiovascular fitness more effectively than traditional exercise. MICE, on the other hand, provides a steady, manageable way to improve heart health over longer sessions. These exercise-based strategies could offer patients a more natural way to manage atrial fibrillation with fewer side effects.

What evidence suggests that this trial's exercise training treatments could be effective for atrial fibrillation?

Research has shown that both high-intensity interval training (HIIT) and moderate-intensity continuous exercise (MICE) can benefit people with atrial fibrillation (AF). In this trial, participants will be assigned to different arms to evaluate these exercise methods. The HIIT arm, involving high-intensity interval training, can enhance physical performance, reduce symptoms, and improve quality of life. Some studies suggest it might be even more effective than moderate exercise for these benefits. Meanwhile, the MICE arm, involving moderate-intensity continuous exercise, helps by lowering the risk of AF, reducing symptoms, and improving heart health. Both types of exercise offer more benefits than standard care alone. Overall, exercise training appears promising for managing atrial fibrillation. ^{1 2 3 6 7}

Who Is on the Research Team?

Jennifer L Reed, PhD

Principal Investigator

Ottawa Heart Institute Research Corporation

Are You a Good Fit for This Trial?

This trial is for adults over 40 with persistent or permanent atrial fibrillation, who can exercise and have a resting heart rate of 100 bpm or less. It's not for those who already exercise regularly, have unstable angina, severe valve disease, obstructive cardiomyopathy, are pregnant or breastfeeding, or can't consent to follow-ups.

Inclusion Criteria

You can do a test that measures your ability to exercise without getting too tired or feeling unwell.

You can do a test where you exercise until you feel symptoms.

I am 40 years old or older.

Exclusion Criteria

I have unstable chest pain.

I have been diagnosed with severe narrowing of my heart's mitral or aortic valve.

I have been diagnosed with a thickened heart muscle that obstructs blood flow.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo high-intensity interval training (HIIT) or moderate-intensity continuous exercise training (MICE) along with standard care

12 weeks

Regular exercise sessions

Follow-up

Participants are monitored for changes in exercise capacity, heart rate control, quality of life, and other health metrics

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• High-Intensity Interval Training
• Moderate-Intensity Continuous Exercise Training

Trial Overview The study compares the effects of two types of exercise on people with atrial fibrillation: moderate-intensity continuous training (MICE) versus high-intensity interval training (HIIT), in addition to standard care. The focus is on how these exercises affect fitness levels and quality of life.

How Is the Trial Designed?

Group I: standard care + MICE Experimental Treatment 1 Intervention

standard care + moderate-intensity continuous exercise training (MICE)

Group II: standard care + HIIT Experimental Treatment 1 Intervention

standard care + high-intensity interval training (HIIT)

Group III: standard care Active Control 1 Intervention

Participants do not participate in a on site structured exercise training program.

Who Is Running the Clinical Trial?

Ottawa Heart Institute Research Corporation

Lead Sponsor

Trials

200

Recruited

95,800+

Published Research Related to This Trial

A 12-week study involving 94 patients with persistent and permanent atrial fibrillation found that high-intensity interval training (HIIT) was as effective as continuous aerobic training (CR) in improving functional capacity and quality of life.

Both HIIT and CR showed similar outcomes in terms of disease-specific quality of life, resting heart rate, and physical activity levels, indicating that shorter, more intense workouts can be a viable alternative to longer, moderate-intensity training for these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation: A Randomized Clinical Trial. Reed, JL., Terada, T., Vidal-Almela, S., et al.[2022]

In a study of 81 heart disease patients with very high cardiovascular risk, both moderate and high-intensity interval training (MIIT and HIIT) were found to be safe, with no adverse outcomes reported during the training.

While there were no statistically significant differences in overall exercise improvements between the training types, the HIIT group showed a trend towards greater improvements in exercise tolerance, suggesting it may be more effective than continuous moderate intensity training (MICT).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and improvement in exercise tolerance with interval training vs moderate-intensity continuous training in heart disease patient of very high cardiovascular risk. Pineda-García, AD., Lara-Vargas, JA., Ku-González, A., et al.[2022]

A scoping review of 69 studies on high-intensity interval training (HIIT) in older adults found that HIIT protocols are generally well-tolerated and can provide significant health benefits, particularly in improving cardiorespiratory fitness.

Most research has focused on healthy older adults, highlighting a need for larger studies and more investigation into HIIT's effects on older adults with various health conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training in Older Adults: a Scoping Review. Marriott, CFS., Petrella, AFM., Marriott, ECS., et al.[2021]

In a study of 120 patients with symptomatic atrial fibrillation, a 6-month exercise intervention significantly reduced the recurrence of arrhythmia for both men and women, with hazard ratios indicating a protective effect for both sexes.

Women in the exercise group experienced a notable reduction in symptom severity scores at 12 months, while no significant change was observed in men, suggesting that exercise may have a more pronounced benefit for women in managing symptoms of atrial fibrillation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Influence of Sex on Efficacy of Exercise Training for Patients with Symptomatic Atrial Fibrillation: Insights from the ACTIVE-AF Randomised Controlled Trial. Verdicchio, CV., Mahajan, R., Middeldorp, ME., et al.[2023]

In a study of 49 patients with permanent atrial fibrillation, a 12-week aerobic exercise program significantly improved muscle strength, exercise capacity, and quality of life compared to a control group.

The training group showed notable enhancements in exercise capacity (p < 0.001) and quality of life scores, particularly in physical functioning and general health perceptions, while lean body mass remained unchanged.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of physical exercise training on muscle strength and body composition, and their association with functional capacity and quality of life in patients with atrial fibrillation: a randomized controlled trial. Osbak, PS., Mourier, M., Henriksen, JH., et al.[2015]

A 16-week study involving 81 healthy untrained middle-aged males found that both high-intensity interval training (HIIT) and moderate-intensity continuous exercise (MICE) significantly improved cardiometabolic risk factors and cardiorespiratory fitness.

Both exercise groups showed similar positive effects on metabolic syndrome scores and VO2max, indicating that either training strategy can be effective for enhancing health in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High versus moderate intensity running exercise to impact cardiometabolic risk factors: the randomized controlled RUSH-study. Kemmler, W., Scharf, M., Lell, M., et al.[2021]

Chronic exercise training, regardless of intensity, significantly improves rate control, functional capacity, muscular strength, daily activities, and quality of life in adults with permanent atrial fibrillation, based on a review of 6 studies involving 211 participants.

While the benefits of exercise on overall health and daily functioning are clear, the impact of chronic exercise on aerobic capacity in these patients remains uncertain, indicating a need for further research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of chronic exercise training in individuals with permanent atrial fibrillation: a systematic review. Reed, JL., Mark, AE., Reid, RD., et al.[2018]

Regular physical activity can significantly lower the risk of atrial fibrillation (AF), especially for individuals who exceed the current recommended exercise guidelines.

Achieving a cardiorespiratory fitness level of 8 METs or more during exercise testing is associated with a reduced incidence of AF, although excessive endurance exercise may paradoxically increase AF risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health. Elliott, AD., Maatman, B., Emery, MS., et al.[2018]

A 74-year-old man with permanent atrial fibrillation showed significant health improvements after a 10-week high-intensity interval training program, including better heart rate, blood pressure, and aerobic capacity.

This case suggests that high-intensity interval training may be a beneficial non-pharmacological intervention for patients with permanent atrial fibrillation, especially since they often lack other treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-intensity interval training improves cardiovascular health, exercise capacity, and quality of life in permanent atrial fibrillation: a case study. Reed, JL., Nery, PB., Birnie, DH., et al.[2018]

Aerobic interval training (AIT) for 12 weeks significantly reduced the time patients spent in atrial fibrillation (AF) from 8.1% to 4.8%, while the control group experienced an increase from 10.4% to 14.6%.

AIT also led to improvements in AF symptoms, cardiovascular health (including peak oxygen uptake and heart function), lipid levels, and overall quality of life, indicating its efficacy as a treatment for patients with nonpermanent AF.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial. Malmo, V., Nes, BM., Amundsen, BH., et al.[2022]

Regular physical activity, specifically 360-720 MET-minutes per week (about 60-120 minutes of moderate-to-vigorous exercise), is recommended for patients with atrial fibrillation (AF) to improve outcomes and quality of life, based on data from 21 studies.

Incorporating non-traditional exercises like Yoga into rehabilitation programs may enhance quality of life for AF patients, highlighting the need for personalized exercise plans in their care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atrial Fibrillation Specific Exercise Rehabilitation: Are We There Yet? Buckley, BJR., Risom, SS., Boidin, M., et al.[2022]

High-intensity interval training (HIIT) is as effective, if not more so, than traditional moderate-intensity continuous training (MICT) for patients with cardiovascular disease, based on a systematic review of 23 studies involving 1117 participants.

The safety profile of HIIT in cardiac rehabilitation is promising, with only one major cardiovascular adverse event reported per 17,083 training sessions, indicating that HIIT can be safely implemented in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. Wewege, MA., Ahn, D., Yu, J., et al.[2021]

Aerobic interval training (AIT) led to a significant improvement in peak oxygen consumption (V˙O2peak) by 3.84 mL·kg·min compared to moderate-intensity continuous exercise (MICE) in a study of 1544 coronary artery disease patients over 26 weeks.

AIT also resulted in better cardiovascular risk profile improvements, including reductions in BMI, triglycerides, and waist measurements, as well as lower depression scores, suggesting it may be a more effective rehabilitation strategy for CAD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of Progressive Aerobic Interval Training in Cardiac Rehabilitation. Lee, LS., Tsai, MC., Oh, PI., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9623436/

Effect of High-Intensity Interval Training in Patients With ... In this randomized clinical trial including 86 individuals with atrial fibrillation, HIIT was as efficacious as MICT in improving functional capacity and ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S1050173824000021

Effects of different exercise methods and intensities on the ... High-intensity interval training (HIIT) shows promise, potentially surpassing MICT, especially in reducing age-related AF susceptibility and improving symptoms ...

3. ahajournals.org ahajournals.org/doi/10.1161/CIRCEP.117.005598?doi=10.1161/CIRCEP.117.005598

Does High-Intensity Endurance Training Increase the Risk ... Exercise mitigates many cardiovascular risk factors associated with atrial fibrillation. Endurance training has been associated with atrial structural ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/36315143/

Effect of High-Intensity Interval Training in Patients With ... High-intensity interval training (HIIT) has been shown to elicit greater improvements in functional capacity and QOL compared with moderate to ...

5. gavinpublishers.com gavinpublishers.com/article/view/the-application-of-high-intensity-interval--training-in-atrial-fibrillation-a-literature-review

The Application of High Intensity Interval Training in Atrial ... The findings of these studies reveal promising outcomes related to reduced AF symptoms severity, improved aerobic capacity, quality of life and ...

6. ahajournals.org ahajournals.org/doi/10.1161/JAHA.118.009305

High‐Intensity Interval Training for Patients With ... HIIT has shown a relatively low rate of major adverse cardiovascular events for patients with coronary artery disease or heart failure when applied within CR ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12027975/

Narrative Review of High-Intensity Interval Training: Positive ... This review highlights HIIT as an effective and safe exercise modality for improving CV health, metabolic indicators, mental health, and QoL.