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

Trial Summary

What is the purpose of this trial?

The main purpose of this project is to evaluate the effects of high-intensity interval training (HIIT) compared to moderate-intensity continuous exercise training (MICE) and standard care on exercise capacity and quality of life in patients with persistent or permanent atrial fibrillation. Positive findings are vitally important for these patients, given the condition's substantial morbidity, mortality and high economic costs.

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 data supports the effectiveness of the treatment High-Intensity Interval Training for Atrial Fibrillation?

Research shows that high-intensity interval training (HIIT) can improve functional capacity and quality of life in patients with atrial fibrillation, similar to its benefits in other heart-related conditions. Exercise training, including HIIT, has been found to reduce symptoms and improve heart health in people with atrial fibrillation. ^{1 2 3 4 5}

Is exercise training safe for people with heart conditions?

Research shows that high-intensity interval training (HIIT) and moderate-intensity continuous exercise (MICE) are generally safe for people with heart conditions, with a low rate of major adverse events. HIIT has been well-tolerated in older adults and those with cardiovascular disease, though more research is needed to confirm these findings in larger groups. ^{6 7 8 9 10}

How does exercise training differ from other treatments for atrial fibrillation?

Exercise training, particularly high-intensity interval training (HIIT), is unique because it focuses on improving physical fitness and quality of life rather than directly targeting the heart's rhythm. Unlike medications or surgical interventions, exercise training enhances overall cardiovascular health and functional capacity, which can indirectly benefit those with atrial fibrillation. ^{1 3 11 12 13}

Research Team

Jennifer L Reed, PhD

Principal Investigator

Ottawa Heart Institute Research Corporation

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation: A Randomized Clinical Trial. [2022]

2. England 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. [2023]

3. Sweden 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. [2015]

4. United States pubmed.ncbi.nlm.nih.gov

Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Atrial Fibrillation Specific Exercise Rehabilitation: Are We There Yet? [2022]

6. England pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. [2021]

7. Mexico 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. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

The Effectiveness of Progressive Aerobic Interval Training in Cardiac Rehabilitation. [2019]

9. Switzerland pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training in Older Adults: a Scoping Review. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

High versus moderate intensity running exercise to impact cardiometabolic risk factors: the randomized controlled RUSH-study. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health. [2018]

12. England pubmed.ncbi.nlm.nih.gov

The effects of chronic exercise training in individuals with permanent atrial fibrillation: a systematic review. [2018]

13. Canada 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. [2018]