Skip to main content
SpringerLink
Log in

Exercise in individuals with atrial fibrillation

  • Review
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Despite the high prevalence of atrial fibrillation (AF), there is a lack of recommendations for physical activity and exercise in individuals with AF, including athletes with AF.

Methods

With the aim to review studies that have investigated effects and safety of exercise in individuals with AF, we conducted a literature search in Pubmed using the key words atrial fibrillation AND exercise OR physical activity OR exercise/adverse effects OR adverse outcome.

Results

Observational data from one registry suggest that regular exercise is associated with reduced mortality in AF patients. Three randomized controlled trials (RCTs) have demonstrated that 12-week exercise interventions might reduce the burden of AF and improve exercise capacity by 10–16% in patients with paroxysmal or persistent AF. Three small RCTs suggest that exercise might improve exercise capacity with 15–41% in patients with permanent AF. Exercise might improve quality of life in patients with AF. Data on safety of exercise are sparse. No studies have evaluated the effect of exercise in athletes with AF.

Conclusions

Despite weak evidence, we suggest that individuals with AF should exercise regularly after evaluation of underlying conditions. Recommendations should be individualized. There is a lack of data to support exercise recommendations in athletes with AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al (2016) ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962

    Article  PubMed  Google Scholar 

  2. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ et al (2014) Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation 129:837–847

    Article  PubMed  Google Scholar 

  3. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A et al (2013) Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 34:2746–2751

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD et al (2015) 50 Year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet 386:154–162

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mohanty S, Mohanty P, Tamaki M, Natale V, Gianni C, Trivedi C et al (2016) Differential association of exercise intensity with risk of atrial fibrillation in men and women: evidence from a meta-analysis. J Cardiovasc Electrophysiol 27:1021–1029

    Article  PubMed  Google Scholar 

  6. Gorenek Chair B, Pelliccia Co-Chair A, Benjamin EJ, Boriani G, Crijns HJ, Fogel RI et al (2017) European heart rhythm association (EHRA)/European association of cardiovascular prevention and rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the heart rhythm society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Eur J Prev Cardiol 24:4–40

    Article  Google Scholar 

  7. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM et al (2007) Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 115:2675–2682

    Article  PubMed  Google Scholar 

  8. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS et al (2014) 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:S76–S99

    Article  PubMed  Google Scholar 

  9. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al (2016) 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for cardiovascular prevention and rehabilitation (EACPR). Eur J Prev Cardiol 23:Np1–Nnp96

    Article  PubMed  Google Scholar 

  10. Grimsmo J, Grundvold I, Maehlum S, Arnesen H (2010) High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors—a 28–30 years follow-up study. Eur J Cardiovasc Prev Rehabil 17:100–105

    Article  PubMed  Google Scholar 

  11. Myrstad M, Lochen ML, Graff-Iversen S, Gulsvik AK, Thelle DS, Stigum H et al (2014) Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scand J Med Sci Sports 24:e238–e244

    Article  CAS  PubMed  Google Scholar 

  12. Myrstad M, Nystad W, Graff-Iversen S, Thelle DS, Stigum H, Aaronaes M et al (2014) Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter. Am J Cardiol 114:1229–1233

    Article  PubMed  Google Scholar 

  13. Myrstad M, Aaronaes M, Graff-Iversen S, Nystad W, Ranhoff AH (2015) Does endurance exercise cause atrial fibrillation in women? Int J Cardiol 184:431–432

    Article  PubMed  Google Scholar 

  14. Sanchis-Gomar F, Perez-Quilis C, Lippi G, Cervellin G, Leischik R, Lollgen H et al (2017) Atrial fibrillation in highly trained endurance athletes—description of a syndrome. Int J Cardiol 226:11–20

    Article  PubMed  Google Scholar 

  15. Wernhart S, Halle M (2015) Atrial fibrillation and long-term sports practice: epidemiology and mechanisms. Clin Res Cardiol 104:369–379

    Article  CAS  PubMed  Google Scholar 

  16. Perez-Quilis C, Lippi G, Cervellin G, Lollgen H, Sanchis-Gomar F (2017) Exercising recommendations for paroxysmal AF in young and middle-aged athletes (PAFIYAMA) syndrome. Ann Transl Med 5:24

    Article  PubMed  PubMed Central  Google Scholar 

  17. Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O et al (2016) Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial. Circulation 133:466–473

    Article  PubMed  Google Scholar 

  18. Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U (2017) Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation—a randomized controlled trial. PLoS One 12:e0170060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Risom SS, Zwisler AD, Rasmussen TB, Sibilitz KL, Madsen TL, Svendsen JH et al (2016) Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: Results of the randomized CopenHeartRFA trial. Am Heart J 181:120–129

    Article  PubMed  Google Scholar 

  20. Mertens DJ, Kavanagh T (1996) Exercise training for patients with chronic atrial fibrillation. J Cardiopulm Rehabil 16:193–196

    Article  CAS  PubMed  Google Scholar 

  21. Vanhees L, Schepers D, Defoor J, Brusselle S, Tchursh N, Fagard R (2000) Exercise performance and training in cardiac patients with atrial fibrillation. J Cardiopulm Rehabil 20:346–352

    Article  CAS  PubMed  Google Scholar 

  22. Hegbom F, Sire S, Heldal M, Orning OM, Stavem K, Gjesdal K (2006) Short-term exercise training in patients with chronic atrial fibrillation: effects on exercise capacity, AV conduction, and quality of life. J Cardiopulm Rehabil 26:24–29

    Article  PubMed  Google Scholar 

  23. Hegbom F, Stavem K, Sire S, Heldal M, Orning OM, Gjesdal K (2007) Effects of short-term exercise training on symptoms and quality of life in patients with chronic atrial fibrillation. Int J Cardiol 116:86–92

    Article  PubMed  Google Scholar 

  24. Plisiene J, Blumberg A, Haager G, Knackstedt C, Latsch J, Norra C et al (2008) Moderate physical exercise: a simplified approach for ventricular rate control in older patients with atrial fibrillation. Clin Res Cardiol 97:820–826

    Article  CAS  PubMed  Google Scholar 

  25. Osbak PS, Mourier M, Henriksen JH, Kofoed KF, Jensen GB (2012) 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. J Rehabil Med 44:975–979

    Article  PubMed  Google Scholar 

  26. Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R et al (2015) Impact of CARDIOrespiratory fitness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol 66:985–996

    Article  PubMed  Google Scholar 

  27. Proietti M, Boriani G, Laroche C, Diemberger I, Popescu MI, Rasmussen LH et al (2017) Self-reported physical activity and major adverse events in patients with atrial fibrillation: a report from the EURObservational research programme pilot survey on atrial fibrillation (EORP-AF) general registry. Europace 19:535–543

    Article  PubMed  Google Scholar 

  28. Luo N, Merrill P, Parikh KS, Whellan DJ, Pina IL, Fiuzat M et al (2017) Exercise training in patients with chronic heart failure and atrial fibrillation. J Am Coll Cardiol 69:1683–1691

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rienstra M, Hobbelt AH, Alings M, Tijssen JGP, Smit MD, Brugemann J et al (2018) Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial. Eur Heart J. https://doi.org/10.1093/eurheartj/ehx739

    Article  PubMed  Google Scholar 

  30. Hoogsteen J, Schep G, Van Hemel NM, Van Der Wall EE (2004) Paroxysmal atrial fibrillation in male endurance athletes. A 9-year follow up. Europace 6:222–228

    Article  PubMed  Google Scholar 

  31. Myrstad M, Aaronaes M, Graff-Iversen S, Ariansen I, Nystad W, Ranhoff AH (2016) Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation. Clin Res Cardiol 105:154–161

    Article  PubMed  Google Scholar 

  32. Risom SS, Zwisler AD, Johansen PP, Sibilitz KL, Lindschou J, Gluud C et al (2017) Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev 2:Cd011197

    PubMed  Google Scholar 

  33. Borjesson M, Urhausen A, Kouidi E, Dugmore D, Sharma S, Halle M et al (2011) Cardiovascular evaluation of middle-aged/ senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 18:446–458

    Article  PubMed  Google Scholar 

  34. Riebe D, Franklin BA, Thompson PD, Garber CE, Whitfield GP, Magal M et al (2015) Updating ACSM’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc 47:2473–2479

    Article  CAS  PubMed  Google Scholar 

  35. Heidbuchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P et al (2006) Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil 13:475–484

    Article  PubMed  Google Scholar 

  36. Morseth B, Lochen ML, Ariansen I, Myrstad M, Thelle DS (2018) The ambiguity of physical activity, exercise and atrial fibrillation. Eur J Prev Cardiol 25:624–636

    Article  PubMed  Google Scholar 

  37. Atwood JE, Myers J, Sullivan M, Forbes S, Friis R, Pewen W et al (1988) Maximal exercise testing and gas exchange in patients with chronic atrial fibrillation. J Am Coll Cardiol 11:508–513

    Article  CAS  PubMed  Google Scholar 

  38. Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA et al (2013) Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 20:442–467

    Article  PubMed  Google Scholar 

  39. Helgerud J, Hoydal K, Wang E, Karlsen T, Berg P, Bjerkaas M et al (2007) Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 39:665–671

    Article  PubMed  Google Scholar 

  40. Kemi OJ, Wisloff U (2010) Mechanisms of exercise-induced improvements in the contractile apparatus of the mammalian myocardium. Acta Physiol (Oxf) 199:425–439

    Article  CAS  Google Scholar 

  41. Guasch E, Benito B, Qi X, Cifelli C, Naud P, Shi Y et al (2013) Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol 62:68–77

    Article  PubMed  Google Scholar 

  42. Abed HS, Wittert GA, Leong DP, Shirazi MG, Bahrami B, Middeldorp ME et al (2013) Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA 310:2050–2060

    Article  CAS  PubMed  Google Scholar 

  43. Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NA et al (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 132:e315–e325

    Article  PubMed  Google Scholar 

  44. Shen MJ, Choi EK, Tan AY, Lin SF, Fishbein MC, Chen LS et al (2011) Neural mechanisms of atrial arrhythmias. Nat Rev Cardiol 9:30–39

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to thank Bente Morseth for her advices in the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway

    Marius Myrstad, Sara Reinvik Ulimoen & Arnljot Tveit

  2. Department of Cardiology, St. Olavs Hospital, Trondheim, Norway

    Vegard Malmo & Jan Pål Loennechen

  3. Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Vegard Malmo & Jan Pål Loennechen

  4. Department of Cardiology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Sara Reinvik Ulimoen

Authors
  1. Marius Myrstad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vegard Malmo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sara Reinvik Ulimoen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arnljot Tveit
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Pål Loennechen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marius Myrstad.

Ethics declarations

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Myrstad, M., Malmo, V., Ulimoen, S.R. et al. Exercise in individuals with atrial fibrillation. Clin Res Cardiol 108, 347–354 (2019). https://doi.org/10.1007/s00392-018-1361-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-018-1361-9

Keywords

Search

Navigation