Exercise-Based Cardiac Rehabilitation Improves Exercise Capacity and Health-Related Quality of Life in People with Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Trials

Problem

Atrial fibrillation (AF) is the most common cardiac arrhythmia, associated with increased risks of stroke, heart failure, dementia, and death. Exercise based cardiac rehabilitation (CR) may be effective at improving exercise capacity, health related quality of life (HRQoL) and a range of other clinical outcomes for patients with AF.

Approach

To undertake a systematic review and meta-analysis of the impact of exercise-based CR targeted at patients with AF. We searched PubMED, EMBASE and the Cochrane Library of Controlled Trials using key terms related to exercise-based CR and AF. Randomised and non-randomised controlled trials were included if they compared the effects of an exercise-based CR intervention to a control group. Meta-analyses of outcomes were conducted where appropriate.

Findings

The 9 randomised trials included 959 (483 exercise-based CR vs. 476 controls) patients with various types of AF. There were improvements in HRQoL (mean SF-36 mental component score: 4.00, 95% CI: 0.26 to 7.74; p=0.04 and mean SF-36 physical component score: 1.82, 95% CI 0.06 to 3.59; p=0.04) and exercise capacity (mean peak VO2: 1.59 ml/kg/min 95% CI: 0.11 to 3.08; p = 0.04; mean 6-minute walk test: 46.9 metres, 95% CI: 26.4 to 67.4; p < 0.001) for exercise-based CR. Improvements were also seen in AF symptom burden and markers of cardiac function.

Consequences

Further high quality multicentre randomised trials are needed to clarify the impact of exercise-based CR on key patient and health system outcomes including HRQoL, mortality, hospitalisation and costs and how these effects may vary across AF sub-groups.