On August 27, the late-breaking results of the ACTIVE-AF trial were presented at the European Society of Cardiology (ESC) Congress 2021. Thе trial assessed the impact of a six-month exercise programme combining supervised and home-based aerobic exercise on AF recurrence and symptom severity. Thus far, it is the largest randomized controlled trial investigating the value of an exercise prescription in patients with symptomatic paroxysmal or persistent AF.
The researchers enrolled 120 patients with an average age of 65 years, of whom 43% were women. The intervention included supervised exercise (weekly for three months then fortnightly for three months) and an individualised weekly plan to follow at home. Over the six months the target was to increase aerobic exercise up to 3.5 hours per week. Supervised sessions were typically higher intensity to raise cardiorespiratory fitness, while home-based exercise was typically a moderate intensity aerobic activity of the patient’s choice (e.g. walking, indoor cycling, swimming). The usual care group received exercise advice but no active intervention. All patients received usual medical care from their cardiologist who was blinded to study group allocation.
The co-primary outcomes were AF symptom severity score and the proportion of patients with recurrent AF at 12 months. Recurrent AF was defined as episodes lasting longer than 30 seconds, undergoing an ablation intervention, or requiring ongoing anti-arrhythmic drug therapy.
At 12 months, the percentage of patients with AF recurrence was significantly lower in the exercise group than in the control group (60% vs 80%; hazard ratio, 0.50; 95% CI, 0.33 - 0.78; P = .002). Patients in the exercise group also had a significant reduction in the severity of their symptoms such as palpitations, shortness of breath or fatigue at 12 months compared to the control group.
