Abstract
Objective: Physical exercise is recommended to help prevent lifestyle diseases. The present study was designed to quantify the efficacy of physical exercise on the quality of life (QoL), exercise ability and cardiopulmonary fitness of patients with atrial fibrillation (AF).Method: A comprehensive systematic literature search was performed in Medline, Embase, Cochrane Library, Web of Science and PubMed databases (from 1970 to December 1st, 2019) for randomized controlled trials (RCTs) comparing physical exercise combined with AF routine treatments to routine treatments alone. The meta-analysis was conducted following PRISMA guidelines. Our main outcomes were QoL (measured by the Short-Form 36 scale, SF-36), exercise ability (measured by the 6-min walk test, 6MWT) and cardiopulmonary fitness (measured by peak oxygen uptake and resting heart rate). Quality assessments were conducted using the Cochrane Collaboration tool.Results: Twelve trials involving 819 patients met the criteria for analysis. The results showed that physical exercise improved the QoL by enhancing physical functioning [standardized mean difference (SMD) = 0.63, 95%CI: 0.18–1.09; p = 0.006], general health perceptions (SMD = 0.64, 95%CI: 0.35–0.93; p < 0.001) and vitality (SMD = 0.51, 95%CI: 0.31–0.71; p < 0.001); increased exercise ability by improving the 6MWT performance (SMD = 0.69, 95%CI: 0.19–1.119; p = 0.007); and enhanced peak VO2 (SMD = 0.37, 95%CI: 0.16–0.57; p < 0.001) while reducing resting heart rate (SMD = −0.39, 95%CI: −0.65 to −0.13; p = 0.004). In addition, meta-regression analysis showed that training mode (pphysicalfunctioning = 0.012, p generalhealthperceptions = 0.035) and training duration (p = 0.047) were the main factors of an intervention that influenced the effect size. Following sub-group analysis, we found that aerobics, Yoga and longer training durations (≥60 min) showed larger improvements.Conclusion: In summary, our meta-analysis shows that physical exercise has a positive effect on the QoL, exercise ability and cardiopulmonary fitness in AF patients. When physicians offer exercise recommendations to AF patients, they should consider both the training mode and training duration to achieve maximum results.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia characterized by the high-frequency electrical activity of the atrium, unsynchronized atrial contraction and irregular ventricular excitation (Calkins et al, 2017)
A systematic literature search was conducted in five electronic databases, including Medline, Embase, the Cochrane Library, Web of Science and PubMed, from 1970 to December 1st, 2019 for RCTs studying the effects of physical exercise on the QoL, exercise ability and cardiopulmonary fitness of patients with AF
In the present meta-analysis, we found that (i) physical exercise had a positive effect on the QoL, exercise ability and cardiopulmonary fitness in patients with AF; (ii) the exercise mode could predict the effect of physical exercise on QoL; and (iii) the exercise duration could predict the effect of physical exercise on exercise ability
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia characterized by the high-frequency electrical activity of the atrium, unsynchronized atrial contraction and irregular ventricular excitation (Calkins et al, 2017). The high incidence of AF is associated with increased rates of mortality and disability. The risk of stroke is 4 to 5 times higher in AF than non-AF patients, leading to a mortality rate of nearly 20% and disability rate of almost 60% (Ganesan et al, 2016; Hahne et al, 2016). AF causes high mortality rates because of sudden cardiac death (Ruwald et al, 2013; Ohsawa et al, 2015). Due to its prevalence and potentially serious complications, the social burden and economic pressure caused by AF should not be ignored in either developed or developing countries. In the USA, there was a 24% increase in the mean cost of AF hospitalization, with a corresponding increase in the economic burden by nearly $1.31 billion (Patel et al, 2014). It can be said that AF has become a major public health problem affecting the improvement of the national residents’ health level and hindering social and economic development (Leong et al, 2017)
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