Role of exercise in atrial fibrillation management

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice and presents a significant and growing public health challenge. In a rigorously conducted Cochrane systematic review, meta-analysis and meta-regression, Buckley et al 1 examine the efficacy and safety of exercise-based cardiac rehabilitation (ExCR) in individuals with AF.1 This editorial seeks to interpret their findings in the context of contemporary sport and exercise medicine, exploring how structured exercise plays a role in the management of patients with AF. If we were to assess the global socioeconomic landscape through the lens of health, the rising incidence and prevalence of AF and the strategies to mitigate this widespread trend would occupy a central place in the minds of healthcare providers and clinicians. AF is the most frequently diagnosed arrhythmia, with a global prevalence exceeding 59 million.2 Its prevalence increases significantly with age, particularly beyond 65 years. The arrhythmia is strongly associated with stroke and heart failure, making it a substantial contributor to both morbidity and mortality. Global trends demonstrate a doubling in the incidence of AF over the past 30 years, with higher rates among males compared with females. Global deaths attributed to AF have almost tripled in recent decades, primarily attributable to the increased incidence of cases among males (42 511 in 1990 to 121 548 in 2019).3 Individuals of both sexes aged between 65 and 69 years demonstrate the highest incidence rates, which peak in the 75–79 year age group.3 Disability-adjusted life years (DALYs) are generally lower for females than males across all age groups. DALYs are predominantly linked to high levels of systolic blood pressure (39%) and high body mass index (BMI, >20%), both of which are risks that can be mitigated through regular exercise. Rising risk factors such as obesity, diabetes, hypertension, physical …