Exercise Training for Atrial Fibrillation
(Exercise-AF Trial)
Recruiting in Palo Alto (17 mi)
+1 other location
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Ottawa Heart Institute Research Corporation
Disqualifiers: Routine exercise, Unstable angina, Severe stenosis, others
No Placebo Group
Trial Summary
What is the purpose of this trial?
The main purpose of this project is to evaluate the effects of high-intensity interval training (HIIT) compared to moderate-intensity continuous exercise training (MICE) and standard care on exercise capacity and quality of life in patients with persistent or permanent atrial fibrillation. Positive findings are vitally important for these patients, given the condition's substantial morbidity, mortality and high economic costs.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment High-Intensity Interval Training for Atrial Fibrillation?
Research shows that high-intensity interval training (HIIT) can improve functional capacity and quality of life in patients with atrial fibrillation, similar to its benefits in other heart-related conditions. Exercise training, including HIIT, has been found to reduce symptoms and improve heart health in people with atrial fibrillation.12345
Is exercise training safe for people with heart conditions?
Research shows that high-intensity interval training (HIIT) and moderate-intensity continuous exercise (MICE) are generally safe for people with heart conditions, with a low rate of major adverse events. HIIT has been well-tolerated in older adults and those with cardiovascular disease, though more research is needed to confirm these findings in larger groups.678910
How does exercise training differ from other treatments for atrial fibrillation?
Exercise training, particularly high-intensity interval training (HIIT), is unique because it focuses on improving physical fitness and quality of life rather than directly targeting the heart's rhythm. Unlike medications or surgical interventions, exercise training enhances overall cardiovascular health and functional capacity, which can indirectly benefit those with atrial fibrillation.13111213
Eligibility Criteria
This trial is for adults over 40 with persistent or permanent atrial fibrillation, who can exercise and have a resting heart rate of 100 bpm or less. It's not for those who already exercise regularly, have unstable angina, severe valve disease, obstructive cardiomyopathy, are pregnant or breastfeeding, or can't consent to follow-ups.Inclusion Criteria
You can do a test that measures your ability to exercise without getting too tired or feeling unwell.
You can do a test where you exercise until you feel symptoms.
I am 40 years old or older.
See 3 more
Exclusion Criteria
I have unstable chest pain.
I have been diagnosed with severe narrowing of my heart's mitral or aortic valve.
I have been diagnosed with a thickened heart muscle that obstructs blood flow.
See 4 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants undergo high-intensity interval training (HIIT) or moderate-intensity continuous exercise training (MICE) along with standard care
12 weeks
Regular exercise sessions
Follow-up
Participants are monitored for changes in exercise capacity, heart rate control, quality of life, and other health metrics
4 weeks
Treatment Details
Interventions
- High-Intensity Interval Training (Behavioral Intervention)
- Moderate-Intensity Continuous Exercise Training (Behavioral Intervention)
Trial OverviewThe study compares the effects of two types of exercise on people with atrial fibrillation: moderate-intensity continuous training (MICE) versus high-intensity interval training (HIIT), in addition to standard care. The focus is on how these exercises affect fitness levels and quality of life.
Participant Groups
3Treatment groups
Experimental Treatment
Active Control
Group I: standard care + MICEExperimental Treatment1 Intervention
standard care + moderate-intensity continuous exercise training (MICE)
Group II: standard care + HIITExperimental Treatment1 Intervention
standard care + high-intensity interval training (HIIT)
Group III: standard careActive Control1 Intervention
Participants do not participate in a on site structured exercise training program.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
London Health Sciences NetworkLondon, Canada
University of Ottawa Heart InsititueOttawa, Canada
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Who Is Running the Clinical Trial?
Ottawa Heart Institute Research CorporationLead Sponsor
References
Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation: A Randomized Clinical Trial. [2022]Patients with atrial fibrillation (AF) experience poor functional capacity and quality of life (QOL). High-intensity interval training (HIIT) has been shown to elicit greater improvements in functional capacity and QOL compared with moderate to vigorous intensity continuous training (MICT) in other cardiovascular populations, yet HIIT remains understudied in AF.
Influence of Sex on Efficacy of Exercise Training for Patients with Symptomatic Atrial Fibrillation: Insights from the ACTIVE-AF Randomised Controlled Trial. [2023]Exercise training reduces recurrence of arrhythmia and symptom severity amongst patients with symptomatic, non-permanent atrial fibrillation. However, there is little evidence on whether this effect is modified by patient sex.
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. [2015]Atrial fibrillation diminishes cardiac function, exercise tolerance and quality of life. The objective of this study was to determine whether exercise training in atrial fibrillation affects muscle strength, body composition, maximal exercise capacity and walking capacity positively, thus improving quality of life.
Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial. [2022]Exercise training is an effective treatment for important atrial fibrillation (AF) comorbidities. However, a high level of endurance exercise is associated with an increased AF prevalence. We assessed the effects of aerobic interval training (AIT) on time in AF, AF symptoms, cardiovascular health, and quality of life in AF patients.
Atrial Fibrillation Specific Exercise Rehabilitation: Are We There Yet? [2022]Regular physical activity and exercise training are integral for the secondary prevention of cardiovascular disease. Despite recent advances in more holistic care pathways for people with atrial fibrillation (AF), exercise rehabilitation is not provided as part of routine care. The most recent European Society of Cardiology report for AF management states that patients should be encouraged to undertake moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. The aim of this review was to collate data from primary trials identified in three systematic reviews and recent real-world cohort studies to propose an AF-specific exercise rehabilitation guideline. Collating data from 21 studies, we propose that 360-720 metabolic equivalent (MET)-minutes/week, corresponding to ~60-120 min of exercise per week at moderate-to-vigorous intensity, could be an evidence-based recommendation for patients with AF to improve AF-specific outcomes, quality of life, and possibly prevent long-term major adverse cardiovascular events. Furthermore, non-traditional, low-moderate intensity exercise, such as Yoga, seems to have promising benefits on patient quality of life and possibly physical capacity and should, therefore, be considered in a personalised rehabilitation programme. Finally, we discuss the interesting concepts of short-term exercise-induced cardioprotection and 'none-response' to exercise training with reference to AF rehabilitation.
High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. [2021]Background Cardiac rehabilitation ( CR ) for patients with cardiovascular disease has traditionally involved low- to moderate-intensity continuous aerobic exercise training ( MICT ). There is growing and robust evidence that high-intensity interval training ( HIIT ) shows similar or greater efficacy compared with MICT across a range of cardiovascular and metabolic measures, in both healthy populations and populations with a chronic illness. However, there is understandable concern about the safety aspects of applying HIIT in CR settings. This systematic review analyzed safety data drawn from recent proof-of-concept studies of HIIT during CR among patients with cardiovascular disease. Methods and Results We included trials comparing HIIT with either MICT or usual care in patients with coronary artery disease or heart failure participating in tertiary care services, such as phase 2 (outpatient) CR . Adverse events occurring during or up to 4 hours after an exercise training session were collated. There were 23 studies included, which analyzed 1117 participants ( HIIT =547; MICT =570). One major cardiovascular adverse event occurred in relation to an HIIT session, equating to 1 major cardiovascular event per 17 083 training sessions (11 333 training hours). One minor cardiovascular adverse events and 3 noncardiovascular adverse events (primarily musculoskeletal complaints) were also reported for HIIT . Two noncardiovascular events were reported in relation to MICT . Conclusions HIIT has shown a relatively low rate of major adverse cardiovascular events for patients with coronary artery disease or heart failure when applied within CR settings.
Safety and improvement in exercise tolerance with interval training vs moderate-intensity continuous training in heart disease patient of very high cardiovascular risk. [2022]Evaluate safety and effects of training at moderate and high intensity intervals (MIIT, HIIT) compared to continuous moderate intensity training (MICT) in heart disease patient with very high cardiovascular risk (CVR).
The Effectiveness of Progressive Aerobic Interval Training in Cardiac Rehabilitation. [2019]Aerobic interval training (AIT) has recently emerged as a more effective strategy than moderate-intensity continuous exercise (MICE) for improving peak oxygen consumption (V˙O2peak) in coronary artery disease (CAD) patients. The primary purpose of this retrospective study was to describe the change in V˙O2peak, and cardiovascular (CV) risk profile characteristics (secondary outcomes) after progressive AIT practiced in the largest, outpatient cardiac rehabilitation (CR) program in North America compared with usual care CR involving MICE.
High-Intensity Interval Training in Older Adults: a Scoping Review. [2021]High-intensity interval training (HIIT) is an increasingly popular form of aerobic exercise which includes bouts of high-intensity exercise interspersed with periods of rest. The health benefits, risks, and optimal design of HIIT are still unclear. Further, most research on HIIT has been done in young and middle-aged adults, and as such, the tolerability and effects in senior populations are less well-known. The purpose of this scoping review was to characterize HIIT research that has been done in older adults including protocols, feasibility, and safety and to identify gaps in the current knowledge. Five databases were searched with variations of the terms, "high-intensity interval training" and "older adults" for experimental or quasi-experimental studies published in or after 2009. Studies were included if they had a treatment group with a mean age of 65 years or older who did HIIT, exclusively. Of 4644 papers identified, 69 met the inclusion criteria. The average duration of training was 7.9 (7.0) weeks (mean [SD]) and protocols ranged widely. The average sample size was 47.0 (65.2) subjects (mean [SD]). Healthy populations were the most studied group (n = 30), followed by subjects with cardiovascular (n = 12) or cardiac disease (n = 9), metabolic dysfunction (n = 8), and others (n = 10). The most common primary outcomes included changes in cardiorespiratory fitness (such as VO2peak) as well as feasibility and safety of the protocols as measured by the number of participant dropouts, adverse events, and compliance rate. HIIT protocols were diverse but were generally well-tolerated and may confer many health advantages to older adults. Larger studies and more research in clinical populations most representative of older adults are needed to further evaluate the clinical effects of HIIT in these groups.
High versus moderate intensity running exercise to impact cardiometabolic risk factors: the randomized controlled RUSH-study. [2021]Aerobic exercise positively impacts cardiometabolic risk factors and diseases; however, the most effective exercise training strategies have yet to be identified. To determine the effect of high intensity (interval) training (HI(I)T) versus moderate intensity continuous exercise (MICE) training on cardiometabolic risk factors and cardiorespiratory fitness we conducted a 16-week crossover RCT with partial blinding. Eighty-one healthy untrained middle-aged males were randomly assigned to two study arms: (1) a HI(I)T-group and (2) a sedentary control/MICE-group that started their MICE protocol after their control status. HI(I)T focused on interval training (90 sec to 12 min >85-97.5% HRmax) intermitted by active recovery (1-3 min at 65-70% HRmax), while MICE consisted of continuous running at 65-75% HRmax. Both exercise groups progressively performed 2-4 running sessions/week of 35 to 90 min/session; however, protocols were adjusted to attain similar total work (i.e., isocaloric conditions). With respect to cardiometabolic risk factors and cardiorespiratory fitness both exercise groups demonstrated similar significant positive effects on MetS-Z-Score (HI(I)T: -2.06 ± 1.31, P = .001 versus MICE: -1.60 ± 1.77, P = .001) and (relative) VO2max (HI(I)T: 15.6 ± 9.3%, P = .001 versus MICE: 10.6 ± 9.6%, P = .001) compared with the sedentary control group. In conclusion, both exercise programs were comparably effective for improving cardiometabolic indices and cardiorespiratory fitness in untrained middle-aged males.
The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health. [2018]The cardiovascular benefits of regular exercise have been well described, including a significant reduction in cardiovascular morbidity and mortality for those meeting recommended guidelines. Yet the impact of physical activity on the incidence of atrial fibrillation (AF) has been less clear. This review seeks to define the optimal dose and duration for the prevention and treatment of AF. In doing so, we review the evidence that supports a decline in AF risk for those who achieve a weekly physical activity dose slightly above the current recommended guidelines. Furthermore, we identify the reduced AF incidence in those individuals who attain a cardiorespiratory fitness of 8 METs (metabolic equivalents of task) or more during maximal exercise testing. Finally, we review the evidence that shows an excess of AF among regular participants of endurance exercise.
The effects of chronic exercise training in individuals with permanent atrial fibrillation: a systematic review. [2018]Atrial fibrillation, the most common sustained cardiac arrhythmia, is associated with significant morbidity and mortality. Chronic exercise training is a recognized form of treatment for those with many forms of heart disease. There might also be a role for exercise in the management of permanent atrial fibrillation; few studies have explored the effects of chronic exercise training in persons with this condition. The purpose of this study was to systematically evaluate and summarize the evidence surrounding the effects of chronic exercise training in persons with permanent atrial fibrillation.
High-intensity interval training improves cardiovascular health, exercise capacity, and quality of life in permanent atrial fibrillation: a case study. [2018]Persons with permanent atrial fibrillation experience reduced exercise tolerance, weight gain, and an associated decline in overall health. We report on a 74-year-old man with permanent atrial fibrillation who underwent a 10-week high-intensity interval training program. Substantial improvements in heart rate, blood pressure, aerobic and functional capacity, and quality of life were observed. These are desirable as these patients are not candidates for other treatment options and more effective therapies for the treatment of atrial fibrillation are needed.