Exercise testing and exercise rehabilitation for patients with atrial fibrillation
Open accessAbstract
Introduction and Purpose: Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increasing prevalence with advancing age. It is associated with dyspnea, exercise intolerance, and increased risk for clinical events, especially stroke and heart failure. This article provides a concise review of exercise testing and rehabilitation in patients with persistent or permanent AF. Clinical Considerations: The first goal in the treatment of AF is to reduce symptoms (eg, palpitations) and a fast ventricular rate. The second goal is to reduce the risk of a stroke. Exercise testing and rehabilitation may be useful once these goals are achieved. However, there are no large, randomized exercise training trials involving patients with AF, and what data are available comes from single-site trials, secondary analyses, and observational studies. Exercise Testing and Training: There are no specific indications for performing a graded exercise test in patients with AF; however, such testing may be used to screen for myocardial ischemia or evaluate chronotropic response during exertion. Among patients with AF, exercise capacity is 15% to 20% lower and peak heart rate is higher than in patients in sinus rhythm. Exercise rehabilitation improves exercise capacity, likely improves quality of life, and may improve symptoms associated with AF. Whole-body aerobic exercise is recommended. Summary: Atrial fibrillation is a common cardiac condition and in these patients, exercise rehabilitation favorably improves exercise capacity. However, prospective randomized controlled trials are needed to better define the effects of exercise training on safety; quality of life; clinical outcomes; and central, autonomic, and peripheral adaptations.
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The rating of perceived exertion methodology may be particularly helpful when counseling patients with arrhythmias that preclude an accurate assessment of heart rate during exercise, including those with atrial fibrillation.
“This methodology may be particularly helpful when counseling patients with arrhythmias that preclude an accurate assessment of HR during exercise, including those with atrial fibrillation [41] .”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [41]
The Exercise Training section describes RPE as a valid, helpful way to guide exercise intensity in patients with atrial fibrillation, while the Exercise Testing section explains why their heart rate can be difficult to measure accurately. The paper does not establish the same recommendation for other arrhythmias that impair heart-rate assessment. (LLM, conf=0.78)
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Sorted by citations
Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., Eijsvogels, T. M. H., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000749 · Cited by 410 · see citing works
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“This methodology may be particularly helpful when counseling patients with arrhythmias that preclude an accurate assessment of HR during exercise, including those with atrial fibrillation [41].”
- Authors
- Keteyian, S. J., Ehrman, J. K., Fuller, B., & Pack, Q. R.
- Affiliations
- Baystate Medical Center (US)
- Corresponding author
- Keteyian, Steven J.
- Venue
- Journal of Cardiopulmonary Rehabilitation and Prevention
- Published
- 2019-03
- Volume
- 39
- Issue
- 2
- Pages
- 65-72
- ISSN
- 1932-7501 (ISSN-L)
- PMC
- PMC6394874
- OpenAlex
- W2919550273
- Cited by
- 60
- References
- 45
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 12 · 2023: 8 · 2022: 16 · 2021: 4 · 2020: 6 · 2019: 1
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Cardiopulmonary Rehabilitation and Prevention (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL135440)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- atrial fibrillation, exercise testing, exercise rehabilitation, exercise capacity, aerobic exercise training, chronotropic response, stroke risk, quality of life, exercise intolerance
- MeSH terms
- Atrial Fibrillation, Exercise Test, Exercise Therapy, Humans
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