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NEXAFAtrial FibrillationOpen Access
Long-term exercise training in patients with non-permanent atrial fibrillation
Key result
An exercise intervention reduces AF burden ~45% vs. usual care without improving AF-specific quality of life.
- 45% relative reduction
- P=0.016
- n=295
Why the trial?
Exercise is advised in atrial fibrillation, but whether sustained training actually reduces AF burden — measured objectively with continuous implantable monitoring — and improves quality of life had not been established in a randomised trial.
Does a one-year exercise intervention reduce atrial fibrillation burden and improve quality of life in patients with non-permanent atrial fibrillation?
Population
295 patients with non-permanent AF and low physical activity (3 Norwegian centres)
Comparison
1-year exercise programme (eight supervised HIT sessions + remote) vs usual care
Design
Randomized (1:1) multicenter trial; insertable cardiac monitor in all patients
Follow-up
1 year (continuous ICM monitoring)
Authors
Discussion
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Implication
A one-year exercise programme cut AF burden (3.9% vs 7.1%) without improving AFEQT; supports exercise for burden reduction, not as a quality-of-life intervention.
Key Points
- To evaluate the effect of a one-year structured and digitally supported exercise training intervention on atrial fibrillation burden and disease-specific quality of life in patients with non-permanent atrial fibrillation.
- Randomized multicenter trial (N=295) conducted across three centers in Norway assigning inactive patients with non-permanent atrial fibrillation 1:1 to a one-year exercise intervention or usual care.
- The intervention consisted of eight supervised high-intensity exercise sessions over the initial four to six weeks followed by remote guidance via a smartwatch, application, and web platform.
- All participants received an insertable cardiac monitor to assess co-primary endpoints: percent time in atrial fibrillation and change in Atrial Fibrillation Effect on Quality of Life (AFEQT) score over one year.
- Atrial fibrillation burden over one year was significantly lower with the exercise intervention compared with usual care (3.9% vs. 7.1%; p=0.016), representing a 45% relative reduction.
- There was no significant difference between groups in AF-specific quality of life change at one year (AFEQT score change +5.6 vs. +4.4; p=0.43).
- Patients in the exercise intervention arm showed improvements in cardiorespiratory fitness and experienced fewer hospitalizations compared to usual care.
Evidence details
What drove the result?
| Outcome | Exercise | Usual care |
|---|---|---|
| AF burden (% of monitored time over 1 year) | 3.9% | 7.1% |
| Co-primary · p=0.016; 45% relative reduction; CI not reported | ||
| AFEQT overall score change at 1 year | +5.6 | +4.4 |
| Co-primary · p=0.43 — not met | ||
Limitations & tradeoffs
Subgroup caution
The co-primary quality-of-life endpoint was not met (p=0.43), so the AF-burden benefit should not be over-read.
Statistical certainty
No confidence intervals or per-arm sample sizes are reported.
Design limitations
Results come from a conference press release without journal publication, and secondary fitness and hospitalisation improvements are reported without numeric detail.
Structured PICO
Does a one-year exercise intervention reduce atrial fibrillation burden and improve quality of life in patients with non-permanent atrial fibrillation?
P
Population
295 patients with non-permanent atrial fibrillation and low physical activity, followed for one year.
I
Intervention
One-year exercise intervention consisting of eight supervised high-intensity sessions over the first four to six weeks followed mainly by remote monitoring and guidance via smartwatch, app and web platform
C
Comparator
Usual care involving no structured or supervised exercise
O
Outcome
Co-primary endpoints: time in AF as a percentage of total monitored time over one year (measured via insertable cardiac monitor) and change in the Atrial Fibrillation Effect on Quality of Life (AFEQT) overall score at one yearsurrogate
Main Result
Effect estimate: 45% relative reduction
Absolute Event Rate: 3.9% vs 7.1%
p-value: p=0.016
A structured one-year exercise intervention significantly reduced atrial fibrillation burden by 45% in patients with non-permanent AF, though it did not significantly improve AF-specific quality of life.
Cite This Study
Bjarne Nes (2026) conducted an RCT in non-permanent atrial fibrillation (n=295). Exercise intervention vs. Usual care was evaluated on Time in AF as a percentage of total monitored time over one year and change in the Atrial Fibrillation Effect on Quality of Life (AFEQT) overall score at one year (45% relative reduction, p=0.016). A one-year exercise intervention significantly reduced atrial fibrillation burden compared to usual care (3.9% vs 7.1%; p=0.016), with no significant difference in AF-specific quality of life.