Exercise Training Improves Cognitive Function and Neurovascular Control in Patients With Heart Failure and Atrial Fibrillation: A Randomized Clinical Trial

Background Atrial fibrillation (AF) may be linked to cognitive impairment in heart failure (HF) patients. Regular exercise training has numerous benefits, including improving adults’ overall health and cognitive function. However, the effects of exercise training on cognitive function in heart failure patients with reduced ejection fraction and permanent atrial fibrillation (HFAF) are not well understood. Objective To test the hypothesis that exercise training improves cognitive function and neurovascular control in patients with HFAF. Methods This randomized clinical trial included patients with HFAF, LVEF ≤40%, and resting HR ≤80 bpm. Montreal Cognitive Assessment score (MoCA), muscle sympathetic nerve activity (MSNA), and forearm blood flow (FBF) assessment were performed before and after the 12-week protocol period. Results Twenty-six patients were randomized to exercise training (HFAF-trained, n=13) or no training (HFAF-untrained, n=13). At baseline, no differences between groups were found. Exercise significantly improved the MoCA score from 14.85 to 22.62 ( P <0.0001), as well as those measuring processing visuospatial, memory, and attention function from 2.23 to 3.31 ( P =0.02); from 1.92 to 2.69 ( P =0.01); and from 2.62 to 3.85 ( P =0.002), respectively. HFAF-training significantly decreased MSNA from 49.6±9.5 to 32.0±7.2 burst/min ( P <0.0001) and forearm vascular resistance from 48.8±13.1 to 28.1±7 units ( P <0.0001). Concomitantly, FBF increased from 1.9±0.5 to 3.0±0.7 mL/min/100mL ( P <0.0001). The untrained group increased MSNA from 50.9±10.6 to 57.6±9.2 burst/min ( P =0.004). No significant changes were found in the other variables in untrained patients. Conclusion Exercise training improves cognitive function and neurovascular control in patients with heart failure with reduced ejection fraction and permanent atrial fibrillation.