Three-month walking training in patients with atrial fibrillation improves quality of life irrespective of disease burden

Abstract Background Atrial fibrillation (AF) substantially impacts quality of life. Previous studies demonstrated the potential for exercise-based cardiac rehabilitation to improve quality of life, especially in those patients following initial diagnosis or catheter ablation. Few studies have evaluated the effects of moderate-intensity walking training for AF patients outside of the context of ablation procedures. Purpose To examine the effect of 11 weeks of walking exercise on disease burden (i.e., time in AF and AF burden) and health-related quality of life (HR-QoL) in patients with AF. Methods We included a total of 129 patients with paroxysmal or persistent AF (1-23 years following diagnosis). We compared changes in patients who signed up for a 4-day long-distance walking march (walking group, n=59, 70±6 years, 17% female) versus controls not taking part in this event (n=70, 69±9 years, 35% female). All participants continued regular care. In addition, we asked the walking group to self-report the distance of every walking training performed in preparation of the walking event uring the 11 weeks prior. Time in AF (primary parameter) was measured objectively with a wireless holter electrocardiogram, providing 5 days of continuous monitoring to quantify time in AF as a percentage of total wear time. Measurements were performed before, during (week 6) and after preparation. As secondary parameters, we examined subjective AF burden using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) and HR-QoL using the SF-36. Participants completed the questionnaires before and after preparation. Mixed models analyses with correction for baseline values and sex were performed. Results The amount of walking training performed by the walking group gradually increased from 23.9±10.7 to 38.8±25.7 (mean±SD) km/week during the training period. There was a trend that time in AF declined in the walking (-1.2±2.5% SE) and increased in the control group (0.3±2.2% SE), but we found no significant effects for time, group or time*group-interaction (p=0.23). AFEQT overall score was different between groups (p=0.036). Although the intervention group demonstrated a trend towards increase (1.4±1.3% SE) and controls a decrease (-1.1±1.2% SE), we found no significant ‘time’ or time*group-interaction effect (p=0.85 and 0.13, respectively). For the SF-36 general health domain, we found a group (p=0.009), time (p=0.004), and group*time-interaction effect (p=0.042). Post-hoc analyses showed a larger increase in the intervention group compared to the control group (4.8±1.6 SE versus 0.6±1.4 SE), with higher scores indicating better qualify of life. Conclusion Patients with paroxysmal or persistent AF who engaged in weekly walking exercise as preparation for a walking event showed improvements in health-related quality of life during 11 weeks follow-up, whereas no changes were found in controls. These improvements were irrespective of disease burden.