Effect of exercise intervention on quality of life and exercise capacity in patients with atrial fibrillation: a systematic review and network meta-analysis

Background: Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, can significantly increase stroke risk, heart failure, and reduce quality of life. Despite growing evidence on the benefits of exercise for AF patients, data heterogeneity and the lack of comparative studies on different exercise modalities limit the accuracy of clinical recommendations. Objective: To compare the effects of different exercise regimens on AF and determine the most effective type of exercise for the treatment of AF. Methods: We systematically searched PubMed/Medline, Embase, the Cochrane Library, and Web of Science for randomized controlled trials of exercise interventions in patients with AF aged 18 years and older. The Cochrane Collaboration Risk of Bias tool (RoB 2) was utilized to assess the risk of bias. We used R software to perform a network meta-analysis. The protocol has been registered with PROSPERO (Number CRD42024628296). Results: A total of 1,477 participants from 16 randomized controlled trials were included in this network meta-analysis. The results indicated that mind-body exercise (MB) was the most effective in improving general health [mean difference (MD) = 12.26, 95% credible intervals (95% Crl): 6.47 to 18.04, surface under the cumulative ranking curve (SUCRA) = 76.31%] and 6-min walk test (MD = 104.80, 95% Crl: 44.25 to 165.10, SUCRA = 99.60%). Additionally, aerobic exercise (AE) was the most effective in increasing vitality (MD = 7.73, 95% Crl: 6.40 to 9.07, SUCRA = 88.07%). Conclusion: This network meta-analysis found that MB had superior effects on general health and exercise capacity. AE significantly improved vitality, social functioning, and mental health, with particular benefits in improving vitality. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier (CRD42024628296).