Cardiopulmonary fitness and quality of life improvements in atrial fibrillation patients following exercise-based cardiac rehabilitation: meta-analysis of randomized control trials

• Exercise improves cardiorespiratory fitness. • Enhance QoL. • Reduce AF recurrence. In this meta-analysis, the authors aimed to provide a comprehensive overview of the benefits of exercise and its potential implications in the management of atrial fibrillation. The authors conducted searches in PubMed, MEDLINE, EMBASE, and Cochrane databases using the terms “atrial fibrillation”, “exercise”, “cardiac rehabilitation”, or “physical activity”. The endpoints included the 6-Minute Walk Test (6MWT), maximal Oxygen uptake (VO 2 max) measured by Cardiopulmonary Exercise Testing (CPET), maximal power measured by CPET, resting Heart Rate (HR), Left Ventricular Ejection Fraction (LVEF), data from the 36-Item Short Form Survey Instrument (SF-36), and AF recurrence post-ablation. The present analysis included 11 randomized control trials published in the past 15-years, involving a total of 1251 patients. The pooled analysis showed significant increases in VO 2 max, 6MWT, and maximal power in AF patients post-exercise (-3.05, 95 % CI: -4.79, -1.3, I 2 = 84 %, p < 0.0001; -42.07, 95 % CI: -56.22, -27.93, I 2 = 0 %, p < 0.00001; -16.39, 95 % CI: -20.76, -12.01, I 2 = 72 %, p < 0.00001, respectively). Sensitivity analysis results remained consistent but significantly reduced heterogeneity. The authors found that the recurrence rate was significantly lower in patients who exercised (RR = 0.76, 95 % CI: 0.62, 0.95, I 2 = 0 %, p = 0.01). Quality of life was assessed using the SF-36 scale, which includes eight domains. The pooled results are as follows: physical function (WMD = -6.46, 95 % CI: -10.48, -2.44, I 2 = 52 %, p = 0.002), role physical (WMD = -13.02, 95 % CI: -16.68, -9.36, I 2 = 32 %, p < 0.00001), general health (WMD = -7.80, 95 % CI: -12.35, -3.25, I 2 = 62 %, p = 0.0008), bodily pain (WMD = -3.54, 95 % CI: -6.82, -0.26, I 2 = 0 %, p = 0.03), vitality (WMD = -8.34, 95 % CI: -14.31, -2.36, I 2 = 74 %, p = 0.006), social function (WMD = -6.44, 95 % CI: -12.17, -0.72, I 2 = 71 %, p = 0.03), role emotional (WMD = -12.18, 95 % CI: -16.46, -7.90, I 2 = 0 %, p < 0.00001), and mental health(WMD = -6.79, 95 % CI: -11.69, -1.88, I 2 = 72 %, p = 0.007). Sensitivity analysis resulted in consistent outcomes with heterogeneity reduced to 0 % for all domains. The present study found that exercise rehabilitation benefits patients with atrial fibrillation. Exercise can improve quality of life and possibly reduce recurrence. While it enhances cardiorespiratory fitness (VO 2 max, 6MWT, maximal power), it does not significantly improve ejection fraction or heart rate.