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Original research article
Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials
  1. Neil A Smart1,
  2. Nicola King2,
  3. Jeffrey D Lambert3,
  4. Melissa J Pearson1,
  5. John L Campbell3,
  6. Signe S Risom4,5 and
  7. Rod S Taylor3,6
  1. 1 School of Science & Technology, University of New England, Armidale, New South Wales, Australia
  2. 2 School of Biomedical Sciences, University of Plymouth, Devon, UK
  3. 3 Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
  4. 4 Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  5. 5 Institute of Nursing, University College Copenhagen, Copenhagen, Denmark
  6. 6 Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Jeffrey D Lambert; j.d.lambert{at}


Objective The aim of this study was to undertake a contemporary review of the impact of exercise-based cardiac rehabilitation (CR) targeted at patients with atrial fibrillation (AF).

Methods We conducted searches of PubMED, EMBASE and the Cochrane Library of Controlled Trials (up until 30 November 2017) using key terms related to exercise-based CR and AF. Randomised and non-randomised controlled trials were included if they compared the effects of an exercise-based CR intervention to a no exercise or usual care control group. Meta-analyses of outcomes were conducted where appropriate.

Results The nine randomised trials included 959 (483 exercise-based CR vs 476 controls) patients with various types of AF. Compared with control, pooled analysis showed no difference in all-cause mortality (risk ratio (RR) 1.08, 95% CI 0.77 to 1.53, p=0.64) following exercise-based CR. However, there were improvements in health-related quality of life (mean SF-36 mental component score (MCS): 4.00, 95% CI 0.26 to 7.74; p=0.04 and mean SF-36 physical component score: 1.82, 95% CI 0.06 to 3.59; p=0.04) and exercise capacity (mean peak VO2: 1.59 ml/kg/min, 95% CI 0.11 to 3.08; p=0.04; mean 6 min walk test: 46.9 m, 95% CI 26.4 to 67.4; p<0.001) with exercise-based CR. Improvements were also seen in AF symptom burden and markers of cardiac function.

Conclusions Exercise capacity, cardiac function, symptom burden and health-related quality of life were improved with exercise-based CR in the short term (up to 6 months) targeted at patients with AF. However, high-quality multicentre randomised trials are needed to clarify the impact of exercise-based CR on key patient and health system outcomes (including health-related quality of life, mortality, hospitalisation and costs) and how these effects may vary across AF subtypes.

  • atrial fibrillation
  • exercise training
  • meta-analysis
  • health-related quality of life

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  • Contributors All authors contributed significantly to the submitted work. NAS was the team leader, who also assisted with study inclusion/exclusion, data extraction/analysis and writing and editing of both the main text and supplementary files. MJP contributed to the initial idea conception, conducted some of the data extraction, study quality assessment and assisted with manuscript writing. NK contributed to the initial idea conception, conducted much of the data extraction, study quality assessment and assisted with manuscript writing. JDL contributed to the initial idea conception, conducted some of the data extraction, study quality assessment and assisted with manuscript writing. RST contributed the initial idea conception, verified the data extraction, study quality assessment and assisted with manuscript writing. JLC assisted with manuscript writing. SSR contributed to the manuscript writing.

  • Funding This publication presents independent research funded by the National Institute for Health Research (NIHR) under its NIHR Senior Investigator award (Grant Reference Number NF-SI-0514-10155).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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