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Journal of the American College of Cardiology

Clinical Articles, Lead Article

Improved cardiorespiratory fitness reduces arrhythmia risk

Obese atrial fibrillation patients have a lower chance of arrhythmia recurrence if they have high levels of cardiorespiratory fitness, and risk continues to decline as exercise capacity increases as part of treatment, according to a study published recently in the Journal of the American College of Cardiology.1

Researchers evaluated 825 atrial fibrillation patients with a BMI of over 27. After exclusions, 308 patients were divided into low, adequate and high cardiorespiratory fitness groups based on baseline exercise performance and followed for four years to measure their fitness levels’ impact on arrhythmia recurrence. Patients were also offered a physician-led program designed to produce weight loss and increase exercise activity.

After four years of follow up, 17% of patients in the low cardiorespiratory fitness group were free from arrhythmia, compared to 76% in the adequate group and 84% in the high group. Those who improved upon their cardiorespiratory fitness had even further risk reduction. Researchers found that for every increase in metabolic equivalent (MET), there was a 20% reduction in risk of arrhythmia recurrence, and this increase was still shown after adjusting for weight changes and baseline exercise performance.

Dr Prashanthan Sanders (University of Adelaide)

Dr Prashanthan Sanders (University of Adelaide)

Patients were also divided into four groups to determine freedom from arrhythmia based on weight loss and gains in exercise capacity, and researchers found that a gain in exercise capacity greater than two METs in addition to weight loss was associated with two times greater freedom from arrhythmia.

“While weight loss is important for heart disease patients, especially those with arrhythmia, our study shows it’s beneficial to have high cardiorespiratory fitness and continue to improve on that,” said Dr Prashanthan Sanders, senior author of the study (Centre for Heart Rhythm Disorders, University of Adelaide in Adelaide, Australia). “An ideal treatment plan would include a focus on both,” he added.

In an accompanying editorial comment, Dr Paul D Thompson, (Hartford Hospital, Hartford, Connecticut, USA), said, “What’s most exciting about this new study is that it is the first to demonstrate that increasing exercise capacity reduces atrial fibrillation risk.”

“These new results, and the cumulative data linking moderate physical activity to reduced atrial fibrillation risk, suggest that until definitive trial data are available, clinicians should recommend moderate exercise training to our patients with atrial fibrillation, not only to reduce atrial fibrillation, but also for its overall cardiovascular benefits,” Dr Thompson added.


1. Pathak RK, Elliott A, Middeldorp ME, et al.  Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation the CARDIO-FIT study. J Am Coll Cardiol 2015;66:985–96.

Published on: September 30, 2015

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  • ArrhythmiaAlliance
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