An Exercise and Physical Activity Program in Patients With Atrial Fibrillation: The ACTIVE-AF Randomized Controlled Trial

Adrian D. Elliott, Christian V. Verdicchio, Rajiv Mahajan, Melissa E. Middeldorp, Celine Gallagher, Ricardo S. Mishima, Jeroen M.L. Hendriks, Rajeev K. Pathak, Gijo Thomas, Dennis H. Lau, Prashanthan Sanders

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Background: There are limited data on the effect of exercise interventions on atrial fibrillation (AF) recurrence and symptoms. Objectives: The aim of this study was to determine the efficacy of an exercise and physical activity intervention on AF burden and symptoms among patients with symptomatic AF. Methods: This prospective, randomized controlled trial included 120 patients with paroxysmal or persistent, symptomatic AF, randomized 1:1 to receive an exercise intervention, combining home and supervised aerobic exercise over 6 months, or to receive usual care. The coprimary outcomes were: 1) AF recurrence, off antiarrhythmic medications and without catheter ablation; and 2) symptom severity assessed by using a validated questionnaire. Results: By 12 months, freedom from AF was achieved in 24 (40%) of 60 patients in the exercise group and 12 (20%) of 60 patients in the control group (HR: 0.50: 95% CI: 0.33 to 0.78). At 6 months, AF symptom severity was lower in the exercise group compared with the control group (mean difference –2.3; 95% CI: –4.3 to –0.2; P = 0.033). This difference persisted at 12 months (–2.3; 95% CI: –4.5 to –0.1; P = 0.041). Total symptom burden was lower at 6 months in the exercise group but not at 12 months. Peak oxygen consumption was increased in the exercise group at both 6 and 12 months. There were no between-group differences in cardiac structure or function, body mass index, or blood pressure. Conclusions: Participation in an exercise-based intervention over 6 months reduced arrhythmia recurrence and improved symptom severity among patients with AF.

Original languageEnglish
Pages (from-to)455-465
Number of pages11
JournalJACC: Clinical Electrophysiology
Issue number4
Publication statusPublished or Issued - Apr 2023


  • arrhythmia
  • cardiorespiratory fitness
  • exercise
  • risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this