Efficacy of exercise intervention for atrial fibrillation: a systematic review and meta-analysis

This meta-analysis examined the efficacy of exercise interventions for atrial fibrillation (AF). PubMed, Embase, and the Cochrane Library databases were searched for potentially eligible randomized controlled trials (RCTs) from inception to Nov 2024. Patients were diagnosed with AF. The intervention group received exercise management. The control group received standard AF management. The outcomes were the Short Form 36 Health Survey Questionnaire (SF-36), heart rate at rest (HR), 6-min walk test (6MWT), peak oxygen uptake (VO2 peak), and the changes in VO2 peak. The RCTs were evaluated according to the Cochrane risk bias tool. Sixteen RCTs (593 and 556 participants in the exercise and control groups) were included. Regarding the SF-36, the exercise intervention did not improve the general health (WMD = 4.10, 95%CI: -3.17, 11.37, P = 0.269; I2 = 86.4%, Pheterogeneity<0.001), physical function (PF) (WMD = 7.50, 95%CI: -5.78, 22.77, P = 0.268; I2 = 98.8%, Pheterogeneity<0.001), and vitality (WMD = 4.45, 95%CI: -1.80, 10.69, P = 0.163; I2 = 80.0%, Pheterogeneity<0.001) scores. The exercise intervention did not improve the HR at rest (WMD=-1.71, 95%CI: -5.23, 1.82, P = 0.343; I2 = 61.6%, Pheterogeneity=0.016). The exercise intervention improved the 6MWT (WMD = 66.27, 95%CI: 16.49, 116.04, P = 0.009; I2 = 77.4%, Pheterogeneity=0.001), VO2 peak (WMD = 3.08, 95%CI: 0.88, 5.29, P = 0.006; I2 = 63.3%, Pheterogeneity=0.018) and changes in VO2 peak (WMD = 3.78, 95%CI: 2.16, 5.39, P < 0.001; I2 = 0.0%, Pheterogeneity=0.615) in patients with AF. No publication bias was observed. The sensitivity analyses suggested that the results were robust. In patients with AF, an exercise intervention appears to improve the 6MWT and VO2 peak, but not resting HR and overall health-related quality of life. However, subgroup analyses indicated that exercise significantly improved the vitality (VT) subscore of the SF-36 in specific patient populations, suggesting benefits in certain clinical contexts. Future studies should prioritize head-to-head comparisons of exercise modalities across AF subtypes, standardized adherence monitoring, and longitudinal registry-linked designs to assess clinical progression and real-world applicability.