Patient education and physical training for patients with AF
Strengths
The strengths of this study include a complete re-
habilitation programme, the use of disease-specific
individualized training programmes and exercise tests
performed by physiotherapists who were blinded to
the 2 groups.
The study included patients with paroxysmal or
persistent AF, whereas other studies have primarily
included patients with permanent AF. Thus, in gene-
ral, participants in our study seemed to have higher
baseline scores compared with an unselected popula-
tion of AF (17). Dudrik et al. have previously shown
that progression from paroxysmal to persistent AF is
associated with a decrease in health-related quality of
life (30). We therefore performed stratified analyses on
type of AF, but we did not find any differences in the
effect of rehabilitation between the 2 groups.
This study examined the effect of a complete rehabi-
litation programme for patients with AF. Previous stu-
dies have shown beneficial effects of education about
anticoagulation treatment on treatment compliance and
found that physical training was beneficial regarding
physical capacity and QoL (7, 9, 24, 28). In addition,
non-randomized studies indicated a beneficial effect
of physical exercise, weight loss, and aggressive risk
factor management (5–7).
Limitations
The primary limitation was the number of participants,
although it was comparable with other studies in
patients with AF (7–11). The physical training of the
control group was not monitored. Due to logistics we
could not include all relevant patients. Patients could
not be included if they were admitted for a short period
when no nurse or physicians leading the study were
on duty, However, this is non-systematic selection and
could therefore not influence the study results. Also, a
precise registration of the AF burden would have been
optimal, e.g. implanting a loop-recorder. However, the
economy of the study was restricted. No information
was collected regarding the degree of the patients’
physical activity during the follow-up period, which
could affect the QoL scores.
Thus, this study has limitations. No long-term po-
sitive effect of patient education and physical training
on QoL of the studied patients was found. Therefore,
the cost-effectiveness of this rehabilitation programme
for this patient group is questionable.
Conclusion
This study indicated that a multifaceted rehabilitation
programme including education and physical training
in patients with paroxysmal or persistent AF may have
449
a beneficial short-term (but no long-term) effect on
QoL and physical exercise capacity estimated with
disease-specific and generic QoL questionnaires.
ACKNOWLEDGEMENTS
The authors would like to thank physiotherapists Rikke Nie-
mann Hargaard, Kasper Juul Larsen, and Klaus Sletten Kris-
tensen for their instruction in the physical exercise training and
physiotherapists Camilla Zyrmylen and Thomas Wibaek Asp
for performing the blinded physical tests. Thanks to clinical
dietitian Lonneke Hjermitslev and clinical psychologist Lisbeth
Hede Jørgensen for their assistance in the education. This study
was supported by the Research Foundation of the Medical As-
sociation of North Jutland and the Aalborg AF Study Group.
The authors have no conflicts of interest to declare.
REFERENCES
1. Anderson L, Taylor RS. Cardiac rehabilitation for people
with heart disease: an overview of Cochrane systematic
reviews. Cochrane Database Syst Rev 2014; 12.
2. McCabe PJ, Schad S, Hampton A, Holland DE. Knowledge
and self-management behaviors of patients with recently
detected atrial fibrillation. Heart Lung J Acute Crit Care
2008; 37: 79–90.
3. Qureshi WT, Alirhayim Z, Blaha MJ, Juraschek SP, Keteyian
SJ, Brawner CA et al. Cardiorespiratory fitness and risk
of incident atrial fibrillation results from the Henry Ford
exercise testing (FIT) project. Circulation 2015; 131:
1827–1834.
4. Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta
AB, Mahajan R, et al. Impact of CARDIOrespiratory FIT-
ness on arrhythmia recurrence in obese individuals with
atrial fibrillation the CARDIO-FIT Study. J Am Coll Cardiol
2015; 66: 985–996.
5. Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan
R, Wong CX, et al. Long-term effect of goal-directed weight
management in an atrial fibrillation cohort: a long-term
follow-up study (LEGACY). J Am Coll Cardiol 2015; 65:
2159–2169.
6. Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan
R, Twomey D, et al. Aggressive risk factor reduction study
for atrial fibrillation and implications for the outcome of
ablation: the ARREST-AF cohort study. J Am Coll Cardiol
2014; 64: 2222–2231.
7. Hegbom F, Sire S, Heldal M, Orning OM, Stavem K, Gjesdal
K. Short-term exercise training in patients with chronic atrial
fibrillation: effects on exercise capacity, AV conduction,
and quality of life. J Cardiopulm Rehabil 2006; 26: 24–29.
8. Giacomantonio NB, Bredin SSD, Foulds HJA, Warburton
DER. A systematic review of the health benefits of exercise
rehabilitation in persons living with atrial fibrillation. Can
J Cardiol 2013; 29: 483–491.
9. Osbak PS, Mourier M, Kjaer A, Henriksen JH, Kofoed KF,
Jensen GB. A randomized study of the effects of exercise
training on patients with atrial fibrillation. Am Heart J
2011; 162: 1080–1087.
10. Osbak PS, Mourier M, Henriksen JH, Kofoed KF, Jensen GB.
Effect of physical exercise training on muscle strength and
body composition, and their association with functional
capacity and quality of life in patients with atrial fibrilla-
tion: a randomized controlled trial. J Rehabil Med 2012:
44: 975–979.
11. Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kal-
lemose T, Dixen U. Cardiovascular exercise and burden of
arrhythmia in patients with atrial fibrillation – a randomi-
zed controlled trial. PLoS One 2017; 12: 1–16.
J Rehabil Med 51, 2019