Exercise cuts atrial fibrillation burden in one-year trial

At three centers in Norway, 295 patients with nonpermanent atrial fibrillation had a small monitor implanted to track every episode over a year. Half were assigned to a tailored exercise program. Their monitored time in atrial fibrillation fell to 3.9%, compared with 7.1% for patients receiving usual care—a 45% relative reduction.

The NEXAF trial, led by Dr. Bjarne Nes of the Norwegian University of Science and Technology in Trondheim, combined two phases. Patients first completed eight supervised high-intensity sessions over four to six weeks. They then exercised mainly at home, with guidance and remote monitoring through a smartwatch, an app and a web-based platform. The control group had no structured or supervised exercise program.

The intervention also improved cardiorespiratory fitness and resting heart rate. Researchers recorded a 37% reduction in total hospitalizations and a 46% reduction in atrial fibrillation-related hospitalizations compared with usual care. But the program did not significantly improve atrial fibrillation-specific quality of life: the AFEQT score rose by 5.6 points with exercise and 4.4 with usual care, with p = 0.43.

That distinction matters. The trial measured a meaningful change in the rhythm condition itself and fewer hospital stays, but it did not show a significant quality-of-life advantage after one year. The results come from a randomized trial, while the exercise model was delivered with what researchers described as modest personnel resources; its performance in wider routine care remains to be established.

So what changes, concretely? For eligible patients who are currently not being referred to exercise rehabilitation, the NEXAF model offers a way to begin with professional supervision and continue at home with digital support. Researchers said only around 1 in 10 eligible patients are currently referred for exercise-based rehabilitation. The new evidence gives clinicians a measurable reason to consider structured, long-term exercise alongside usual atrial fibrillation care.