Can structured exercise-based cardiac rehabilitation (ExCR) improve symptom control and reduce arrhythmia burden in patients with atrial fibrillation (AF)? A meta-analysis published in the British Journal of Sports Medicine provides strong evidence of benefit without added risk.

This analysis reviewed 20 randomized clinical trials (RCTs) encompassing 2,039 patients with AF, followed for a mean of 11 months. ExCR did not reduce all-cause mortality (8.3% vs 6.0%; relative risk [RR] 1.06; 95% confidence interval [CI], 0.76 to 1.48) or serious adverse events (2.9% vs 4.1%; RR 1.30; 95% CI, 0.66 to 2.56) but offered several significant clinical benefits.

ExCR reduced AF symptom severity (mean difference [MD] −1.61; 95% CI, −3.06 to −0.16), AF burden (MD −1.61; 95% CI, −2.76 to −0.45), episode frequency (MD −0.57; 95% CI, −1.07 to −0.07), and episode duration (MD −0.58; 95% CI, −1.14 to −0.03). It lowered AF recurrence risk (RR 0.68; 95% CI, 0.53 to 0.89) and improved maximal oxygen consumption (VO₂ peak) by 3.18 mL/kg/min (95% CI, 1.05 to 5.31). Mental health-related quality of life improved, while physical scores showed no significant change. Benefits remained consistent across AF subtypes, exercise doses, and delivery modes.