# How physical exercise affects the quality of life in patients with atrial fibrillation - Savonia AMK

> Students’ mini review of the BIP week learning task.

## Background: Evidence-Based Physical Therapy (EBP)
Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 43 in 2024, a Blended Intensive program (BIP) was held at Charles University in the Czech Republic regarding EBP. The program featured welcome words from the president of The European Network of Physiotherapy in Higher Education (ENPHE) and covered the basis of EBP and challenges in various physical therapy fields.

More than 43 physiotherapy students and 9 teachers from five universities participated:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University, Czech Republic
* Universidad Europea de Madrid, Spain
* CEERRF, France

Students worked in groups to produce articles on themes including sport, prevention, injuries, neurological diseases, respiratory diseases, cardiovascular diseases, children, and older adults. This specific task involved conducting a mini-review and using the PEDro scale to assess study quality regarding atrial fibrillation.

## Atrial Fibrillation and Treatment Strategies
Treatment for recently diagnosed atrial fibrillation (AF) involves identifying reversible risk factors, anticoagulation therapy, and beta-blockers. Patients often report symptoms such as fatigue, decreased exercise tolerance, dyspnea, palpitations, and a reduced quality of life (QOL).

Non-pharmacological therapies include:
* **Ablation therapy:** A hospital procedure to inactivate heart tissue responsible for abnormal electrical signals.
* **Pacemaker placement:** Considered in severe cases resulting in heart failure.

## Mini Review Findings
A bibliographic search on PubMed using MeSH terms and filters for "Randomized Controlled Trial" yielded 62 studies. After screening, 6 studies were included in this review.

### Key Study Summaries
* **Reed et al. (2022):** High-intensity interval training (HIIT) was as effective as 60-minute cardiovascular rehabilitation but achieved results in less than half the time. Twice-weekly 23-minute HIIT improved functional capacity, QOL, resting heart rate, and physical activity levels.
* **Osbak et al. (2012):** Exercise training improved exercise capacity, QOL, and physical strength. Short-term training increased walking capacity by 13% and exercise capacity by 9%. Long-term training enhanced capillary and arteriole density in muscles.
* **Malmo et al. (2016):** Twelve weeks of HIIT reduced AF time in patients with paroxysmal or persistent AF, improving symptoms, exercise capacity, heart function, lipid levels, and QOL.
* **Osbak et al. (2011):** A 12-week aerobic exercise program improved physical capacity and QOL in patients with permanent AF, including better walking distance and reduced resting heart rates.
* **Borland et al. (2020):** Compared physiotherapist-led exercise (PT-X) with physical activity on prescription (PAP). PT-X significantly improved physical fitness, though HR-QOL and lab tests did not differ between groups.
* **Joensen et al. (2019):** Education and physical training may provide short-term, but not long-term, beneficial effects on QOL and physical exercise capacity.

## Conclusion
The review indicates that moderate and supervised exercise improves symptoms and quality of life in patients with atrial fibrillation. The specific type of exercise appears less important than the act of exercising itself. While secondary outcomes improved, further investigation is required.

## Authors
* **Maria Jose Atristain Vega**, physiotherapy student, Charles University, Czech Republic
* **Xiana Rosales Conde**, physiotherapy student, University of A Coruña, Spain
* **Lucie Hecklová**, physiotherapy student, Charles University, Czech Republic
* **Daniel Del Río Frade**, physiotherapy student, University of A Coruña, Spain
* **José Antonio Ginés**, physiotherapy student, Universidad Europea de Madrid, Spain
* **David Pajovic**, physiotherapy student, CEERRF, France
* **Marja Äijö**, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia, University of Applied Sciences, Kuopio, Finland
* **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic
* **Ivana Vláčilová**, Physiotherapist, PhD., Charles University, Czech Republic
* **Veronica Robles García**, PhD. PT. OT. Lecturer, University of A Coruña, A Coruña, Spain
* **Beatriz Martínez Toledo**, PT. Lecturer at University of A Coruña, A Coruña, Spain
* **Montserrat Fernández Pereira**, PT, Lecturer at University of A Coruña, A Coruña, A Coruña, Spain
* **Zeltia Naia**, PhD, MSc, PT Professor, University of A Coruña, A Coruña, Spain
* **Lorena Canosa Carro**, PT, MSc, PhD. Lecturer at Universidad Europea de Madrid, Spain
* **Adrien Pallot**, PT, MSc, Lecturer at CEERRF, France

## References
* Borland M, et al. Exercise-based cardiac rehabilitation improves physical fitness in patients with permanent atrial fibrillation – A randomized controlled study. *Eur Rev Aging Phys Act* 2022 Apr 29;19(1):14. doi:10.1186/s11556-022-00293-1
* Hegbom F, et al. Short-term exercise training in patients with chronic atrial fibrillation: effects on exercise capacity, AV conduction, and quality of life. *J Cardiopulm Rehabil.* 2006 Jan-Feb;26(1):24-9. doi:10.1097/00008483-200601000-00005.
* Joensen AM, et al. Effect of patient education and physical training on quality of life and physical exercise capacity in patients with paroxysmal or persistent atrial fibrillation: A randomized study. *J Rehabil Med.* 2019 Jun 18;51(6):442-450. doi:10.2340/16501977-2551. PMID: 30931484.
* Malmo V, et al. Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial. *Circulation.* 2016 Feb 2;133(5):466-73. doi:10.1161/CIRCULATIONAHA.115.018220.
* Osbak PS, et al. 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 fibrillation: a randomized controlled trial. *J Rehabil Med.* 2012 Nov;44(11):975-9. doi:10.2340/16501977-1039. PMID: 22951598.
* Reed JL, et al. Effect of High- Intensity Interval Training in Patients With Atrial Fibrillation: A Randomized Clinical Trial. *JAMA Netw Open.* 2022 Oct 3;5(10):e2239380. doi:10.1001/jamanetworkopen.2022.39380. PMID: 36315143; PMCID: PMC9623436.