In overweight patients with atrial fibrillation (AF), the implementation of an intensive physical activity program, aimed at weight loss and better physical capacity, significantly reduces the risk of recurrence and the severity of symptoms, as much in men as in women, according to an Australian study [1].
The benefit on recurrences of arrhythmia appears greater in women after improvement in physical condition.
Obesity, hypertension, diabetes, sleep apnea… numerous modifiable risk factors linked to lifestyle are involved in the development of atrial fibrillation (AF) and its progression to more serious forms. Control of these risk factors is also widely emphasized in the recommendations concerning primary and secondary prevention, in order to limit the occurrence of AF or complications.
Several studies have in fact demonstrated the interest of this approach.
If over the age of 50, men are more often affected than women by this type of arrhythmia, no study has yet evaluated the impact, depending on the sexes, of a change in lifestyle, in particular weight loss. In this study, the Dr Jean-Jacques Noubiab (Center for Heart Rhythm Disorders, University of Adelaide, Australia) and colleagues wanted to determine the effect of an intense physical activity program combining aerobic exercise and muscle strengthening, distinguishing between men and women.
They included 355 patients with symptomatic AF and overweight (>27 kg/m2), 64% of whom were men. These patients were cared for at their center in Adelaide. Women were on average older than men (65.5 years versus 62.5 years) and had a higher average BMI (34 versus 32). They were also more often affected by paroxysmal AF (67.8% versus 48.3%). Men were more likely to have excessive alcohol consumption (44.4% versus 5.8%).
After having a stress test, patients received a personalized physical activity program, initially including 20 minutes of low-intensity exercise three times per week, then progressing to moderate-intensity exercise sessions for more three hours per week (at least 200 minutes). Patients also received standard treatment to control heart rate and rhythm.
During follow-up, which lasted more than four years, AF was assessed at least once a year by clinical examination, 12-lead electrocardiogram (ECG) and seven-day Holter recording. The primary endpoint was freedom from AF recurrence.
The results show an average weight loss of 7 to 8 kg and an improvement in cardio-respiratory capacity of almost 2 METs (Metabolic Equivalent of Task), with no significant difference between men and women. The frequency, duration, severity and symptoms of AF significantly improved at the end of follow-up, also without differences by sex. The transition from persistent AF to paroxysmal AF was, however, more frequent in men at the end of follow-up (21.8% versus 14%). According to the researchers, higher age among women and more comorbidities could explain these differences.
Patients were divided according to weight loss (≥ 10% compared to initial weight vs 10%) and change in physical capacity (≥ 2MET vs <2 MET). Multivariate analysis of the data reveals a reduction of almost 60% in AF recurrences in both men and women who lost more than 10% of their initial weight, compared to those who had a less significant weight loss (HR= 0.41).
Concerning the improvement of cardio-respiratory capacity, it appears more beneficial in women since the risk of recurrence is reduced by 87% in the event of progression of the MET score of more than 2 points, compared to less progression (HR = 0.13, 95% CI, [0,05 – 0,30]).
In men, there appears to be no significant difference in the rate of AF recurrence depending on the improvement in physical condition.
“This study confirms the need to treat lifestyle risk factors to limit arrhythmia recurrence and reduce symptom severity” in all patients with AF, the authors concluded.
This article was originally published on the Mediquality.net website.
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