{
  "abstract": "Objective To undertake a contemporary review of the impact of exercise based cardiac rehabilitation (ExCR) for patients with atrial fibrillation (AF).Data sources CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, WoS Core Collection, LILACS and trial registers were searched from inception up to 24 March 2024.Eligibility criteria Randomised clinical trials (RCTs) comparing ExCR with any non-exercise control.Design Random effect meta-analyses presented as effect estimates and 95% CIs. Meta-regression examined study level effect modification. Cochrane risk of bias, GRADE (Grading of Recommendations Assessment, Development and Evaluation) and trial sequential analysis (RTSA) were applied.Results 20 RCTs (n=2039) with a mean follow-up of 11 months showed that ExCR did not impact all cause mortality (8.3% vs 6.0%, relative risk (RR) 1.06, 95% 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 did reduce 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), episode duration (MD −0.58, 95% CI −1.14 to −0.03), AF recurrence (RR 0.68, 95% CI 0.53 to 0.89), and improved exercise capacity (maximal oxygen consumption (VO 2 peak) MD 3.18, 95% CI 1.05 to 5.31 mL/kg/min). There was benefit for the mental component but not the physical component of a health related quality of life questionnaire. No differential effects across AF subtype, ExCR dose, or mode of delivery were seen.Conclusion Meta-analyses of RCT evidence for ExCR in patients with AF demonstrated several clinical benefits without an increase in serious adverse events. GRADE and RTSA assessments indicated further high quality and adequately powered RCTs are needed.",
  "authors": [
    {
      "affiliations": [
        "Cardiovascular Health Research Group, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK",
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, UK"
      ],
      "name": "Benjamin JR Buckley"
    },
    {
      "affiliations": [
        "MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK"
      ],
      "name": "Linda Long"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, UK"
      ],
      "name": "Deirdre A Lane"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Hospital, Copenhagen, Denmark"
      ],
      "name": "Signe Risom"
    },
    {
      "affiliations": [
        "Cardiovascular Health Research Group, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK"
      ],
      "name": "Charlotte Jane Fitzhugh"
    },
    {
      "affiliations": [
        "Department of Clinical Medicine, Faculty Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark"
      ],
      "name": "Selina K Berg"
    },
    {
      "affiliations": [
        "Department of Clinical Medicine, Faculty Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark"
      ],
      "name": "Pernille Palm"
    },
    {
      "affiliations": [
        "Department of Cardiology and Internal Medicine, Amager and Hvidovre University Hospital, Copenhagen, Denmark"
      ],
      "name": "Kirstine L Sibilitz"
    },
    {
      "affiliations": [
        "Department of Clinical Medicine, Faculty Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark",
        "Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Jesper H Svendsen"
    },
    {
      "affiliations": [
        "Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark"
      ],
      "name": "Christian Gluud"
    },
    {
      "affiliations": [
        "Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Nyborg, Denmark"
      ],
      "name": "Ann-Dorthe Zwisler"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, UK"
      ],
      "name": "Gregory Y H Lip"
    },
    {
      "affiliations": [
        "School of Health and Social Care, Edinurgh Napier University, Edinburgh, UK"
      ],
      "name": "Lis Neubeck"
    },
    {
      "affiliations": [
        "MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK"
      ],
      "name": "Rod S Taylor"
    }
  ],
  "title": "Exercise based cardiac rehabilitation for atrial fibrillation: Cochrane systematic review, meta-analysis, meta-regression and trial sequential analysis",
  "uid": "24c1cbe0-e623-5410-a5ac-55a8c8020167"
}