One-Year Exercise Intervention Cuts Atrial Fibrillation Burden by 45% in NEXAF Trial
核心洞察
A one-year hybrid exercise intervention reduced atrial fibrillation (搜索) burden by 45% compared with usual care (3.9% vs. 7.1%; p=0.016) in the NEXAF trial presented at ESC Congress 2026.
The intervention improved cardiorespiratory fitness and resting heart rate, and was associated with 37% fewer total hospitalizations and 46% fewer AF-related hospitalizations.
No significant difference in AF-specific quality of life was observed between groups (AFEQT score: +5.6 vs. +4.4; p=0.43).
A one-year exercise program combining short-term supervised sessions with long-term home-based exercise reduced atrial fibrillation (搜索) (AF) burden by 45% compared with usual care, according to results from the NEXAF trial presented in a Hot Line session at ESC Congress 2026.
The trial, led by Dr. Bjarne Nes, Principal Investigator of the NEXAF trial at the Norwegian University of Science and Technology in Trondheim, Norway, enrolled 295 patients across three centers in Norway. Participants had a mean age of 64 years, 30% were women, and all had non-permanent AF with physical activity levels below general recommendations.
A Persistent Implementation Gap in AF Care
While the incidence of some cardiovascular diseases is stable or decreasing, AF prevalence is rising. Although lifestyle changes and risk factor modification are acknowledged as central components of AF management, tailored exercise remains underused.
Despite recommendations in ESC Guidelines, there is currently an implementation gap — only around 1 in 10 eligible patients are being referred for exercise-based rehabilitation, according to a survey from the European Heart Rhythm Association.
Dr. Nes also highlighted a knowledge gap: "The few trials that have been published evaluating exercise are mostly short-term, small-scale studies where AF burden has not been continuously monitored."
Trial Design and Endpoints
The NEXAF trial was designed to evaluate the effects of a one-year exercise intervention in reducing total AF burden and improving AF-specific quality of life (QoL) in symptomatic patients with AF. Patients were randomized 1:1 to a one-year exercise intervention or usual care.
The exercise intervention consisted of eight supervised high-intensity sessions during the first four to six weeks, followed mainly by remote exercise monitoring and guidance using a smartwatch, an app, and a web-based platform. Usual care involved no structured or supervised exercise programs. An insertable cardiac monitor was implanted in all participants to continuously record the heart's electrical activity.
The co-primary endpoints were time in AF as a percentage of total time monitored (AF burden) during the one-year follow-up and change in the Atrial Fibrillation (搜索) Effect on Quality of Life (AFEQT) questionnaire overall score at one year.
Primary Results
Researchers found a 45% relative reduction in the co-primary endpoint of AF burden in patients assigned to the exercise intervention versus usual care at one year (3.9% vs. 7.1%, respectively; p=0.016).
Despite the improvement in AF burden, there was no significant difference in AF-specific QoL with the exercise intervention at one year (AFEQT score: +5.6 vs. +4.4; p=0.43).
"Having hard data proving a 45 percent relative drop in actual atrial fibrillation (搜索) burden is huge. It moves exercise directly into the category of a primary medical treatment," said Rigved Tadwalkar, MD, a board certified consultative cardiologist and medical director of the Cardiac Rehabilitation Center at Providence Saint John's Health Center in Santa Monica, CA. Tadwalkar was not involved in the research.
Secondary Outcomes and Clinical Implications
Regarding secondary endpoints, improvements were observed in measures of cardiorespiratory fitness and resting heart rate with the exercise intervention. The researchers also observed a 37% reduction in total hospitalizations and a 46% reduction in AF-related hospitalizations.
Summing up the findings, Dr. Nes said: "In this large, randomized trial, a one-year exercise intervention induced a meaningful reduction in total AF burden, improved fitness and led to fewer AF-related hospital admissions compared to usual care."
He noted that the hybrid model combining short-term supervision with long-term home-based exercise and digital support was delivered with modest personnel resources and was clinically feasible. "The trial strengthens the arguments for broader implementation of structured, long-term exercise in AF care," he concluded.
Limitations and Broader Applicability
The trial population may limit how broadly the results apply. Participants were physically inactive, had non-permanent AF, and were treated at Norwegian centers. The program also began with supervised high-intensity sessions, which may not be appropriate for all people with AF.
"Experiencing an episode during a workout could understandably make someone anxious about exercising or discourage them from continuing," said Paul Drury, MD, board certified cardiologist and associate medical director of electrophysiology at MemorialCare Saddleback Medical Center in Laguna Hills, CA. Drury was not involved in the research.
"That is why individualized exercise plans, appropriate medical evaluation, and reassurance from a health care professional can be important in helping patients stay active safely," Drury added.
"This study adds more evidence to what we already believe to be true — that exercise improves nearly all aspects of cardiac health, including atrial fibrillation (搜索)," said Rod Passman, MD, a professor of medicine and director of the Center for Arrhythmia Research at Northwestern University. Passman was not involved in the research.
"It will be important to replicate these findings on more diverse populations over longer time periods, but this reinforces the holistic approach to AFib and emphasizes the value of lifestyle modification to help treat the disease," Passman said.
The research has not yet been published in a peer-reviewed scientific journal. The first dedicated ESC Guidelines on cardiac rehabilitation were published recently in the European Heart Journal.