- Exercise interventions are underutilized in the treatment of atrial fibrillation (AFib), an abnormal heart rhythm disorder.
- A one-year clinical trial with a tailored exercise program reduced time spent in atrial fibrillation by 45% compared with usual care (3.9% vs. 7.1%).
- Participants in the exercise group had improved cardiorespiratory fitness and resting heart rate, along with 37% fewer total hospitalizations and 46% fewer AFib-related hospitalizations.
An individualized exercise program significantly reduced atrial fibrillation burden — the amount of time spent in arrhythmia — in people with the condition, according to new research.
Some people with AFib may tend to exercise less due to concern that physical activity could trigger another episode, or worsen symptoms such as:
However, new findings suggest that a carefully designed exercise program could help reduce the time people spend in AFib while also improving cardiovascular health.
The NEXAF trial investigated whether a combination of supervised and home-based exercise could reduce AFib burden and improve quality of life among people with symptomatic, but non-permanent AFib over one year. At the end of one year, participants in the exercise group spent almost half as much time in AFib as those receiving usual care.
The research was presented at the European Society of Cardiology Congress 2026, held August 28–31 in Munich, Germany, and led by Dr. Bjarne Nes from the Norwegian University of Science and Technology. It has not yet been published in a peer-reviewed scientific journal.
“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,” said Rod Passman, MD, a professor of medicine and director of the Center for Arrhythmia Research at Northwestern University. Passman wasn’t involved in the research.
Despite these promising findings, more research will be required to see how this hybrid exercise approach might affect a broader patient population.
“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 told Healthline.
The trial included 295 people treated at three centers in Norway. Participants had an average age of 64, and 30% were women. All had non-permanent AFib and physical activity levels below general recommendations.
Researchers randomly assigned participants in equal numbers to either usual care or a one-year exercise intervention. Usual care did not include an exercise program.
Participants in the intervention group completed eight supervised, high-intensity exercise sessions during the first four to six weeks. They then transitioned primarily to home-based exercise, with remote guidance and monitoring provided through a smartwatch, an app, and a web platform.
Every participant received an insertable cardiac monitor. Unlike a consumer fitness tracker, this device is placed under the skin and continuously records the heart’s electrical activity, allowing researchers to measure how much time each person spent in AFib over the follow-up period.
The trial’s two primary outcomes were AFib burden and the change in AFib-specific quality of life after one year.
During the one-year trial, the exercise group spent 3.9% of their time in AFib, compared with 7.1% among those receiving usual care. This represents a 45% relative reduction in AFib burden over the duration of the trial.
“Having hard data proving a 45 percent relative drop in actual atrial fibrillation 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 wasn’t involved in the research.
However, the quality-of-life findings were less conclusive. Scores increased by 5.6 points in the exercise group and 4.4 points in the usual-care group, but the difference was not statistically significant.
Secondary findings also supported the exercise intervention. Researchers reported improvements in cardiorespiratory fitness and resting heart rate, along with a 37% reduction in total hospitalizations and a 46% reduction in AFib-related hospitalizations.
The trial population may limit how broadly the results apply. Participants were physically inactive, had non-permanent AFib, and were treated at Norwegian centers.
The program also began with supervised high intensity sessions, which may not be appropriate for all people with AFib.
“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 wasn’t 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 told Healthline.
The NEXAF findings add to a growing body of research linking physical activity with improved outcomes both before and after an AFib diagnosis.
A recent study involving 87,000 adults found that low, moderate, and high levels of physical activity were associated with lower risks of stroke and death compared with inactivity, regardless of whether subjects had AFib or not.
Separate research involving more than 6,000 people with a year of Fitbit activity data found that each additional hour of weekly physical activity was associated with an 11% lower risk of developing AFib during follow-up.
For people already living with AFib, the first step before beginning or substantially intensifying an exercise program is to speak with a cardiologist.
Tadwalkar recommended following the model used in the trial:
- Begin with professional support from a clinician.
- Start with supervised sessions.
- Develop an individualized plan.
- Transition to home or gym exercise using a heart monitor.
The trial also highlights the growing role of fitness trackers and other wearables in monitoring patients with heart arrhythmias.
“Over the long haul, combining consumer tech like smartwatches with real clinical oversight is what will let us reach millions of heart patients,” Tadwalkar said.
The NEXAF trial offers encouraging evidence that structured exercise may become a more prominent component of AFib care. However, the findings do not suggest that exercise should replace medications.
“The findings should also reassure many people with AF that being physically active can be both safe and beneficial when exercise is appropriately tailored to their health and fitness level,” Drury said.
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