Time to implement fitness and reduction of fatness in atrial fibrillation therapy

This editorial refers to ‘Self-reported physical activity and major adverse events in patients with atrial fibrillation: a report from the EURObservational Research Programme Pilot Survey on Atrial Fibrillation (EORP-AF) General Registry’ by M. Proietti et al. , doi:10.1093/europace/euw150. Atrial fibrillation (AF) is not a benign condition and contributes importantly to cardiovascular morbidity and mortality. Until recently, only non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonist OACs have been associated with reduction of mortality,1 but not rhythm control therapy. Regular not-vigorous physical activity and respiratory cardiofitness are protective against cardiovascular diseases and all-cause mortality.2,3 Physical activity, especially vigorous exertion and endurance sports, however, has been associated with an increased risk of AF.4 Yet, there is increasing evidence that moderate physical activity and cardiorespiratory fitness are associated with a reduced risk of AF.5 For example, in obese patients (body mass index ≥27 kg/m2), baseline cardiorespiratory fitness was associated with a higher freedom of AF. Furthermore, an improvement in cardiorespiratory fitness (≥2 metabolic equivalents) during follow-up contributed to a further AF burden reduction in association with weight loss, an improvement of glycaemic and lipid control, a reduction in blood pressure, a decrease of atrial and ventricular sizes, and increase in diastolic function and a reduction of systemic inflammation.5 However, data on the effects of physical activity on outcome in patients with AF are lacking. In the current issue of EP-Europace , Proietti et al. 6 report on the relationship between physical activity and major cardiovascular outcomes in AF patients prospectively enrolled in the EURObservational Research Programme on AF (EORP-AF) Pilot Survey conducted in nine European countries. Their aim was to assess, …