Physical Therapy and the Arrhythmias: The potential benefits and challenges of their kinship
Year 2024,
Volume: 6 Issue: 3, 114 - 120, 29.07.2024
Fnu Anamika
,
Vaidehi Mendpara
,
Sakshi Sachdeva
,
Kinna Parikh
Sai Gautham Kanagala
Shreya Garg
,
Nikita Garg
Rohit Jain
Abstract
Cardiovascular disease is the primary cause of mortality in the United States, and cardiac arrhythmias are a common cause of hospital admission with significant mortality and morbidity. Cardiovascular diseases significantly burden the healthcare system, with high costs associated with hospitalization, medication, and ongoing management. By finding cost-effective methods to prevent and treat cardiovascular diseases, healthcare resources can be allocated more efficiently, ultimately improving health outcomes and reducing the burden on the healthcare system. Exercise therapy is a low-cost intervention that can be done without expensive equipment or medical procedures. Exercise therapy can help decrease risk factors for heart disease, including high blood pressure, obesity, and high cholesterol, by improving overall fitness and reducing chronic inflammation. Over time, there have been concerns about exercise-induced arrhythmia because it can reduce physical activity among patients with arrhythmia. In this review, we emphasized the beneficial effects of physical activity on arrhythmia patients.
References
- Heart disease facts. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/heartdisease/facts.htm. Published October 14, 2022. Accessed February 8, 2023.
- Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st Century: Novel methods and new insights. Circ Res. 2020 Jun 19;127(1):4-20. doi: 10.1161/CIRCRESAHA.120.316340.
- Atrial fibrillation (2022). Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/heartdisease/atrial_fibrillation.htm. Accessed February 8, 2023.
- Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017 Apr 25;4(4):CD003200. doi: 10.1002/14651858.CD003200.pub7.
- 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. February 2018. Washington, DC: U.S. Department of Health and Human Services, 2018. Available at: https://health.gov/sites/default/files/2019-09/PAG_Advisory_Committee_Report.pdf. Accessed February 8, 2023.
- Hansen D, Dendale P, Coninx K, Vanhees L, Piepoli MF, Niebauer J, Cornelissen V, Pedretti R, Geurts E, Ruiz GR, Corrà U, Schmid JP, Greco E, Davos CH, Edelmann F, Abreu A, Rauch B, Ambrosetti M, Braga SS, Barna O, Beckers P, Bussotti M, Fagard R, Faggiano P, Garcia-Porrero E, Kouidi E, Lamotte M, Neunhäuserer D, Reibis R, Spruit MA, Stettler C, Takken T, Tonoli C, Vigorito C, Völler H, Doherty P. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur J Prev Cardiol. 2017 Jul;24(10):1017-31. doi: 10.1177/2047487317702042.
- Lavie CJ, Arena R, Swift DL, Johannsen NM, Sui X, Lee DC, Earnest CP, Church TS, O’Keefe JH, Milani RV, Blair SN. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. 2015 Jul 3;117(2):207-19. doi: 10.1161/CIRCRESAHA.117.305205.
- Raghuveer G, Hartz J, Lubans DR, Takken T, Wiltz JL, Mietus-Snyder M, Perak AM, Baker-Smith C, Pietris N, Edwards NM; American Heart Association Young Hearts Athero, Hypertension and Obesity in the Young Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Cardiorespiratory Fitness in Youth: An Important Marker of Health: A Scientific Statement From the American Heart Association. Circulation. 2020 Aug 18;142(7):e101-18. doi: 10.1161/CIR.0000000000000866.
- Guasch E, Mont L. Diagnosis, pathophysiology, and management of exercise-induced arrhythmias. Nat Rev Cardiol. 2017 Feb;14(2):88-101. doi: 10.1038/nrcardio.2016.173.
- Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation. 2008 Aug 19;118(8):800-7. doi: 10.1161/CIRCULATIONAHA.108.785626.
- Ortega-Moral A, Valle-Sahagún B, Barón-Esquivias G. Efficacy of exercise in patients with atrial fibrillation: Systematic review and meta-analysis. Med Clin (Barc). 2022 Oct 28;159(8):372-9. doi: 10.1016/j.medcli.2021.11.013.
- Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O, Wisloff U, Loennechen JP. Aerobic interval training reduces the burden of atrial fibrillation in the short term: A randomized trial. Circulation. 2016 Feb 2;133(5):466-73. doi: 10.1161/CIRCULATIONAHA.115.018220.
- Stucki G, Kroeling P. Physical therapy and rehabilitation in the management of rheumatic disorders. Baillieres Best Pract Res Clin Rheumatol. 2000 Dec;14(4):751-71. doi: 10.1053/berh.2000.0111.
- Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, Rebato C, Elosua R. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008 May;10(5):618-23. doi: 10.1093/europace/eun071.
- Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation - A randomized controlled trial. PLoS One. 2017 Feb 23;12(2):e0170060. doi: 10.1371/journal.pone.0170060.
- Egan B, Zierath JR. Exercise metabolism and the molecular regulation of skeletal muscle adaptation. Cell Metab. 2013 Feb 5;17(2):162-84. doi: 10.1016/j.cmet.2012.12.012.
- Hawley JA, Lundby C, Cotter JD, Burke LM. Maximizing cellular adaptation to endurance exercise in skeletal muscle. Cell Metab. 2018 May 1;27(5):962-76. doi: 10.1016/j.cmet.2018.04.014.
- MacDougall JD, Hicks AL, MacDonald JR, McKelvie RS, Green HJ, Smith KM. Muscle performance and enzymatic adaptations to sprint interval training. J Appl Physiol (1985). 1998 Jun;84(6):2138-42. doi: 10.1152/jappl.1998.84.6.2138.
- McRae G, Payne A, Zelt JG, Scribbans TD, Jung ME, Little JP, Gurd BJ. Extremely low volume, whole-body aerobic-resistance training improves aerobic fitness and muscular endurance in females. Appl Physiol Nutr Metab. 2012 Dec;37(6):1124-31. doi: 10.1139/h2012-093.
- Nobrega AC, O’Leary D, Silva BM, Marongiu E, Piepoli MF, Crisafulli A. Neural regulation of cardiovascular response to exercise: role of central command and peripheral afferents. Biomed Res Int. 2014:2014:478965. doi: 10.1155/2014/478965.
- Franciosi S, Perry FKG, Roston TM, Armstrong KR, Claydon VE, Sanatani S. The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Auton Neurosci. 2017 Jul:205:1-11. doi: 10.1016/j.autneu.2017.03.005.
- Billman GE. Cardiac autonomic neural remodeling and susceptibility to sudden cardiac death: effect of endurance exercise training. Am J Physiol Heart Circ Physiol. 2009 Oct;297(4):H1171-93. doi: 10.1152/ajpheart.00534.2009.
- Blomqvist CG, Saltin B. Cardiovascular adaptations to physical training. Annu Rev Physiol. 1983;45:169-89. doi: 10.1146/annurev.ph.45.030183.001125.
- Lee CK, Lee JH, Ha MS. Comparison of the effects of aerobic versus resistance exercise on the autonomic nervous system in middle-aged women: A Randomized Controlled Study. Int J Environ Res Public Health. 2022 Jul 27;19(15):9156. doi: 10.3390/ijerph19159156.
- McCorry LK. Physiology of the autonomic nervous system. Am J Pharm Educ. 2007 Aug 15;71(4):78. doi: 10.5688/aj710478.
- Rubart M, Zipes DP. Mechanisms of sudden cardiac death. J Clin Invest. 2005 Sep;115(9):2305-15. doi: 10.1172/JCI26381.
- Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden cardiac death. Heart Rhythm. 2006 Jan;3(1):108-13. doi: 10.1016/j.hrthm.2005.09.021.
- Qin R, Murakoshi N, Xu D, Tajiri K, Feng D, Stujanna EN, Yonebayashi S, Nakagawa Y, Shimano H, Nogami A, Koike A, Aonuma K, Ieda M. Exercise training reduces ventricular arrhythmias through restoring calcium handling and sympathetic tone in myocardial infarction mice. Physiol Rep. 2019 Feb;7(4):e13972. doi: 10.14814/phy2.13972.
- Eijsvogels TM, Fernandez AB, Thompson PD. Are there deleterious cardiac effects of acute and chronic endurance exercise? Physiol Rev. 2016 Jan;96(1):99-125. doi: 10.1152/physrev.00029.2014.
- Shen MJ, Choi EK, Tan AY, Lin SF, Fishbein MC, Chen LS, Chen PS. Neural mechanisms of atrial arrhythmias. Nat Rev Cardiol. 2011 Sep 27;9(1):30-9. doi: 10.1038/nrcardio.2011.139.
- Manolis AS, Manolis AA. Exercise and arrhythmias: A double-edged sword. Pacing Clin Electrophysiol. 2016 Jul;39(7):748-62. doi: 10.1111/pace.12879.
- Lau DH, Linz D, Schotten U, Mahajan R, Sanders P, Kalman JM. Pathophysiology of paroxysmal and persistent atrial fibrillation: Rotors, foci and fibrosis. Heart Lung Circ. 2017 Sep;26(9):887-93. doi: 10.1016/j.hlc.2017.05.119.
- Mahajan R, Lau DH, Brooks AG, Shipp NJ, Manavis J, Wood JP, Finnie JW, Samuel CS, Royce SG, Twomey DJ, Thanigaimani S, Kalman JM, Sanders P. Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity. J Am Coll Cardiol. 2015 Jul 7;66(1):1-11. doi: 10.1016/j.jacc.2015.04.058.
- Elliott AD, Maatman B, Emery MS, Sanders P. The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health. Heart Rhythm. 2017 Nov;14(11):1713-20. doi: 10.1016/j.hrthm.2017.07.001.
- Reeves JT, Groves BM, Cymerman A, Sutton JR, Wagner PD, Turkevich D, Houston CS. Operation Everest II: cardiac filling pressures during cycle exercise at sea level. Respir Physiol. 1990 May-Jun;80(2-3):147-54. doi: 10.1016/0034-5687(90)90078-d.
- Takahashi Y, Jaïs P, Hocini M, Sanders P, Rotter M, Rostock T, Hsu LF, Sacher F, Clémenty J, Haïssaguerre M. Shortening of fibrillatory cycle length in the pulmonary vein during vagal excitation. J Am Coll Cardiol. 2006 Feb 21;47(4):774-80. doi: 10.1016/j.jacc.2005.10.043.
- Guasch E, Benito B, Qi X, Cifelli C, Naud P, Shi Y, Mighiu A, Tardif JC, Tadevosyan A, Chen Y, Gillis MA, Iwasaki YK, Dobrev D, Mont L, Heximer S, Nattel S. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol. 2013 Jul 2;62(1):68-77. doi: 10.1016/j.jacc.2013.01.091.
- Risom SS, Zwisler AD, Johansen PP, Sibilitz KL, Lindschou J, Gluud C, Taylor RS, Svendsen JH, Berg SK. Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev. 2017 Feb 9;2(2):CD011197. doi: 10.1002/14651858.CD011197.pub2.
- Keteyian SJ, Ehrman JK, Fuller B, Pack QR. Exercise testing and exercise rehabilitation for patients with atrial fibrillation. J Cardiopulm Rehabil Prev. 2019 Mar;39(2):65-72. doi: 10.1097/HCR.0000000000000423.
Year 2024,
Volume: 6 Issue: 3, 114 - 120, 29.07.2024
Fnu Anamika
,
Vaidehi Mendpara
,
Sakshi Sachdeva
,
Kinna Parikh
Sai Gautham Kanagala
Shreya Garg
,
Nikita Garg
Rohit Jain
References
- Heart disease facts. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/heartdisease/facts.htm. Published October 14, 2022. Accessed February 8, 2023.
- Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st Century: Novel methods and new insights. Circ Res. 2020 Jun 19;127(1):4-20. doi: 10.1161/CIRCRESAHA.120.316340.
- Atrial fibrillation (2022). Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/heartdisease/atrial_fibrillation.htm. Accessed February 8, 2023.
- Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017 Apr 25;4(4):CD003200. doi: 10.1002/14651858.CD003200.pub7.
- 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. February 2018. Washington, DC: U.S. Department of Health and Human Services, 2018. Available at: https://health.gov/sites/default/files/2019-09/PAG_Advisory_Committee_Report.pdf. Accessed February 8, 2023.
- Hansen D, Dendale P, Coninx K, Vanhees L, Piepoli MF, Niebauer J, Cornelissen V, Pedretti R, Geurts E, Ruiz GR, Corrà U, Schmid JP, Greco E, Davos CH, Edelmann F, Abreu A, Rauch B, Ambrosetti M, Braga SS, Barna O, Beckers P, Bussotti M, Fagard R, Faggiano P, Garcia-Porrero E, Kouidi E, Lamotte M, Neunhäuserer D, Reibis R, Spruit MA, Stettler C, Takken T, Tonoli C, Vigorito C, Völler H, Doherty P. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur J Prev Cardiol. 2017 Jul;24(10):1017-31. doi: 10.1177/2047487317702042.
- Lavie CJ, Arena R, Swift DL, Johannsen NM, Sui X, Lee DC, Earnest CP, Church TS, O’Keefe JH, Milani RV, Blair SN. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. 2015 Jul 3;117(2):207-19. doi: 10.1161/CIRCRESAHA.117.305205.
- Raghuveer G, Hartz J, Lubans DR, Takken T, Wiltz JL, Mietus-Snyder M, Perak AM, Baker-Smith C, Pietris N, Edwards NM; American Heart Association Young Hearts Athero, Hypertension and Obesity in the Young Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Cardiorespiratory Fitness in Youth: An Important Marker of Health: A Scientific Statement From the American Heart Association. Circulation. 2020 Aug 18;142(7):e101-18. doi: 10.1161/CIR.0000000000000866.
- Guasch E, Mont L. Diagnosis, pathophysiology, and management of exercise-induced arrhythmias. Nat Rev Cardiol. 2017 Feb;14(2):88-101. doi: 10.1038/nrcardio.2016.173.
- Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation. 2008 Aug 19;118(8):800-7. doi: 10.1161/CIRCULATIONAHA.108.785626.
- Ortega-Moral A, Valle-Sahagún B, Barón-Esquivias G. Efficacy of exercise in patients with atrial fibrillation: Systematic review and meta-analysis. Med Clin (Barc). 2022 Oct 28;159(8):372-9. doi: 10.1016/j.medcli.2021.11.013.
- Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O, Wisloff U, Loennechen JP. Aerobic interval training reduces the burden of atrial fibrillation in the short term: A randomized trial. Circulation. 2016 Feb 2;133(5):466-73. doi: 10.1161/CIRCULATIONAHA.115.018220.
- Stucki G, Kroeling P. Physical therapy and rehabilitation in the management of rheumatic disorders. Baillieres Best Pract Res Clin Rheumatol. 2000 Dec;14(4):751-71. doi: 10.1053/berh.2000.0111.
- Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, Rebato C, Elosua R. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008 May;10(5):618-23. doi: 10.1093/europace/eun071.
- Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation - A randomized controlled trial. PLoS One. 2017 Feb 23;12(2):e0170060. doi: 10.1371/journal.pone.0170060.
- Egan B, Zierath JR. Exercise metabolism and the molecular regulation of skeletal muscle adaptation. Cell Metab. 2013 Feb 5;17(2):162-84. doi: 10.1016/j.cmet.2012.12.012.
- Hawley JA, Lundby C, Cotter JD, Burke LM. Maximizing cellular adaptation to endurance exercise in skeletal muscle. Cell Metab. 2018 May 1;27(5):962-76. doi: 10.1016/j.cmet.2018.04.014.
- MacDougall JD, Hicks AL, MacDonald JR, McKelvie RS, Green HJ, Smith KM. Muscle performance and enzymatic adaptations to sprint interval training. J Appl Physiol (1985). 1998 Jun;84(6):2138-42. doi: 10.1152/jappl.1998.84.6.2138.
- McRae G, Payne A, Zelt JG, Scribbans TD, Jung ME, Little JP, Gurd BJ. Extremely low volume, whole-body aerobic-resistance training improves aerobic fitness and muscular endurance in females. Appl Physiol Nutr Metab. 2012 Dec;37(6):1124-31. doi: 10.1139/h2012-093.
- Nobrega AC, O’Leary D, Silva BM, Marongiu E, Piepoli MF, Crisafulli A. Neural regulation of cardiovascular response to exercise: role of central command and peripheral afferents. Biomed Res Int. 2014:2014:478965. doi: 10.1155/2014/478965.
- Franciosi S, Perry FKG, Roston TM, Armstrong KR, Claydon VE, Sanatani S. The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Auton Neurosci. 2017 Jul:205:1-11. doi: 10.1016/j.autneu.2017.03.005.
- Billman GE. Cardiac autonomic neural remodeling and susceptibility to sudden cardiac death: effect of endurance exercise training. Am J Physiol Heart Circ Physiol. 2009 Oct;297(4):H1171-93. doi: 10.1152/ajpheart.00534.2009.
- Blomqvist CG, Saltin B. Cardiovascular adaptations to physical training. Annu Rev Physiol. 1983;45:169-89. doi: 10.1146/annurev.ph.45.030183.001125.
- Lee CK, Lee JH, Ha MS. Comparison of the effects of aerobic versus resistance exercise on the autonomic nervous system in middle-aged women: A Randomized Controlled Study. Int J Environ Res Public Health. 2022 Jul 27;19(15):9156. doi: 10.3390/ijerph19159156.
- McCorry LK. Physiology of the autonomic nervous system. Am J Pharm Educ. 2007 Aug 15;71(4):78. doi: 10.5688/aj710478.
- Rubart M, Zipes DP. Mechanisms of sudden cardiac death. J Clin Invest. 2005 Sep;115(9):2305-15. doi: 10.1172/JCI26381.
- Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden cardiac death. Heart Rhythm. 2006 Jan;3(1):108-13. doi: 10.1016/j.hrthm.2005.09.021.
- Qin R, Murakoshi N, Xu D, Tajiri K, Feng D, Stujanna EN, Yonebayashi S, Nakagawa Y, Shimano H, Nogami A, Koike A, Aonuma K, Ieda M. Exercise training reduces ventricular arrhythmias through restoring calcium handling and sympathetic tone in myocardial infarction mice. Physiol Rep. 2019 Feb;7(4):e13972. doi: 10.14814/phy2.13972.
- Eijsvogels TM, Fernandez AB, Thompson PD. Are there deleterious cardiac effects of acute and chronic endurance exercise? Physiol Rev. 2016 Jan;96(1):99-125. doi: 10.1152/physrev.00029.2014.
- Shen MJ, Choi EK, Tan AY, Lin SF, Fishbein MC, Chen LS, Chen PS. Neural mechanisms of atrial arrhythmias. Nat Rev Cardiol. 2011 Sep 27;9(1):30-9. doi: 10.1038/nrcardio.2011.139.
- Manolis AS, Manolis AA. Exercise and arrhythmias: A double-edged sword. Pacing Clin Electrophysiol. 2016 Jul;39(7):748-62. doi: 10.1111/pace.12879.
- Lau DH, Linz D, Schotten U, Mahajan R, Sanders P, Kalman JM. Pathophysiology of paroxysmal and persistent atrial fibrillation: Rotors, foci and fibrosis. Heart Lung Circ. 2017 Sep;26(9):887-93. doi: 10.1016/j.hlc.2017.05.119.
- Mahajan R, Lau DH, Brooks AG, Shipp NJ, Manavis J, Wood JP, Finnie JW, Samuel CS, Royce SG, Twomey DJ, Thanigaimani S, Kalman JM, Sanders P. Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity. J Am Coll Cardiol. 2015 Jul 7;66(1):1-11. doi: 10.1016/j.jacc.2015.04.058.
- Elliott AD, Maatman B, Emery MS, Sanders P. The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health. Heart Rhythm. 2017 Nov;14(11):1713-20. doi: 10.1016/j.hrthm.2017.07.001.
- Reeves JT, Groves BM, Cymerman A, Sutton JR, Wagner PD, Turkevich D, Houston CS. Operation Everest II: cardiac filling pressures during cycle exercise at sea level. Respir Physiol. 1990 May-Jun;80(2-3):147-54. doi: 10.1016/0034-5687(90)90078-d.
- Takahashi Y, Jaïs P, Hocini M, Sanders P, Rotter M, Rostock T, Hsu LF, Sacher F, Clémenty J, Haïssaguerre M. Shortening of fibrillatory cycle length in the pulmonary vein during vagal excitation. J Am Coll Cardiol. 2006 Feb 21;47(4):774-80. doi: 10.1016/j.jacc.2005.10.043.
- Guasch E, Benito B, Qi X, Cifelli C, Naud P, Shi Y, Mighiu A, Tardif JC, Tadevosyan A, Chen Y, Gillis MA, Iwasaki YK, Dobrev D, Mont L, Heximer S, Nattel S. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol. 2013 Jul 2;62(1):68-77. doi: 10.1016/j.jacc.2013.01.091.
- Risom SS, Zwisler AD, Johansen PP, Sibilitz KL, Lindschou J, Gluud C, Taylor RS, Svendsen JH, Berg SK. Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database Syst Rev. 2017 Feb 9;2(2):CD011197. doi: 10.1002/14651858.CD011197.pub2.
- Keteyian SJ, Ehrman JK, Fuller B, Pack QR. Exercise testing and exercise rehabilitation for patients with atrial fibrillation. J Cardiopulm Rehabil Prev. 2019 Mar;39(2):65-72. doi: 10.1097/HCR.0000000000000423.