One-Year Exercise Program Reduced Atrial Fibrillation Burden in Randomized Trial
In the randomized NEXAF trial, a tailored exercise program combining initial supervised sessions with longer-term home exercise and digital monitoring reduced the amount of time participants spent in atrial fibrillation. The intervention also improved fitness and was associated with fewer hospitalizations, but it did not significantly improve atrial-fibrillation-specific quality-of-life scores.
A one-year exercise program combining brief in-person supervision with home-based training and digital monitoring reduced atrial fibrillation burden in a randomized trial presented at ESC Congress 2026, according to reporting from Medical Xpress and the European Society of Cardiology.
The NEXAF trial included 295 patients with nonpermanent atrial fibrillation, symptoms, and physical activity levels below general recommendations. Participants had a mean age of 64, and 30% were women. They were treated at three centers in Norway and randomly assigned either to the exercise intervention or to usual care.
The intervention began with eight supervised high-intensity exercise sessions delivered over four to six weeks. Participants then continued mainly with remote exercise monitoring and guidance through a smartwatch, an app, and a web-based platform. The usual-care group did not receive a structured or supervised exercise program. All participants had an insertable cardiac monitor, allowing researchers to continuously track their heart rhythm during the follow-up period.
After one year, the exercise group spent 3.9% of monitored time in atrial fibrillation, compared with 7.1% in the usual-care group. Researchers reported this as a 45% relative reduction in atrial fibrillation burden, one of the trial’s co-primary outcomes; the difference had a p-value of 0.016.
The intervention was also linked to improvements in cardiorespiratory fitness and resting heart rate. Total hospitalizations were reduced by 37%, while atrial-fibrillation-related hospitalizations were reduced by 46% in the exercise group, according to the report.
The results were less conclusive for the other co-primary outcome. Atrial-fibrillation-specific quality of life, measured using the Atrial Fibrillation Effect on Quality of Life questionnaire, improved by 5.6 points in the exercise group and 4.4 points with usual care. The difference was not statistically significant, with a p-value of 0.43.
Dr. Bjarne Nes of the Norwegian University of Science and Technology, the trial’s principal investigator, said the study addressed limitations in earlier exercise research, which he characterized as generally small, short-term, and lacking continuous monitoring of atrial fibrillation burden. He also pointed to an implementation gap: despite recommendations in European Society of Cardiology guidelines, a survey cited in the report found that only about one in 10 eligible patients were referred for exercise-based rehabilitation.
The trial supports the feasibility of a hybrid model using short-term supervision followed by digitally supported home exercise. Its findings concern patients with the characteristics studied and do not establish that the program produces the same results for all people with atrial fibrillation.
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