The Norwegian Exercise in Atrial Fibrillation Trial

NEXAF

Doente / População Intervenção / Exposição Comparação Desfecho

In 295 inactive adults with non-permanent atrial fibrillation, a 12-month supervised-then-home exercise programme reduced AF burden and AF-specific quality of life at 12 months compared with usual care.

N

295doentes

Desenho

multicentre (Trondheim, Bærum/Drammen, Tromsø), open-label, two-arm RCT; 1:1 supervised plus eHealth-based exercise vs usual care; blinded statistical analysis; 12-month follow-up with insertable cardiac monitor

Desfecho

co-primary: (1) total time in atrial fibrillation (burden, %) measured by insertable cardiac monitor over 12 months; (2) AFEQT overall score at 12 months

Relevância

2Importante — um de vários pilares.

ResultadoAF burden 3.9% vs 7.1% at one year, a 45% relative reduction (P = 0.016), but the co-primary quality-of-life score did not differ (AFEQT +5.6 vs +4.4; P = 0.43). Fitness rose and resting heart rate fell; total hospitalisations were 37% lower and AF-related hospitalisations 46% lower.

Nes BM, et al. Presented at ESC Congress 2026, Hot Line 8, 30 August.

Discussão e crítica

Exercise halves the time spent in atrial fibrillation, measured by an implanted monitor rather than by symptoms — the cleanest evidence yet that the arrhythmia itself responds to training. The second co-primary endpoint did not move: patients did not feel better, the same dissociation between rhythm and symptoms that the sham-controlled ablation trial in this session found. Open-label against usual care, 295 patients, and the hospitalisation figures are secondary and unadjusted for multiplicity.