Dr Bjarne Nes discusses findings from the NEXAF trial, which showed that a one-year exercise program reduced atrial fibrillation burden in patients with non-permanent AF.
Exercise and lifestyle modification are recommended as part of atrial fibrillation management, but exercise-based rehabilitation remains underused in clinical practice. The NEXAF trial was designed to assess whether a structured, long-term exercise intervention could reduce AF burden and improve quality of life in symptomatic patients with non-permanent AF.
The study randomized 295 patients to either a one-year exercise intervention or usual care. The intervention combined eight supervised high-intensity exercise sessions during the first four to six weeks with longer-term home-based exercise supported by remote monitoring. At one year, AF burden was reduced by 45% relative to usual care, while no significant between-group difference was seen in AF-specific quality of life. Improvements were also observed in cardiorespiratory fitness and resting heart rate, alongside reductions in total and AF-related hospitalizations.
Dr Bjarne Nes, Norwegian University of Science and Technology, Trondheim, Norway, spoke with touchCARDIO about the clinical findings, the importance of addressing inactivity and low fitness in AF, and the challenge of translating exercise recommendations into routine practice.
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Could you give us an overview of the key clinical findings from NEXAF?
In this study, we randomized 295 patients who exercised for one year, and we found that the exercise group reduced their time in atrial fibrillation over the whole year.
That is an important finding because both patients and clinicians are still somewhat concerned about whether exercise, and particularly intensive exercise, could actually worsen their AF.
We think we can now reassure them that exercise is safe and tolerable for these patients.
What can be done to help integrate these findings into clinical practice?
The first step would be to acknowledge that inactivity and low fitness are risk factors for these patients, just like being overweight or having high blood pressure. The medicine for treating inactivity and low fitness is obviously more exercise. So that would be the first step.
How important are guidelines in helping clinicians bring lifestyle interventions into AF care?
I think the most recent atrial fibrillation management guidelines highlighted both exercise and lifestyle intervention as important parts of AF care. But we have seen from recent surveys that there is still an implementation gap.
Only around one in 10 patients who would be eligible for exercise-based cardiac rehabilitation are actually referred to it, so we still have a way to go.
We hope this study can at least inspire further studies and support implementation in clinical practice.
How important is quality of life for these patients, and what did NEXAF show?
 It is very important. Quality of life was actually our other primary endpoint — specifically AF-related quality of life. What we found was that this measure increased in both groups equally. So there was no difference between the groups in quality of life.
What other research at ESC Congress 2026 has particularly interested you?
For me, the most interesting studies are the large studies that bring in the lifestyle perspective and lifestyle interventions, particularly exercise. It is a great honor for us to be able to present a Norwegian exercise study on the big stage together with all the pharmacological and procedural studies.
Cite: NEXAF: One-year exercise program reduces atrial fibrillation burden. touchCARDIO. September 1, 2026.
Disclosure: No funding was received in the publication of this article. Thank you to Dr Bjarne Nes for providing his expert insights. Dr Bjarne Nes has nothing to disclose in relation to this content.
Editor: Nicola Cartridge, Director of Content
