AFAC Rehabilitation Gym

In the past 3 years, there has been an increased awareness of the importance of cardiac rehabilitation in the management of atrial fibrillation, particular following AF ablation. Some references of the seminal articles are listed below.

In response to this emerging evidence, we have established an AF specific cardiac rehabilitation programme which is supported by arrhythmia nurses, exercise physiologists and dieticians.

The goals of this program are primarily improved arrhythmia control through weight loss and cardiac fitness with a long term goal being reverse cardiac remodelling and better quality of life secondary to superior symptom control.

We have partnered with Trench Health and Fitness who will be using a purpose equipped cardiac gymnasium at our Practice, AF Ablation Clinic, 183 Stirling Highway Nedlands.

The exercise component of this program is run independently of our practice by Trench Health and Fitness. Prof Weerasooriya oversees the entire programme and our arrhythmia Nurse Practitioners are present at all times.

We provide full correspondence to GPs regarding the patient’s progress.

In general terms, the goals are as follows:

1. Overweight – BMI will be recorded, patients will have an individualised exercise program designed up by the exercise physiologists with a goal of losing 10-20% of their body weight.

2. Lifestyle and dietary modification – patients will be encouraged to use a lifestyle journal and consume a low calorie diet under supervision of the exercise physiologists, arrhythmia NP and dietician.

3. Regular Exercise Program – Exercise prescription – The patient will be provided an exercise prescription and will have 6-10 supervised sessions before exercising independently

4. Blood Pressure – Blood pressure will be recorded and we will optimise medical management and ensure medication compliance and education. The target is systolic < 130mmHg and diastolic < 80mmHg.

5. Cholesterol – Will be measured and patients will be medically managed.
Aim for LDL

6. Blood Sugar Control.
a. If patient is diabetic, Hba1c will be measured and optimal glycaemic control will be targeted.
b. If patient is not diabetic – Arrhythmia NP will liase with GP practice nurse to obtainany recent results of GTT, fasting BSL.

7. Alcohol – Patients will be encouraged to limit alcohol to 1 standard measure per day

8. Smoking Cessation – Those patients who are smokers will receive counselling and assistance
to cease.

9. OSA – Patients with suspected OSA will be referred for a sleep study and respiratory consult to optimise their condition with the appropriate treatment.

References:
Elliott AD, Mahajan R, Pathak RK, Lau DH, Sanders P. (2016). Exercise Training and Atrial Fibrillation: Further Evidence for the Importance of Lifestyle Change. Circulation, 133 (5):457-459.

Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Hendriks JM, Twomey D, Kalman JM, Abhayaratna WP, Lau DH, Sanders P. (2015). Impact of CARDIO respiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study. Journal of the American College of Cardiology, 66(9):985-96.

Pathak RK, Middeldorp ME, Meredith M, Mehta AB, Mahajan R, Wong CX, Twomey D, Elliott AD, Kalman JM, Abhayaratna WP, Lau DH, Sanders P. (2015).Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up Study (LEGACY). Journal of the American College of Cardiology, 65(20):2159-69.

Pathak RK, Middeldorp ME, Lau DH, Mehta AB, Mahajan R, Twomey D, Alasady M, Hanley L, Antic NA, McEvoy RD, Kalman JM, Abhayaratna WP, Sanders P. (2014). Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. Journal of the American College of Cardiology, 64(21):2222-31.