The short answer: People with atrial fibrillation do not necessarily need to avoid physical activity altogether, but they should not attempt to copy high-intensity exercise sessions on their own. NEXAF has been reported as a one-year program that began with supervised exercise and then transitioned to monitored home-based exercise; the program was reported to reduce atrial fibrillation burden, improve fitness and reduce hospitalizations compared with usual care. The results were presented at ESC Congress 2026, so they do not replace individual assessment, medication or treatment prescribed by a clinician.
This article is for people who have recently been diagnosed or want to return to physical activity. Its goal is to help you prepare a starting plan to discuss with your clinician, understand how to monitor your response and recognize when to stop exercising. This is educational information, not an individualized exercise prescription.
What exercise model did NEXAF study?
NEXAF stands for Norwegian Exercise in Atrial Fibrillation Trial. The protocol describes a randomized trial comparing a structured exercise program with usual care in people with paroxysmal or persistent atrial fibrillation who were previously physically inactive. One primary objective was to assess “atrial fibrillation burden,” meaning the total time a patient remains in atrial fibrillation; the protocol also describes assessing atrial fibrillation-specific quality of life (according to pmc.ncbi.nlm.nih.gov).
The important point is that NEXAF does not simply provide a list of exercises. Participants began with guided exercise sessions and then continued at home using a smartwatch, an app and an online platform. Intensity was adjusted according to heart rate, perceived exertion and each person’s practical capacity.
At ESC Congress 2026, the research team reported that the one-year program reduced atrial fibrillation burden compared with usual care; overall hospitalizations decreased by 37%, and atrial fibrillation-related hospitalizations decreased by 46%. Cardiorespiratory fitness also improved, while the difference in atrial fibrillation-specific quality-of-life scores did not reach statistical significance (according to escardio.org).
Therefore, what was studied was a physical-activity management model, not a single exercise or a heart-rate zone that applies to everyone. These percentages are results reported at a conference; the full peer-reviewed report is needed to provide more detail on adherence, adverse effects and patient subgroups.
How should people with atrial fibrillation interpret these results?
The most cautious message is this: physical activity should be individualized and increased gradually, rather than avoided altogether or increased abruptly to a very strenuous level. The 2024 ESC Guidelines recommend an appropriate exercise program for people with paroxysmal or persistent atrial fibrillation to improve cardiorespiratory fitness and reduce recurrence. A general reference target for adults is 150–300 minutes of moderate-intensity activity or 75–150 minutes of vigorous-intensity activity per week, but this is not a prescription to apply immediately to every individual (according to escardio.org).
Cardiac rehabilitation is an option to discuss if you need an assessed and supervised program. The guidance cited in the references states that cardiac rehabilitation may be considered for people with atrial fibrillation to reduce symptoms, the number of atrial fibrillation episodes and the duration of each episode, and to improve exercise capacity. Intensity, duration, exercise type and progression rate should be based on cardiovascular risk, fitness, comorbidities and the patient’s preferences (according to academic.oup.com).
How to prepare to begin exercising
1. Check whether you need an assessment before exercising
Speak with a cardiologist or cardiac rehabilitation team before starting or increasing intensity if you were recently diagnosed, experience frequent palpitations, take medication to control rhythm or heart rate, have ever fainted, have heart failure, valvular heart disease, coronary artery disease, uncontrolled blood pressure or have been inactive for a long time.
A clinician may review your electrocardiogram, current medications, stroke risk, exercise capacity and comorbidities. If indicated, they may also consider an exercise stress test or a supervised cardiac rehabilitation program. Anticoagulants do not automatically prohibit exercise, but the risks of falls, impact and injury should be discussed separately.
2. Choose a manageable starting level
- Choose low-impact activities such as walking on a level surface or using a stationary bicycle; begin with a duration that has been assessed as tolerable for you.
- Use the “talk test”: at a moderate intensity, you should still be able to speak in complete sentences, but not entirely comfortably if you continue talking. This is a simple estimate and does not replace medical assessment.
- Warm up and cool down gradually; do not stop abruptly immediately after exertion.
- Change only one variable at a time: first increase the number of days or the duration, and only then consider increasing speed.
- Record the type of exercise, duration, perceived exertion, symptoms and when palpitations occur.
A hypothetical example to discuss with a clinician: someone who has been inactive might propose starting with short, easy walks on a level surface, including a warm-up and cool-down, and increasing duration only after the current level is stable and no warning symptoms occur. This is a framework for discussion, not a training schedule prescribed for everyone.
3. Use wearable devices for the right purpose
A smartwatch can help track activity trends, but it does not replace an electrocardiogram or assessment by a health professional. Wrist-based heart-rate data may be inaccurate during exercise, when the rhythm is irregular or when the device has poor contact with the skin. If you use a wearable device, also review how to use wearable-device data for safe exercise; do not treat every device alert as a definitive diagnosis.
4. Increase intensity only when the current level is stable
Do not use the high-intensity intervals in NEXAF as a target for unsupervised exercise. The study included screening, instruction and professional monitoring; its participants also did not represent everyone with atrial fibrillation, particularly people with long-standing persistent atrial fibrillation, permanent atrial fibrillation, decompensated heart failure or an acute illness.
If you are stable with light-to-moderate activity, have no concerning symptoms and have your clinician’s approval, a cardiac rehabilitation team can help develop a progression based on frequency, intensity, duration, type of exercise and progression. Light strength training may be considered, but you should learn proper technique, avoid holding your breath and not move independently to heavier weights.
When should you stop exercising or call emergency services?
Stop exercising, sit or lie down in a safe place and contact a healthcare professional if palpitations increase noticeably, you develop unusual shortness of breath, dizziness, a feeling that you may faint, sudden fatigue or symptoms that differ from previous episodes. Do not continue exercising to “see whether it goes away on its own.”
Call the emergency services where you are immediately if you have chest pain or pressure, severe shortness of breath, fainting, weakness or numbness on one side of the body, facial drooping, difficulty speaking, confusion or sudden changes in vision. These may be signs of a heart attack or stroke; do not drive yourself and do not wait for the symptoms to resolve on their own (according to heart.org).
What NEXAF cannot yet establish
- The study participants were not representative of every patient: NEXAF focused on physically inactive people with atrial fibrillation, primarily those with non-permanent atrial fibrillation.
- The results cannot establish that quality of life will improve for everyone: the conference report noted benefits in terms of atrial fibrillation burden and physical fitness, but found no significant improvement in the disease-specific quality-of-life score.
- It does not replace standard treatment: Exercise does not replace anticoagulants, rate-control medication, antiarrhythmic medication, catheter ablation or other treatments prescribed by a doctor.
- The findings should not yet be generalized into a recommendation for strenuous exercise at home: The full report is needed to determine the precise exercise intensity, adherence, adverse effects and effectiveness in different subgroups.
A minimum plan to take to your appointment
- Write down the type of atrial fibrillation you have been diagnosed with, your symptoms during exertion and how long you have been physically inactive.
- List your current medications, cardiovascular, pulmonary and metabolic conditions, and any history of falls.
- Ask whether you need an exercise stress test, a cardiac rehabilitation assessment or a supervised exercise programme.
- Agree on the starting activity, exertion level, method for monitoring symptoms and criteria for stopping exercise.
- Assess whether to increase the intensity only after the agreed period has passed; do not increase it simply because your watch displays a low heart rate.
- Do not stop taking anticoagulants, rate-control medication or other cardiovascular medication on your own because you are starting an exercise programme.
Conclusion: NEXAF reinforces an approach in which people with atrial fibrillation may benefit from structured exercise that includes an initial period of guidance and long-term monitoring. Safe implementation does not mean copying a workout found online; it means receiving an appropriate assessment, starting at a tolerable level, progressing gradually, monitoring symptoms and coordinating with your care team.
Reference source
- Hot Line 8: Answers in AF — European Society of Cardiology.
- Tailored exercise programme shown to reduce atrial fibrillation burden — European Society of Cardiology.
- 2026 ESC Guidelines on cardiac rehabilitation — European Heart Journal.
- 2024 ESC Guidelines for the management of atrial fibrillation — European Society of Cardiology.
- Effects of 1-year exercise in patients with atrial fibrillation: study protocol for the Norwegian Exercise in Atrial Fibrillation (NEXAF) randomised controlled trial — BMJ Open Heart / PMC.
- What are the Symptoms of Atrial Fibrillation? — American Heart Association.
