{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:44:16Z","timestamp":1787755456104,"version":"build-2784847793"},"reference-count":45,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"RUHX","award":["This study was funded via RUHX charity"],"award-info":[{"award-number":["This study was funded via RUHX charity"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,18]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, associated with significant morbidity, mortality and healthcare utilisation. AF rhythm control strategies demonstrate attrition with time. A number of modifiable AF risk factors contribute to an atrial cardiomyopathy culminating in incident AF but importantly also recurrence. We propose that a novel multidisciplinary lifestyle intervention (Super Rehab, SR) may improve symptoms and AF burden.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>This is a single-centre, randomised controlled study. Patients aged \u226518 years with a body mass index \u226527\u2009kg\/m<jats:sup>2<\/jats:sup> with paroxysmal or persistent AF will be randomised 1:1 to National Health Service (NHS) usual care (UC) or to SR (together with NHS UC). SR incorporates high-intensity exercise, personalised dietary advice and AF risk factor modification. SR will be undertaken over 12 months. In addition to baseline assessments, follow-up assessments will occur at the 6, 12 and 15-month time points. The primary outcome will be the difference in AF symptom burden at 12 months between groups. Secondary outcomes include AF burden (assessed by an implantable cardiac monitor), changes to cardiac structure and function and computed tomography-based assessment of epicardial adipose tissue.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>Ethics approval was granted by London-Chelsea Research Ethics Committee (reference: 22\/LO\/0479 22\/08\/2022). All participants will provide written informed consent prior to enrolment. Study findings will be disseminated via presentations to relevant stakeholders, national and international conferences and open-access peer-reviewed research publications. A summary will also be communicated to the participants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>ClinicalTrials.gov ID <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05596175\">NCT05596175<\/jats:ext-link>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103090","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T05:25:38Z","timestamp":1757913938000},"page":"e103090","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of a novel intervention (Super Rehab) in overweight patients with atrial fibrillation (SuRe AF): protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct05596175","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0670-2567","authenticated-orcid":false,"given":"David","family":"Murphy","sequence":"first","affiliation":[{"name":"Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"},{"name":"Department for Health, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8753-1343","authenticated-orcid":false,"given":"John","family":"Graby","sequence":"additional","affiliation":[{"name":"Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"},{"name":"Department for Health, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Peacock","sequence":"additional","affiliation":[{"name":"Department for Health, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Abramik","sequence":"additional","affiliation":[{"name":"Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"},{"name":"Department for Health, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos","family":"Antoniades","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan Carl Luis","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department for Health, University of Bath, Bath, UK"},{"name":"Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department for Health, University of Bath, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Khavandi","sequence":"additional","affiliation":[{"name":"Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"key":"2025091422251897000_15.9.e103090.1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.005155","article-title":"Temporal trends in incidence, prevalence, and mortality of atrial fibrillation in primary care","volume":"6","author":"Lane","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2025091422251897000_15.9.e103090.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht280"},{"key":"2025091422251897000_15.9.e103090.3","unstructured":"BHF . 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