IN CONTROL II

Habitual physical activity is beneficial for cardiovascular health. Yet, many patients with cardiovascular disease are sedentary, and current physical activity programs often fail to achieve lasting improvements. At the extreme end of the activity spectrum, more athletes engage in long-term, high-volume, high-intensity training.  Emerging evidence suggests that there may be an upper limit of exercise for heart health and exceeding this threshold may attenuate the benefits of an active lifestyle. The FIT-HEART consortium seeks to develop tailored physical activity interventions for cardiovascular disease patients and to investigate safe exercise limits for recreational and elite athletes. The research FIT-HEART has three main goals: Co-create, implement and evaluate an innovative program that promotes physical activity by integrating incentives from the individual’s (social) environment tailored to the needs of specific subgroups, which can be seamlessly integrated into healthcare systems across the Netherlands, with potential for future expansion to other patient groups and the broader population. Assess the upper limits of exercise on heart health in recreational and professional athletes by conducting prospective studies in unique cohorts. This approach integrates extensive cardiac phenotyping, wearable monitoring, novel AI technologies, digital twinning, immunophenotyping, and long-term evaluation of clinical outcomes. Establish and expand a multidisciplinary, synergistic consortium focused on sports, exercise, and heart health. Our mission is to nurture young talent, foster innovative cross-domain collaborations, and secure funding for ongoing and future research. In partnership with end-users, we will disseminate outcomes to professionals, patients, and the public, while raising awareness of the wide-ranging health benefits of an active lifestyle. The origin The FIT-HEART consortium emerged from a shared ambition among academic institutions, healthcare partners, patient organizations, and policymakers to address sedentary lifestyles in cardiovascular disease patients and to investigate the cardiac effects of extreme exercise in both elite and recreational athletes. This interdisciplinary initiative builds upon prior collaborative research in sports cardiology, preventive medicine, and behavioral interventions aimed at promoting physical activity. FIT-HEART is well-aligned with the strategic agendas of the Dutch Heart Foundation and the Dutch CardioVascular Alliance (DCVA), both of which prioritize innovative solutions to reduce the burden of cardiovascular disease. By integrating incentives from people’s social environment, the consortium aims to create personalized treatment options that encourage lasting physical activity, while taking into account subgroup-specific needs. In parallel, the integration of advanced cardiovascular methodologies enables FIT-HEART to identify recreational and professional athletes at an early stage who are at risk for adverse cardiovascular health outcomes.

Atrial fibrillation (AF) is not benign. It commonly progresses from paroxysmal AF (PAF) to permanent AF. AF progression is associated with major adverse cardiovascular/cerebral events (MACCE). Cardiovascular risk factors and comorbidities (CVR) are present long before the first AF episode, causing a progressive atrial cardiomyopathy (ACM). The mechanisms of ACM vary between patients hindering effective AF management. The EmbRACE network now aims to unravel the diversity of mechanisms underlying ACM, identify simple diagnostic tools to identify them, and develop a therapeutic approach to prevent ACM progression. The Research Early rhythm-control therapy is one promising intervention to potentially interfere with ACM progression next to CVR management. For a sustained impact we aim to develop care pathways to prevent ACM and AF progression and MACCE. Therefore, we will identify and validate relevant cellular and molecular determinants of ACM and AF and their clinical surrogate parameters; develop an in-silico platform to simulate identified mechanisms of ACM and AF and their effects on AF progression and, based on these data, make suggestions for future refinement of ACM therapy; explore the variety of temporal patterns of PAF as markers of ACM subtypes, demonstrate their prognostic relevance and identify surrogate markers available in clinical practice, based on AI and machine learning; test in a randomized trial stratified for sex the hypothesis that early AF ablation and optimal CVR management in AF patients with ACM delays ACM progression and reduces MACCE; explore whether lifestyle management reduces ACM progression, whereas with only rate control ACM progresses; validate the RACE V AF progression score in real life cohorts and translate this and other knowledge into novel care pathways for AF. The origin Atrial fibrillation is the most common cardiac arrhythmia and can lead to a variety of complications, such as stroke. Currently, there are limited treatment options for this cardiac arrhythmia. Moreover, the disease is often noticed late, which makes proper treatment even more difficult. Therefore, the Dutch Heart Foundation funded the RACE V consortium. Afterwards, the Dutch Heart Foundation guided an exploration to form a national consortium as a follow-up around this theme. This led to the EmbRACE consortium, which is a national network of six university medical centers, UMC Groningen, Maastricht UMC+, UMC Utrecht, Amsterdam UMC and LUMC and Erasmus MC, and hospitals in Arnhem and Eindhoven. The Dutch Heart Foundation funds the research.