The effect of walking exercises performed using behavior change model on symptom severity and quality of life in patients with atrial fibrillation: A randomized controlled trial

Atrial fibrillation is one of the most common arrhythmias, and when rate and rhythm control cannot be achieved, it can impair the pump function of the heart. In untreated or uncontrolled atrial fibrillation, it is also very dangerous in terms of preparing the ground for heart failure and stroke. For this reason, the study was conducted to evaluate the effect of walking exercises performed using a behavioral change model on symptom severity and quality of life in patients with atrial fibrillation. The study was conducted in the cardiology clinic of a university hospital with a prospective, parallel group randomized controlled design. A total of 78 patients were included in the sample, 39 in the intervention group and 39 in the control group, with block randomization. Patient Identification Form, University of Toronto Atrial Fibrillation Severity Scale and Short Form 36 were used as data collection tools. In the application of the study, according to the COM-B behavior change model, the intervention group was informed about the benefits of physical activity at the beginning of the study, and they were asked to record the number of steps by walking with a pedometer for an average of 30 minutes at least 3 days a week. In order to provide motivation, weekly phone calls were made by the intervention group and the researcher, and their walking status was also followed. The control group was observed without intervention. The scales were administered to the intervention and control groups at baseline, at week 4, and at week 12. The gait follow-up chart was received from the intervention group at week 4 and week 12. Data were collected between April 2022 and February 2023. Ethical permission and registration number of the study were obtained. Frequency, percentage, mean, standard deviation for descriptive data in data analysis; For normal distribution, skewness and kurtosis values, histograms and Q-Q plot values were examined. Chi-square was used for categorical variables, t-test was used for independent groups for group comparison, repeated measure ANOVA was used for within-group comparison, and mixed ANOVA was used to evaluate group-time interaction. The significance level was taken as p<0.05. The mean age of the patients participating in the study was 59.13± 10.77 years in the intervention group and 60.90±9.09 years in the control group. It was determined that the patients had a similar distribution in terms of sociodemographic characteristics (p>0.05). In the intervention group, the average walking time was 92.35 minutes in the 1st week, and 134.08 minutes/week at the end of the 12th week. While the average number of steps was 2048.22 in the 1st week, it increased to 2998.97 at the end of the 12th week. This increase was found to be significant in terms of both exercise duration and number of steps (p<0.01). It was determined that AF symptom severity score averages in the intervention group did not differ according to time in the AF load dimension after the application of walking exercise (p>0.05), but the symptom severity score averages decreased (p<0.05). It was determined that the mean scores of Quality of Life in the intervention group increased over time (p<0.05). It was determined that the mean scores of the intervention group's Quality of Life were higher than the mean scores of the control group at the 12th week, except for the physical role difficulty sub-dimension (p<0.05). In the study, it was found that walking exercises performed using the behavior change model caused a decrease in the severity of AF symptoms at the end of 12 weeks, and an improvement in physical functionality, emotional role difficulty, energy/vitality, mental health, social functionality, pain and general health, which are sub-dimensions of quality of life. A significant change was also observed in the energy/vitality sub-dimension at the end of the 4th week. The most significant improvement occurred in the social functionality sub-dimension of quality of life. There was no significant change in the AF burden and the physical role difficulty sub-dimension of quality of life during the 12-week period with walking exercises. Walking exercises can be encouraged in AF patients using a behavior modification model. Patients should be motivated for walking exercises, which can be applied in any environment, health benefits should be revealed more clearly with further research, and exercise efficiency should be evaluated with the technique of measuring the number of steps.