A nurse-led COM-B-based walking intervention to improve symptoms and quality of life in patients with atrial fibrillation: A randomized controlled trial.

BACKGROUND

Atrial fibrillation (AF) is associated with substantial symptom burden and reduced quality of life. Although physical activity is recommended, sustained engagement remains challenging. Behaviorally informed, nurse-led interventions may support long-term adherence in outpatient cardiopulmonary care.

OBJECTIVES

To evaluate the effects of a nurse-led, COM-B-based walking intervention on quality of life (primary outcome), symptom severity, AF burden, and physical activity in patients with persistent or permanent AF.

METHODS

In this randomized trial, 78 patients were randomized (39/group); 75 with complete longitudinal data (37 intervention, 38 control) were analyzed. The 12-week intervention combined COM-B-based nurse education, pedometer-supported walking (≥30 min, ≥3 days/week), and weekly calls. Outcomes were assessed at baseline, week 4, and week 12 using repeated-measures analyses. SF-36 domains used Bonferroni α = 0.00,625.

RESULTS

After Bonferroni adjustment, significant group × time effects were observed for physical functioning, emotional role limitations, vitality/energy, social functioning, and bodily pain, whereas physical role limitations, mental health, and general health did not meet the adjusted threshold. Symptom severity showed a significant group × time interaction (F = 23.258, p < 0.001, ηp² = 0.242); the unadjusted week-12 between-group mean difference was -5.14 (SE = 1.25, 95% CI -7.64 to -2.64). AF burden did not differ by group over time (p = 0.767).

CONCLUSION

The primary analysis showed significant group × time effects in five of eight SF-36 domains, not across all domains. Nurse-led support may facilitate subjective symptom management when measured AF burden is unchanged; larger, longer trials are needed.

CLINICAL TRIAL REGISTRATION: NCT05189691.