Journal of Rehabilitation Medicine 51-6 | Page 48

J Rehabil Med 2019; 51: 442–450 ORIGINAL REPORT EFFECT OF PATIENT EDUCATION AND PHYSICAL TRAINING ON QUALITY OF LIFE AND PHYSICAL EXERCISE CAPACITY IN PATIENTS WITH PAROXYSMAL OR PERSISTENT ATRIAL FIBRILLATION: A RANDOMIZED STUDY Albert M. JOENSEN, MD, PhD 1,2 , Pia T. DINESEN, MD, PhD 1,2 , Lotte T. SVENDSEN, RN 1 , Tina K. HOEJBJERG, RN 1 , Annette FJERBAEK, PT 3 , Jane ANDREASEN, PT, MSc, PhD 3,4 , Maria B. SOTTRUP, RN 1 , Søren LUNDBYE-CHRISTENSEN, MSc, PhD 2,5 , Henrik VADMANN, MD, PhD 1,2 and Sam RIAHI, MD, PhD 1,2 From the 1 Department of Cardiology, Aalborg University Hospital, 2 Aalborg AF Study Group, Aalborg University Hospital, 3 Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, 4 Public Health and Epidemiology Group, Department of Health, Science and Technology, Aalborg University and 5 Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark Objective: To examine the effect of a rehabi- litation programme on quality of life and phy- sical capacity in patients with atrial fibrillation. Methods: Patients with paroxysmal or persistent atrial fibrillation were randomized to either a 12- week rehabilitation programme with education and physical training (intervention group) or standard care (control group). At baseline, after 3, 6 and 12 months participants completed 5 different quality of life questionnaires (Quality of Life in patients with Atrial Fibrillation (AF-QoL-18), Atrial Fibrillation Ef- fect on QualiTy of Life (AFEQT), Patient Health Ques- tionnaire (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7) and EuroQol 5D (EQ-5D)), and physical exercise tests. Differences in mean] scores between groups were analysed by repeated measu- res analysis of variance (ANOVA). Results: Fifty-eight patients (age range 43–78 years, 31% female) were included. In the intervention gro- up the AF-QoL-18 score increased from baseline (48.4 (standard deviation (SD) 22.8)) to 6 months (68.0 (SD 15.2)) compared with the control group (base- line 51.6 (SD 22.3), 6 months 59.2 (SD 27.3)). After 12 months, there was no difference. Similar patterns were found for the other questionnaires. Maximum exercise capacity improved in the intervention group from baseline (176 W (SD 48)) to 6 months (190 W (SD 55)). There was no change in the control group. Conclusion: Education and physical training may have a short-term (but no long-term) beneficial ef- fect on quality of life and physical exercise capacity in patients with atrial fibrillation. Key words: atrial fibrillation; rehabilitation; quality of life; physical exercise; education. Accepted Mar 22, 2019; Epub ahead of print Apr 1, 2019 J Rehab Med 2019: 51: 442–450 Correspondence address: Albert Marni Joensen, Department of Car- diology, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aal- borg, Denmark. E-mail: [email protected] C ardiac rehabilitation takes a cross-functional approach to the aftercare of patients, including individually de- signed treatment plans, patient information and education plans, physical exercise, dietary guidance, psychosocial LAY ABSTRACT Atrial fibrillation is the most common cardiac arrhythmia and the number of atrial fibrillation patients is growing worldwide. In addition to an increase in risk of stroke and heart failure patients with atrial fibrillation also ex- perience decrease in fitness and quality of life. In our study 58 atrial fibrillation patients draw lots to partici- pate or not in a rehabilitation program with education and exercise training in addition to usual treatment. We measured fitness by a bicycle test at the beginning of the study and after 3 and 6 months, moreover partici- pants filled out questionnaires on quality of life at the beginning of the study and after 3, 6 and 12 months. We found that our rehabilitation program may have a short term (but no long term) effect on quality of life and fitness in atrial fibrillation patients. support, optimization of medical treatment, risk factor control, and individual maintenance of treatment goals. There is strong evidence that rehabilitation has a be- neficial effect on quality of life (QoL) in patients with coronary heart disease (CHD) (1). However, patients with atrial fibrillation (AF) are seldom and not systematically offered rehabilitation. Previous studies have demonstrated that patients with AF lack knowledge regarding the natural history of AF, consequences, treatment and how to manage a change in QoL caused by AF (2). In addition, the relationship between physical exer- cise and AF has been disputed. Among 64,561 patients, Qureshi et al. found an inverse relationship between cardiorespiratory fitness and incident AF, especially in obese subjects who underwent exercise treadmill testing (3). In 825 obese patients with AF, Pathak et al. demonstrated a lower burden of AF in patients who lost weight and improved their cardiorespiratory fitness (4, 5). Pathak et al. also demonstrated a bene- ficial effect of aggressive risk factor management on the long-term success of AF ablation (6). Randomized studies on patients with primarily permanent AF have demonstrated beneficial effects of physical exercise on physical capacity, AF symptoms and QoL (7–11). The prevalence of AF is increasing (12), therefore, it is important to investigate whether a rehabilitation This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2551 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977