Zhongguo quanke yixue (Jan 2024)
Development Trajectory and Predictors of Strength-duration Adherence to Home-based Exercise Rehabilitation among Patients with Atrial Fibrillation after Radiofrequency Catheter Ablation: a Longitudinal Study
Abstract
Background The prevalence of atrial fibrillation (AF) in China is increasing year by year, and the prognosis and quality of life of patients urgently need attention. Current studies have confirmed that exercise rehabilitation is a beneficial way to improve the prognosis and poor quality of life in patients with AF after radiofrequency catheter ablation (RFCA). Adherence is a key measure of whether the benefits of exercise rehabilitation persist, but its trajectory remains unknown. Objective To examine the development trajectory and predictors of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA using five-period follow-up data based on prospective longitudinal observation. Methods Convenience sampling method was used to select 246 patients with AF who attended the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University for RFCA from May to November 2020 for follow-up. The baseline survey was conducted 1 week after enrollment, and the follow-up survey was conducted at 3, 6, 9 and 12 months after enrollment. The general and clinical data of patients were collected. The strength-duration adherence was monitored and recorded using smart devices or fitness log to assess exercise adherence in terms of strength-duration adherence; Self-efficacy for Exercise Scale (SEE), Fear of Activity in Patients with Chronic Heart Failure (Fact-CHF), Perceived Social Support Scale (PSSS), Patient Activation Measure 13 (PAM13) were used for assessing self-efficacy of exercise, fear of activity, social support and motivation level. Mplus tool was used to construct latent class growth model (LCGM), and the optimal fitting model was selected to determine the development trajectory of strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA. Logistic regression analysis was used to identify the predictors of trajectory categories. Results A total of 202 patients were included in the final analysis with 44 patients lost to follow-up. The number of patients at baseline, 3 months, 6 months, 9 months, and 12 months after exercise were 202, 201, 185, 174 and 159, respectively, and the strength-duration adherence were (0.83±0.55), (1.07±0.54), (0.99±0.57), (0.91±0.55) and (0.89±0.60). The LCGM results showed group heterogeneity in the process of change in strength-duration adherence to exercise rehabilitation in patients, which was divided into 3 latent classes based on their development trajectories, including 69 in slow decline-low level group (34.2%), 14 in rapid increase-high level group (6.9%), and 119 in sustained adherence group (58.9%). Multinomial unordered Logistic regression showed higher levels of intensity-time adherence in the rapid increase-high level group and sustained adherence group using the slow decline-low level group as the reference group (P<0.001). The patients in the rapid increase-high level group and sustained adherence group were older, with higher level of exercise self-efficacy (P<0.05). The level of fear of activity was lower in the rapid increase-high level group, and the level of activation was higher in the sustained adherence group (P<0.05) . Conclusion The strength-duration adherence to home-based exercise rehabilitation among patients with AF after RFCA showed a multi-class curve growth trajectory. In the future, intensive interventions can be conducted periodically according to the time-varying characteristics and predictors, to improve and stabilize the adherence to home-based exercise rehabilitation.
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