Effect of an Exercise and Nutrition Program on Quality of Life in Patients With Atrial Fibrillation: The Atrial Fibrillation Lifestyle Project (ALP)
Jesse Bittman, MD,
Cynthia J. Thomson, PhD,
Lloyd A. Lyall, BA (Hons),
Stephanie L. Alexis, BSc, RD,
Eric T. Lyall,
Sebastian L. Cannatella, BSc (Hons),
Mahasti Ebtia, MD,
Alexander Fritz,
Benjamin K. Freedman, MSc, BA (Hons),
Nooshin Alizadeh-Pasdar, PhD, RD,
Joan M. LeDrew, RN, BScN,
Teddi L. Orenstein Lyall, MD
Affiliations
Jesse Bittman, MD
Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Corresponding author: Dr Jesse Bittman, 1081 Burrard St, Rm 5900, Burrard Bldg, St. Paul’s Hospital, Vancouver, British Columbia V6Z 1Y6, Canada. Tel.: +1-604-806-8735; fax: +1-604-806-9057.
Cynthia J. Thomson, PhD
Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, British Columbia, Canada
Lloyd A. Lyall, BA (Hons)
School of Humanities and Sciences, Stanford University, Stanford, California, USA
Stephanie L. Alexis, BSc, RD
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Eric T. Lyall
Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
Sebastian L. Cannatella, BSc (Hons)
Department of Biochemistry and Microbiology, Faculty of Science, University of Victoria, Victoria, British Columbia, Canada
Mahasti Ebtia, MD
Division of Cardiology, Department of Medicine, University of British Columbia Vancouver, British Columbia, Canada
Alexander Fritz
Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, British Columbia, Canada; School of Humanities and Sciences, Stanford University, Stanford, California, USA; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada; Department of Biochemistry and Microbiology, Faculty of Science, University of Victoria, Victoria, British Columbia, Canada; Division of Cardiology, Department of Medicine, University of British Columbia Vancouver, British Columbia, Canada; Department of Science, University of Victoria, Victoria, British Columbia, Canada; School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada; Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada; Cardiac Rehabilitation Services, Richmond Hospital, Vancouver Coastal Health, Richmond, British Columbia, Canada
Benjamin K. Freedman, MSc, BA (Hons)
School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
Nooshin Alizadeh-Pasdar, PhD, RD
Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, British Columbia, Canada; School of Humanities and Sciences, Stanford University, Stanford, California, USA; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada; Department of Biochemistry and Microbiology, Faculty of Science, University of Victoria, Victoria, British Columbia, Canada; Division of Cardiology, Department of Medicine, University of British Columbia Vancouver, British Columbia, Canada; Department of Science, University of Victoria, Victoria, British Columbia, Canada; School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada; Faculty of Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada; Cardiac Rehabilitation Services, Richmond Hospital, Vancouver Coastal Health, Richmond, British Columbia, Canada
Joan M. LeDrew, RN, BScN
Cardiac Rehabilitation Services, Richmond Hospital, Vancouver Coastal Health, Richmond, British Columbia, Canada
Teddi L. Orenstein Lyall, MD
Division of Cardiology, Department of Medicine, University of British Columbia Vancouver, British Columbia, Canada
Background: Studies of separate exercise and weight loss interventions have reported improvements in quality of life (QoL) or reduction in atrial fibrillation (AF) burden. We investigated the impact of a structured exercise, nutrition, and risk-factor-modification program on QoL and AF burden. Methods: In this trial, 81 successive patients with body mass index > 27 kg/m2 and nonpermanent AF were randomized to an intervention (n = 41) or control group (n = 40). The intervention consisted of cardiovascular risk management and a 6-month nutrition and exercise program, followed by a 6-month maintenance program. All participants received usual AF care. The primary end-point was QoL at 6 and 12 months. Results: At 6 months, we observed improved QoL among patients in the intervention group, relative to that among control-group patients (intervention (I) n = 34, control (C) n = 38) in the 36-item Short Form Survey Instrument scores on the subscales of vitality (I: 13.2 ± 20.4; C: 1.0 ± 14.9, P 27 kg/m2 et la FA était non permanente à une intervention (n = 41) ou à un groupe témoin (n = 40). L’intervention a consisté en la prise en charge du risque cardiovasculaire et un programme d’alimentation et d’exercice de six mois, et a été suivie d’un programme de maintien de six mois. Tous les participants ont reçu les soins usuels relatifs à la FA. Le principal critère d’évaluation était la QdV après six mois et 12 mois. Résultats: Après six mois, nous avons observé la QdV chez les patients du groupe d’intervention par rapport à celle des patients du groupe témoin (intervention [I] n = 34, témoin [C] n = 38) selon les scores de la version abrégée du questionnaire de 36 items aux sous-échelles sur la vitalité (I : 13,2 ± 20,4; C : 1,0 ± 14,9, P < 0,001), le fonctionnement social (I : 14,7 ± 24,1; C : 2,4 ± 21,2, P = 0,018), le bien-être émotionnel (I : 5,5 ± 14,1 ; C : –1,0 ± 13,3, P = 0,017), et les perceptions de la santé générale (I : 8,1 ± 12,3; C : 2,7 ± 13,3, P = 0,009). Au suivi après six mois, l’amélioration des scores aux sous-échelles sur la vitalité (P = 0,021) et le bien-être émotionnel (P = 0,036) demeurait significative. Le fardeau de la FA selon le moniteur Holter et le score selon la Toronto Atrial Fibrillation Severity Scale n’avait pas changé de façon significative. Conclusions: Un programme structuré d’exercice et d’alimentation a donné lieu à des améliorations significatives et soutenues de la QdV, sans réduire le fardeau de la FA. Ce type de programme peut constituer un traitement supplémentaire aux personnes qui connaissent une diminution de leur QdV en raison de la FA.
