Abstract
Objective
Engaging patients with atrial fibrillation (AF) in moderate-intensity physical activity has been encouraged by published guidelines. We examined factors associated with engagement in moderate physical activity among older adults with AF.
Methods
This was a retrospective study involving ninety patients with episodes of Afib with RVR duData are from the SAGE (Systematic Assessment of Geriatric Elements)-AF study. Older adults (≥ 65 years) with AF and a CHA2DS2-VASc ≥ 2 were recruited from several clinics in Massachusetts and Georgia between 2015 and 2018. The Minnesota Leisure Time Physical Activity questionnaire was used to assess whether participants engaged in moderate-intensity physical activity (i.e. at least 150 minutes of moderate exercise). Logistic regression was utilized to examine the sociodemographic and clinical characteristics and geriatric elements associated with engaging in moderate-intensity physical activity.
Results
Participants were on average 76 years old and 48% were women. Approximately one-half (52%) of study participants engaged in moderate-intensity physical activity. Morbid obesity (adjusted OR [aOR]=0.41, 90%CI=0.23-0.73), medical history of renal disease (aOR= aOR=0.68,90%CI= 0.48-0.96), slow gait speed (aOR=0.44, 90%CI=0.32-0.60), cognitive impairment (aOR=0.74, 90%CI=0.56-0.97), and social isolation (aOR=0.58, 90%CI= 0.40-0.84) were independently associated with a lower likelihood, while higher AF related quality of life score (aOR=1.64, 90%CI=1.25-2.16) a greater likelihood, of meeting recommended levels of moderate physical activity.
Conclusions
Nearly one-half of older adults with NVAF did not engage in moderate-intensity exercise. Clinicians should identify older patients with NVAF who are less likely to engage in physical activity and develop tailored interventions to promote regular physical activity.
Keywords: Atrial fibrillation, Physical Activity, Moderate Exercise
Introduction
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an estimated prevalence of at least 33.5 million worldwide. 1 AF markedly decreases quality of life and increases the risk of stroke, heart failure, dementia, and death. 2-7 Lifestyle interventions, including participation in regular exercise and risk factor management, have been shown to benefit older patients with AF by decreasing their symptoms and improving their quality of life. 8-10
Widely disseminated guidelines by national agencies encourage moderate-intensity physical activity in patients with AF yet advocate against chronic excessive endurance exercise among middle-age and older adults with AF. 11 Patients with AF who engage in moderate-intensity physical activity have a lower risk of CVD mortality compared with those who are inactive and moderate exercise has been shown to result in a lower risk of CVD mortality than strenuous exercise. 12 In addition, moderate-intensity physical activity has been shown to enhance quality of life, exercise capacity, and the ability to perform activities of daily living among adults with AF. 13 However, little is known about the extent of engagement in moderate exercise or the factors that may promote or hinder engagement in moderate exercise among older adults with AF. Understanding these facilitators or barriers would help clinicians identify patients with AF who are less likely to meet recommended levels of physical activity and develop tailored interventions to promote moderate-intensity physical activity in these individuals.
Using data from a large contemporary cohort, the Systematic Assessment of Geriatric Elements (SAGE)-AF study, 14,15 we examined the sociodemographic, geriatric, clinical, and patient reported elements associated with meeting recommended levels of moderate physical exercise.
Methods
Study Population
The data used for this cross-sectional analysis were derived from the prospective cohort study, Systematic Assessment of Geriatric Elements (SAGE) in AF. 14,15 Participants were recruited from multiple primary care and specialty care clinics in Massachusetts and Georgia between 2015 and 2018. Participants included were 65 years and older, diagnosed with NVAF, and had a CHA2DS2-VASc ≥2 16. Patients with contraindications to oral anticoagulation, or on anticoagulation therapy for conditions other than AF, those with impaired decision making who were unable to provide written consent, or were non-English speakers were excluded. The Institutional Review Boards at the University of Massachusetts Medical School, Boston University, and Mercer University approved this study. Participants were enrolled into this observational study after providing written informed consent.
Measurement of Physical Activity
The Minnesota Leisure-Time Physical Activity (MLTPA) questionnaire was used to evaluate self-reported level of physical activity and was completed at the time of study enrollment. [REF-17, 18] The MLTPA questionnaire asks participants to self-report whether they have performed the following moderate activities during the prior 2 weeks: (1) walking at a fairly brisk pace for exercise, (2) moderately strenuous household chores (i.e., scrubbing, vacuuming), (3) moderately strenuous outdoor chores (i.e., mowing or raking lawn, working in the garden), (4) dancing, (5) bowling, or (6) any regular exercise program other than walking such as stretching, strengthening exercises, or swimming. The questionnaire assesses the frequency (how many times) and duration (in minutes) participants spend doing each reported activity. The total duration of moderate exercise that participants engaged in on a weekly basis was calculated by adding the number of minutes that participants reported having performed each of the activities mentioned previously. The total number of minutes of moderate exercise was then categorized as a binary variable (yes/no) for engaging in at least 150 minutes of moderate exercise on a weekly basis or meeting recommendations for moderate-intensity physical activity. Existing AF guidelines recommend that patients with AF engage in moderate-intensity physical activity, however do not focus on the duration (time) 11; we utilized the recommended category, by AHA/ACC guidelines, of moderate exercise in minutes for all apparently healthy adults (at least 150 minutes of moderate exercise). 19
Clinical and Geriatric Elements
Trained research staff collected data through the conduct of in-person interviews and through the review of participants’ medical records. Trained study staff used standard methods to review participants’ medical charts and abstract sociodemographic and clinical data including age, sex, race, marital status, and level of education. Clinical factors included body mass index (BMI; overweight, obese, morbidly obese), anticoagulant therapy, type of AF, time since AF diagnosis, calculated stroke and bleeding risk scores, medical history, and relevant laboratory findings.
We used the Cardiovascular Health Survey (CHS) frailty scale to assess frailty among study participants. 20 Gait speed was assessed using the time to walk 15 feet. 21 Social isolation was assessed using the Social Support Scale and Social Network Scale. 22 Participants’ cognitive function was assessed using the Montreal Cognitive Assessment Battery (MoCA) with a score ≤ 23 classified as being cognitively impaired. 23 The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD7) were used to examine the presence of depressive and anxiety symptoms, respectively. 24,25 Occurrence of falls in the past 6 months, and sensory deficits, including visual and hearing impairments, were self-reported by participants. AF related quality of life was assessed using the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire and OAC treatment satisfaction was assessed using the Anticoagulation Treatment Satisfaction (ACTS) scale. 26,27
Statistical Analysis
We compared those who met the recommended number of minutes of moderate exercise (≥150 minutes) to those who did not (<150 minutes) according to participants’ baseline sociodemographic, clinical, and psychosocial characteristics. We used chi-square tests to examine between group differences for categorical variables and unpaired t-tests for continuous variables.
Logistic regression as used to determine the factors associated with meeting the working definition of moderate exercise. We adjusted for groups of variables based on their clinical relevance as well as their level of significance (p < 0.05) in their independent association with engagement in moderate physical activity. In Model 1, we examined the association of socio-demographic and clinical variables with participation in moderate exercise. In Model 2, we additionally controlled for geriatric elements (i.e., gait speed, falls in past 6 months, cognitive impairment, social isolation, depression, anxiety, and visual impairment) that may influence meeting the recommended minutes of moderate exercise. In Model 3, we further controlled for a patient reported element, namely AFEQT. All statistical analyses were conducted using SAS v9.4 (SAS Institute Inc., Cary, NC, USA).
Results
A total of 1,244 participants were included in this study. Participants were on average 76 years old, nearly half were women, and three-fifths did not graduate from college. The average body mass index of participants was 30 kg/m2. Approximately 14 % of the study sample were frail and 60 % had paroxysmal AF. Slightly over one-half of study participants (52%) engaged in moderate-intensity physical activity.
Factors Associated with Moderate Physical Activity
Women, those who were obese and morbidly obese, and those who had a history of anemia, asthma/COPD, diabetes, heart failure, hypertension, myocardial infarction, peripheral vascular disease, and renal disease were less likely to meet the recommended level of physical activity than respective comparison groups [Table 1]. In addition, participants who were cognitively impaired, were socially isolated, had symptoms of anxiety and depression, experienced a fall in the past 6 months, were visually impaired, current smokers, and those with a lower AFEQT score were less likely to meet the working definition of moderate exercise than respective comparison groups [Table 2].
Table 1. Baseline Socio-demographic and Clinical Characteristics of Participants According to Self-Reported Moderate Physical Activity: SAGE-AF Study.
Abbreviations; DOAC: Direct Oral Anticoagulant; TIA: Transient Ischemic Attack; COPD: Chronic Obstructive Pulmonary Disease; CHA2DS2-VASc: Stroke risk assessment; HAS-BLED: Bleeding risk assessment
| Baseline Characteristics | Moderate Physical Activity | P-value | |
|---|---|---|---|
| Yes (n=652) | No (n=592) | ||
| Socio-demographics | |||
| Age, years, (M, SD) | 75 (7) | 77 (7) | <0.001 |
| Female (%) | 299 (46) | 308 (52) | 0.03 |
| Married (%) | 394 (62) | 300 (51) | <0.01 |
| Non-Hispanic White (%) | 571 (88) | 485 (82) | <0.01 |
| College graduate or more (%) | 317 (50) | 210 (36) | <0.001 |
| Clinical | |||
| Mean Body Mass Index (kg/m2) (SD) | 29 (6) | 31 (7) | <0.001 |
| Body Mass Index (kg/m2) | |||
| Normal (<25) | 133 (20) | 113 (19) | <0.001 |
| Overweight (25-29.9) | 250 (38) | 186 (32) | |
| Obese (30-39.9) | 237 (36) | 231 (39) | |
| Morbidly Obese (≥40) | 31 (5) | 60 (10) | |
| Type of AF (%) | |||
| Paroxysmal | 403 (62) | 338 (57) | 0.06 |
| Persistent | 157 (24) | 152 (26) | |
| Permanent | 28 (4) | 45 (8) | |
| Left Ventricular Ejection Fraction | 56 (11) | 53 (14) | <0.01 |
| Time since AF Diagnosis, mean, years (SD) | 5 (4) | 6 (4) | 0.16 |
| On OAC (%) | 559 (86) | 505 (85%) | 0.83 |
| Medical History (%) | |||
| Alcohol Use | 227 (35) | 157 (27) | <0.01 |
| Anemia | 186 (29) | 205 (35) | <0.01 |
| Asthma/COPD | 141 (22) | 175 (30) | <0.01 |
| Diabetes | 156 (24) | 190 (32) | <0.01 |
| Heart Failure | 192 (29) | 271 (46) | <0.001 |
| Hypertension | 576 (88) | 546 (92) | 0.02 |
| Major Bleeding | 118 (18) | 126 (21) | 0.16 |
| Myocardial Infarction | 107 (16) | 135 (23) | <0.01 |
| Peripheral vascular disease | 76 (12) | 103 (17) | <0.01 |
| Renal Disease | 146 (22) | 210 (35) | <0.001 |
| Stroke/TIA | 52 (8) | 70 (12) | 0.03 |
| Hemoglobin | 13 (2) | 13 (2) | <0.01 |
| Risk Scores (M, SD) | |||
| CHA2DS2-VASc | 4 (2) | 5 (2) | <0.001 |
| HAS-BLED | 3 (1) | 3 (1) | <0.01 |
Table 2. Baseline Psychosocial, Geriatric, and Patient Reported Characteristics of Participants According to Self-Reported Moderate Physical Activity: SAGE-AF Study.
Abbreviations; MOCA: Montreal Cognitive Assessment; PHQ9: Patient Health Questionnaire 9; GAD7: Generalized Anxiety Disorder; AFEQT: Atrial Fibrillation Effect on Quality of Life; ACTS: Anticoagulation Treatment Satisfaction; TTR: Time in Therapeutic Range
| Baseline Characteristics | Moderate Physical Activity | P-value | |
|---|---|---|---|
| Yes (n=652) | No (n=592) | ||
| Psychosocial and Geriatric | |||
| Gait Speed (%) | |||
| Normal | 539 (83) | 347 (59) | <0.001 |
| Slow | 111 (17) | 245 (41) | |
| Frailty (%) | |||
| Not frail | 391 (60) | 22 (4) | <0.001 |
| Pre-frail | 248 (38) | 411 (69) | |
| Frail | 13 (2) | 159 (27) | |
| Cognitive Impairment (MOCA≤23) (%) | 229 (35) | 299 (51) | <0.001 |
| Social Isolation (%) | 60 (9) | 96 (16) | <0.001 |
| Depression (PHQ9 ≥ 5) (%) | 143 (22) | 210 (36) | <0.001 |
| Anxiety (GAD-7 ≥5) (%) | 131 (20) | 160 (27) | <0.01 |
| Fall in Past 6 months (%) | 126 (19) | 144 (24) | 0.03 |
| Sensory Deficits (%) | |||
| Visual Impairment | 193 (30) | 235 (40) | <0.001 |
| Hearing Impairment | 243 (37) | 208 (35) | 0.45 |
| Patient Reported Outcomes | |||
| AFEQT | |||
| Score (M, SD) | 84 (16) | 76 (19) | <0.001 |
| ACTS (M, SD) | |||
| Burden Score | 17 (6) | 17 (6) | 0.76 |
| Benefit Score | 11 (4) | 10 (4) | <0.001 |
| TTR (warfarin), mean, time (SD) | 0.5 (0.4) | 0.5 (0.4) | 0.34 |
| Health Behavior | |||
| Current smoker (%) | 15 (2) | 20 (3) | 0.14 |
On the other hand, married participants, non-Hispanic whites, those with a college degree or higher, participants with a history of alcohol use and stroke/TIA, and those that were robust (not frail) and had a normal gait speed were more likely to engage in moderate-intensity physical activity [Table 1] and [Table 2].
In our fully adjusted regression models, morbidly obese participants were 60 % less likely than participants with a normal BMI to engage in moderate activity ([Table 3]; adjusted OR [aOR]= 0.41; 95% CI= 0.23-0.73). Participants with slow gait speed (aOR= 0.44; 95% CI= 0.32-0.60), a medical history of renal disease (aOR= 0.68,90% CI= 0.48-0.96), who were cognitively impaired (aOR=0.74; 95% CI= 0.56-0.97), and participants with low social support (aOR=0.58; 95% CI= 0.40-0.84) were significantly less likely to meet the recommended level of physical activity than respective comparison group after adjusting for other potentially confounding variables [Table 3]. Participants with a high AF related quality of life (AFEQT score >80) were two-thirds more likely to meet the recommended level of physical activity after adjusting for other covariates [Table 3].
Table 3. Factors Associated with Self-Reported Moderate Physical Activity: SAGE-AF Study.
Model 1: Adjusting for sociodemographic and clinical factors and smoking status; Model 2: M1 + Geriatric Elements; Model 3: Model 1 + Model 2 + patient reported outcomes; Abbreviations: TIA: Transient Ischemic Attack; CHA2DS2-VASc: Stroke risk assessment; HAS-BLED: Bleeding risk assessment; MOCA: Montreal Cognitive Assessment; PHQ-9: Patient Health Questionnaire 9; GAD-7: Generalized Anxiety Disorder; AFEQT: Atrial Fibrillation Effect on Quality of Life.
| Model 1 Adjusted OR (95 % CI) | Model 2 Adjusted OR (95 % CI) | Model 3 Adjusted OR (95 % CI) | |
|---|---|---|---|
| Socio-demographic | |||
| Age (yrs) | |||
| 65-74 | Ref. | Ref. | Ref. |
| 75-84 | 0.71 (0.51, 0.97) | 0.74 (0.53, 1.03) | 0.73 (0.52, 1.02) |
| 85+ | 0.51 (0.33, 0.79) | 0.66 (0.42, 1.05) | 0.63 (0.40, 1.00) |
| Sex (Female vs Male) | 0.81 (0.60, 1.10) | 0.88 (0.64, 1.21) | 0.91 (0.66, 1.25) |
| Married (No vs Yes) | 0.89 (0.69, 1.16) | 0.97 (0.74, 1.27) | 0.97 (0.74, 1.28) |
| Non-Hispanic White (Yes vs No) | 1.25 (0.88, 1.78) | 0.92 (0.63, 1.34) | 0.90 (0.61, 1.32) |
| College Graduate (Yes vs No) | 1.36 (1.06, 1.74) | 1.19 (0.92, 1.55) | 1.16 (0.89, 1.51) |
| Clinical | |||
| Body Mass Index (BMI), kg/m2 | |||
| Normal | Ref. | Ref. | Ref. |
| Overweight | 0.90 (0.64, 1.27) | 0.88 (0.62, 1.25) | 0.86 (0.60, 1.23) |
| Overweight | 0.90 (0.64, 1.27) | 0.88 (0.62, 1.25) | 0.86 (0.60, 1.23) |
| Obese | 0.72 (0.51, 1.02) | 0.70 (0.49, 1.00) | 0.71 (0.50, 1.02) |
| Morbidly Obese | 0.35 (0.20, 0.61) | 0.39 (0.22, 0.70) | 0.41 (0.23, 0.73) |
| Type of AF (%) | |||
| Paroxysmal | Ref. | Ref. | Ref. |
| Persistent | 0.98 (0.73, 1.31) | 0.99 (0.74, 1.34) | 1.04 (0.77, 1.30) |
| Permanent | 0.69 (0.41, 1.17) | 0.61 (0.36, 1.04) | 0.65 (0.38, 1.11) |
| Medical History | |||
| Alcohol Use | 1.32 (0.97, 1.78) | 1.16 (0.85, 1.59) | 1.12 (0.81, 1.54) |
| Anemia | 1.03 (0.78, 1.35) | 1.08 (0.82, 1.44) | 1.07 (0.81, 1.42) |
| Asthma/COPD | 0.82 (0.62, 1.10) | 0.86 (0.64, 1.16) | 0.91 (0.67, 1.22) |
| Diabetes | 0.95 (0.69, 1.31) | 1.01 (0.72, 1.41) | 0.99 (0.71, 1.38) |
| Heart Failure | 0.69 (0.51, 0.94) | 0.79 (0.57, 1.09) | 0.83 (0.60, 1.15) |
| Hypertension | 0.91 (0.60, 1.39) | 0.99 (0.63, 1.53) | 0.95 (0.61, 1.48) |
| Myocardial Infarction | 0.78 (0.55, 1.10) | 0.73 (0.51, 1.04) | 0.72 (0.51, 1.03) |
| Peripheral vascular disease | 0.78 (0.54, 1.14) | 0.79 (0.53, 1.16) | 0.78 (0.53, 1.14) |
| Renal Disease | 0.76 (0.54, 1.06) | 0.71 (0.50, 1.00) | 0.68 (0.48, 0.96) |
| Stroke/TIA | 0.78 (0.48, 1.25) | 0.83 (0.50, 1.35) | 0.78 (0.48, 1.29) |
| Risk Scores | |||
| CHA2DS2-VASc | 1.05 (0.90, 1.22) | 1.08 (0.92, 1.27) | 1.09 (0.93, 1.28) |
| HAS-BLED | 0.94 (0.79, 1.11) | 0.98 (0.82, 1.17) | 1.00 (0.84, 1.20) |
| Geriatric Elements | |||
| Gait Speed | |||
| Normal | Ref. | Ref. | |
| Slow | 0.45 (0.33, 0.61) | 0.44 (0.32, 0.60) | |
| Cognitive Impairment (MOCA) | 0.75 (0.57, 0.99) | 0.74 (0.56, 0.97) | |
| Social Isolation | 0.55 (0.38, 0.81) | 0.58 (0.40, 0.84) | |
| Depression (PHQ-9 ≥ 5) | 0.68 (0.49, 0.94) | 0.76 (0.55, 1.05) | |
| Anxiety (GAD-7 ≥5) | 0.85 (0.61, 1.20) | 0.93 (0.66, 1.31) | |
| Fall in the Past 6 months | 0.92 (0.68, 1.24) | 0.96 (0.71, 1.30) | |
| Visual Impairment | 0.82 (0.63, 1.07) | 0.85 (0.65, 1.12) | |
| Patient Reported Outcome | |||
| AFEQT >80 | 1.64 (1.25, 2.16) |
Discussion
In our large cohort of older adults with NVAF, slightly more than one-half met current recommendations for participation in moderate physical activity. We showed that morbid obesity, slow gait speed, a medical history of renal disease, cognitive impairment, and social isolation were associated with a lower likelihood of engaging in moderate-intensity physical activity, while participants with a higher health related quality of life were more likely to meet these recommendations.
Extent of Engagement in Moderate Physical Activity
In our cohort, nearly half of older adults with AF reported that they did not engage in moderate-intensity physical activity. We postulate that patients’ inability to engage in activity may be playing an important role with failing to meet these recommendations. SAGE-AF participants are older adults with a number and variety of comorbidities who may not have yet adapted to their condition and may be discouraged or reluctant to engage in various physical activities. In a study assessing quality of life among 161 patients with AF, approximately 90 % indicated that their condition affected their ability to perform regular daily activities. 28 In addition, patients with AF may be misinformed about their ability to exercise, or even the guideline recommendations of engaging in moderate-intensity physical exercise and avoidance of chronic excess endurance exercise 11. Older adults with AF may also lack information about how to be physically active while coping with other comorbidities, which may explain the large proportion of individuals in the present study who failed to report regular engagement in moderate physical activity. Therefore, healthcare providers should develop tailored interventions to improve the extent of engagement in moderate physical activity.
Factors Associated with Moderate Physical Activity
To the best of our knowledge, no previous study has examined factors associated with moderate physical activity among older adults with AF. In our study, morbidly obese participants with NVAF were less likely to engage in moderate-intensity physical activity than participants with a normal BMI. Prior studies in healthy individuals have shown that the higher the BMI, the greater the limitation in physical activity observed. 29, 30 In addition, due to the various complications of obesity, including inspiratory muscle fatigue and restrictive ventilation, exercise can be very difficult in severely obese patients. 31-34 Therefore, clinicians need to play a crucial role in encouraging morbidly obese patients with AF to engage in some form of physical activity which would also result in the further benefit of weight loss in this high-risk population.
Slow gait speed and social isolation were associated with a lower likelihood of participating in moderate physical activity. Both gait speed and social isolation have been shown to be associated with longer time spent being sedentary, loss of capacity for daily living activities, and reduced time spent in objective physical activity. 35, 36 It has been previously shown that healthy adults with high walking speed were more likely to meet recommended levels of physical exercise. 35 Also, interpersonal interactions and social participation were independently associated with physical performance among older adults. Social disengagement and decrease interpersonal interactions were associated with poor physical performance 37. Health care providers should encourage social engagement and interpersonal interactions through participation in community fitness programs, such as group walks in neighborhoods, and in peer-delivered physical activity interventions which has been shown to increase physical activity behavior. 38
In the present study, participants who were cognitively impaired were less likely to meet current recommendations for moderate exercise. We postulate that physicians may be more skeptical to engage cognitively impaired adults in their treatment as well as inform them about the importance of incorporating regular moderate exercise into their daily routines.
Participants with a medical history of renal disease were associated with a lower likelihood of participating in moderate exercise. In fact, reduced physical activity and sedentary lifestyle are common in patients with renal disease. 39 Due to the strikingly low physical activity among patients with chronic kidney disease (CKD), 40 detailed exercise guidelines for CKD patients have been published. Patients with CKD are recommended to engage in specific types of exercise and structured activities including strength, flexibility, and aerobic activities. Health care providers should encourage AF patients with CKD to engage in these structured activities to the extent of meeting the recommended intensity of moderate physical activity.
Our study also showed that participants with high AF related quality of life were more likely to report being engaged in moderate activity than those with a low AF related quality of life. Indeed, in the prior study of 161 patients with symptomatic AF, improvement of AF-related symptoms and quality of life improved the physical health index among those who underwent catheter ablation 28
Our findings have clinical relevance in managing older adults with AF. Since only one-half of older adults with AF reported participating in moderate exercise, health care providers need to encourage patients to partake in regular physical activity and inform them about the health benefits this may provide. In addition, health care providers should identify any physical function or social barriers, including obesity and social isolation, that may hinder meeting the recommended levels of physical activity. Identifying and addressing these “modifiable” factors may help in increasing the proportion of those engaging in moderate exercise. Lifestyle counseling, including risk factor modification, and patient-centered communication should also be the focus of health care providers in order to improve engagement among older adults with AF.
Study Strengths and Limitations
Our study has several strengths and limitations. First, we included a large and diverse cohort of older adults with NVAF. Second, this study is unique in examining the impact of various geriatric elements, as well as patient reported elements such as AFEQT, that may influence physical activity. Third, we used the Minnesota Leisure Time Physical Activity (LTPA) Questionnaire, a validated questionnaire, to assess physical activity. A limitation of the present study, however, is that physical activity was self-reported. Subjective methods of physical activity assessments among healthy adults tend to overestimate actual participation in physical activity compared with objective methods of assessment In addition, our study participants are mostly non-Hispanic whites which limits the generalizability of our findings to other study populations. Finally, no causal inferences can be made, and we cannot determine the directionality of the associations since this analysis was cross-sectional in design.
Conclusions
A considerable proportion of older adults with NVAF did not report being engaged in moderate physical activity. Participants who were morbidly obese, cognitively impaired, had a slow gait speed, had a medical history of renal disease, and were socially isolated were less likely, while those with a higher AFEQT score were more likely, to meet these activity recommendations. Our findings provide information for healthcare providers to assess factors that influence the engagement of older men and women with NVAF in moderate-intensity physical activity and reinforces the need for sustained efforts by healthcare providers to ensure better engagement of their older patients in regular moderate-intensity physical activity which may reduce patient’s symptoms of AF and improve their quality of life.
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