Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with a poor cardiovascular disease risk profile, dramatically reduced quality of life (QoL), and a high risk of mortality. In 2020, the Canadian Cardiovascular Society (CCS) released the first exercise targets (≥200 minutes/week of moderate intensity physical activity (PA), 2-3 days/week of resistance training, and if >65 years of age, 10 minutes/day of flexibility exercise 2 days/week) for patients with AF and included exercise physiology in an integrated care model for those living with AF. Inclusion of exercise targets and exercise physiology in the guidelines may influence the PA recommendations provided by healthcare providers (HCP) and patient PA levels for people with AF. The overall purpose of this thesis was to explore the implementation of the exercise recommendations within the 2020 CCS AF guidelines. Study 1 was an observational study aimed at determining if HCPs of patients with AF are discussing PA and exercise with their patients using a self-report questionnaire and physician reports from patient medical charts. The secondary purposes were to explore potential differences in PA and exercise discussion occurrence and prescription, and whether this information is different based on patients’ PA levels and sex. Of the 195 patients, 49% reported not discussing PA or exercise with their University of Ottawa Heart Institute (UOHI) physician. Of the patients who reported a PA and exercise discussion with a UOHI physician, 23% did not have a record of the discussion in their medical charts. Significantly more patients discussed PA and exercise with both their UOHI and family physicians than either of these providers alone (𝛘²=21.64, p<0.001). The occurrence of a PA and exercise discussion was not associated with patients' measured PA levels. Females were provided frequency prescription (i.e., how often to exercise) more than males (𝛘²=3.97, p=0.046), but no other sex differences were identified. Study 2 was a pan-Canadian observational study which used a HCP self-report survey to determine: (i) if HCPs prescribe PA and exercise for patients with AF; (ii) if HCPs believed exercise physiology should be included in AF management; (iii) which HCPs have the highest confidence in prescribing exercise; (iv) which HCPs have exercise prescription training; and (v) if HCPs know the 2020 CCS AF exercise targets. Of the 96 responses, 87% of HCPs reported prescribing PA to their patients with AF at least some of the time. All HCPs believed exercise physiology should be included in AF management. Physicians (60%), kinesiologists (50%), and exercise physiologists (40%) reported always prescribing exercise to patients with AF, which was significantly more than registered nurses (0%; 𝛘²=37.37, p<0.05). More physicians (80%) reported being fairly confident in prescribing exercise to patients with AF than physiotherapists (7%) and registered nurses (6%; 𝛘²=43.14, all p<0.05). More exercise physiologists (95%), kinesiologists (90%), and physiotherapists (78.6%) reported being trained in exercise prescription than registered nurses (11.8%; 𝛘²=23.57, all p<0.05). Only 22.9% of HCPs knew the AF targets were from the CCS, and only 14.6% of HCPs correctly identified all three exercise targets from CCS. Conclusion: This thesis suggests that most HCPs are discussing or prescribing exercise to patients with AF, and that exercise physiologists, kinesiologists, and physicians were the healthcare providers most likely to prescribe exercise to their patients. Future research should focus on progressing toward an AF specific PA counseling method and disseminating the CCS AF guidelines to HCPs of patients with AF, based on the lack of identification of the 2020 CCS AF exercise targets and confidence in prescribing to patients who have AF.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/45585 |
| Date | 25 October 2023 |
| Creators | Comeau, Katelyn Eva-Nelida |
| Contributors | Reed, Jennifer, Pilutti, Lara |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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