Improving physical activity in older patients with atrial fibrillation combined with frailty: development of an intervention using the behaviour change wheel framework

Abstract Background：Physical activity is inadequate in older adults with AF and frailty. Being physically active improves health outcomes and reduces the healthcare burden. Theory-based behaviour change interventions are necessary to enhance physical activity. The aim of this study was to develop an intervention guided by the Behaviour Change Wheel theory to improve physical activity in older patients with AF and frailty. Objective：Our aim was to develop a behaviour change intervention for older patients with AF and frailty to increase their physical activity, improve physical health and reduce the national healthcare burden. Methods：Our study used a framework based on the Behaviour Change Wheel theory to develop a behaviour change intervention through eight steps. Using semi-structured interviews, we identified the determinants of physical activity in older patients with AF and frailty using the COM-B and TDF. Appropriate intervention functions and various policies addressing the determinants of physical functioning in elderly patients with AF and frailty were then selected based on APEASE criteria. Finally, appropriate behaviour change techniques were screened after the APEASE criteria to help achieve translation of the intervention function into intervention content. Results：Our study identified 12 factors that promote and 12 factors that hinder physical activity. We selected seven intervention functions and 15 behavior change techniques based on these factors. These 7 intervention functions and 15 behavior change techniques are eligible for APEASE criteria. We then determined to use an app as a delivery model. Finally, behavioral change interventions were provided for elderly patients with AF combined with frailty to increase the physical activity level and compliance. Conclusions：The Behavior Change Wheel provides a systematic approach to designing behavior change interventions, which can enhance physical activity and delay frailty in elderly patients with AF and frailty and reduce healthcare burden. Findings suggest that potential interventions should focus on enhancing disease knowledge, teaching physical activity skills, providing social support, and using appropriate behavior change techniques in older adults with AF and frailty. Our next step will be to conduct a feasibility study to assess the acceptability and effectiveness of intervention programs.