A nurse-led COM-B–based walking intervention to improve symptoms and quality of life in patients with atrial fibrillation: A randomized controlled trial

BACKGROUND: Atrial fibrillation (AF) is associated with substantial symptom burden and reduced quality of life. Although physical activity is recommended, sustained engagement remains challenging. Behaviorally informed, nurse-led interventions may support long-term adherence in outpatient cardiopulmonary care. OBJECTIVES: To evaluate the effects of a nurse-led, COM-B-based walking intervention on quality of life (primary outcome), symptom severity, AF burden, and physical activity in patients with persistent or permanent AF. METHODS: In this randomized trial, 78 patients were randomized (39/group); 75 with complete longitudinal data (37 intervention, 38 control) were analyzed. The 12-week intervention combined COM-B-based nurse education, pedometer-supported walking (≥30 min, ≥3 days/week), and weekly calls. Outcomes were assessed at baseline, week 4, and week 12 using repeated-measures analyses. SF-36 domains used Bonferroni α = 0.00,625. RESULTS: After Bonferroni adjustment, significant group × time effects were observed for physical functioning, emotional role limitations, vitality/energy, social functioning, and bodily pain, whereas physical role limitations, mental health, and general health did not meet the adjusted threshold. Symptom severity showed a significant group × time interaction (F = 23.258, p < 0.001, ηp² = 0.242); the unadjusted week-12 between-group mean difference was -5.14 (SE = 1.25, 95% CI -7.64 to -2.64). AF burden did not differ by group over time (p = 0.767). CONCLUSION: The primary analysis showed significant group × time effects in five of eight SF-36 domains, not across all domains. Nurse-led support may facilitate subjective symptom management when measured AF burden is unchanged; larger, longer trials are needed. CLINICAL TRIAL REGISTRATION: NCT05189691.