Atrial Fibrillation and Frailty management through Individually Tailored exercise and lifestyle interventions (AF-FIT)

The exercise intervention has been designed with the extensive contribution of people with lived experience of AF during a combination of small and large group consumer engagement and design sessions. Patients who contributed to the co-design process advised that the following considerations are important. The AF-FIT intervention will be delivered by clinical exercise physiologists over a 26-weeek period in a hybrid format (supervised in clinic plus home-based/unsupervised exercise), tailored to the needs and preferences of the individual patient. The intervention will be divided into three, progressive phases to ensure the appropriate stimulus for adaptation. In the BASE phase (0-6 weeks), participants will attend a 1-hour supervised session (remotely through teleconferencing for remote patients) once per week. These sessions will be complimented by two additional 30–45-minute home sessions per week. Supervised sessions will be designed to introduce and instruct patients on the strength, aerobic and balance exercise used throughout the intervention. Strength exercises will be primarily based on compound (i.e. multijoint) exercises from a standing position over a repetition range of 8-15 reps using a combination of bodyweight and free weights to provide movement resistance. Progressive balance exercise is introduced to challenge balance by decreasing arm support, decreasing the base of support and then increasing the complexity of movements. Aerobic exercise will be gradually introduced primarily through walking exercise regulated using a modified Borg scale to prescribe a level of perceived exertion, with calibration from performance during baseline cardiopulmonary exercise testing. Alternative modes of exercise will be permitted to align with participant needs and preferences. Participants will be encouraged to progressively increase weekly aerobic exercise volume by 10-15 minutes per week up to 210 minutes of moderate intensity physical activity per week. During the ADAPTATION phase (7-12 weeks), in-person sessions will decrease to fortnightly, replaced by remote sessions in alternate weeks (non-metropolitan patients will continue to receive weekly remote sessions). Home sessions will increase to three times per week, with graded increases in strength exercise (reps and resistance) and aerobic exercise (time & intensity) stimuli at the discretion of the clinical exercise physiologist. During the MAINTENANCE phase (13-26 weeks), patients may opt to receive an in-person or remote session led by a clinical exercise physiologist each fortnight, with home exercise prescribed for a total of five sessions per week with continuation in progression of strength, balance and aerobic exercise. Session intensity at each stage will be progressed over the intervention, each category is . Phase 1 - BASE is planned to start with external prescription as a 3-5/10 RPE for external prescription and 5-7/10 RPE for clinician delivered. Phase 2 - ADAPTION is planned to progressively taper from the BASE intensity to 4-7/10 RPE for external prescription and 7-9/10 RPE for clinician delivered Phase 2 - MAINTENANCE is planned to continue with external prescription at 4-7/10 RPE for external prescription and 7-9/10 RPE for clinician delivered. To monitor and assess adherence participants will be required to maintain a physical activity and exercise diary.