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In many countries, rural residents have lower life expectancies and poorer health outcomes than urban residents. Adults living in rural Australia have lower physical activity levels than major city counterparts, contributing to this observed health disparity. As physical activity interventions in rural populations have shown minimal success, there is an urgent need for innovative and affordable interventions that facilitate active lifestyles in this vulnerable population. This study assessed the feasibility of physical activity-focused motivational interviewing, delivered by university health sciences undergraduates in a rural Australian region. “Health age” was assessed at baseline (n = 62) from physiological and behavioral measures, immediately followed by the motivational interview, with health age again assessed at 8 weeks follow-up. Mixed methods using a questionnaire (n = 41 at both time points) and one-on-one interview (n = 8) identified aspects of intervention acceptability and feasibility. A large majority rated the motivational interview as meaningful (98%), empathetic (96%), autonomy-focused (88%), and likely to lead to sustained behavior change (98%). Interviews highlighted several potential attitudinal and structural factors that might influence long-term behavior change. Further development of this strategy in rural regions will depend on a deeper understanding of individuals’ and communities’ awareness, attitudes, and beliefs in relation to active lifestyles.

Atrial fibrillation (AF) may exacerbate exercise intolerance and haemodynamic limitations in individuals with heart failure (HF). Therefore, we performed a systematic search and meta-analysis to quantify the impact of AF on exercise tolerance (peak oxygen uptake, VO peak; primary outcome) and exercise haemodynamics (secondary outcomes) in patients with HF. PubMed, Scopus, and Web of Science databases were systematically searched for articles from inception to June 2024. Studies were included if they: (i) examined participants with HF; (ii) compared participants with AF to those not in AF (i.e. sinus rhythm); (iii) measured VO peak from expired gas analysis. A fixed effects meta-analysis was performed, with groups compared using the weighted average effect size, represented as the weighted mean difference (WMD) with 95% confidence intervals (95% CI). Of 573 identified studies, 16 met the full inclusion comparing VO peak in HF-patients in AF [HF-AF; = 1,271, 68% male, 67 years, left ventricular ejection fraction (LVEF): 41%], and HF in sinus rhythm (HF-SR; = 4910; 62% male, 62 years, LVEF: 41%). VO peak was significantly lower in HF-AF (WMD: -1.55mL/kg/min, 95%-CI: -1.81 to -1.28, = 6471). This coincided with a slightly lower peak heart rate (WMD: -2.94 b/min, 95%-CI: -4.76 to -1.13 b/min, = 5115), decreased O pulse (WMD: -1.58 mL/beat, 95% CI: -1.90 to -1.26, = 3049), and lower systolic blood pressure (WMD: -11.11 mmHg, 95% CI: -14.01 to -8.21, = 2409). In patients with HF, AF is associated with greater VO peak impairment, potentially due to reduced stroke volume and/or arterio-venous oxygen difference. This highlights the importance of combined strategies to identify and manage AF in individuals with HF.