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. 2025 May;29(18):1-142.
doi: 10.3310/ZBNG5240.

Behaviour change interventions to promote physical activity in people with intermittent claudication: the OPTIMA systematic review

Ukachukwu O Abaraogu  1   2 , Philippa Dall  2 , Chris Seenan  2 , Sarah Rhodes  3 , Trish Gorely  4 , Joanna McParland  2 , Julie Brittenden  5 , Ebuka M Anieto  2   6 , Lorna Booth  2 , Cathy Gormal  7 , Jeremy Dearling  7 , Candida Fenton  8 , Sarah Audsley  9 , Kimberley Fairer  10   11 , Lindsay Bearne  12 , Dawn A Skelton  2
Affiliations

Behaviour change interventions to promote physical activity in people with intermittent claudication: the OPTIMA systematic review

Ukachukwu O Abaraogu et al. Health Technol Assess. 2025 May.

Abstract

Background: People with intermittent claudication are significantly less active compared to their peers without intermittent claudication, worsening future health outcomes. Supervised exercise therapy is not commonly available, but behaviour change techniques in unsupervised interventions can improve physical activity. Specific behaviour change techniques, theoretical mechanisms and contextual features linked to effectiveness remain unclear.

Objectives: To conduct an integrative synthesis of: effectiveness of behaviour change technique-based interventions on daily physical activity and clinical-/patient-reported outcomes; behaviour change techniques and theoretical mechanisms within effective behaviour change technique-based interventions; feasibility and acceptability. Primary outcomes: short term (< 6 months) and maintenance (> 6 months) of daily physical activity. Secondary outcomes: clinical-/patient-reported outcomes.

Data sources: Seven primary studies databases; Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Health Technology Assessment Database and Trial Registers to 31 August 2023.

Review methods: Systematic review 1: interventions incorporating ≥ 1 behaviour change technique (coded using Behaviour Change Technique Taxonomy version 1, and Theoretical Domains Framework). Systematic review 2: quantitative, qualitative, mixed-methods research on patient/provider experiences. Study quality assessed using revised Cochrane risk-of-bias tool for randomised trials; Risk Of Bias In Non-randomised Studies - of Interventions and Mixed Methods Appraisal Tool.

Results: Fifty-three articles (41 studies) were included in systematic review 1, and 28 articles (28 studies) in systematic review 2. Eleven randomised controlled trials demonstrated that behaviour change technique-based interventions increased daily physical activity in the short term [increase of 0.20 standardised mean difference (95% confidence interval 0.07 to 0.33), ~ 473 steps/day] with high certainty. Evidence of maintenance of daily physical activity is unclear (increase of 0.12 standardised mean difference; ~ 288 steps/day). Behaviour change techniques aimed at improving patients' intentions to engage in physical activity were most effective. Network analysis suggests that behaviour change technique-based interventions improved daily physical activity and may be better than supervised exercise therapy in maintaining daily physical activity. behaviour change technique-based interventions were acceptable and had short-medium-term benefits to initial/absolute claudication distance/time, walking impairment scores and disease-specific quality of life.

Conclusions: The behaviour change technique-based interventions are effective, targeting intention to engage in physical activity, in improving daily physical activity and functional outcomes in the short term, although evidence is limited for maintenance. There is a need for more randomised controlled trials examining daily physical activity and clinical outcomes, including longer-term follow-up, with detailed descriptions of behaviour change techniques, costs and provider views.

Study registration: This study is registered as PROSPERO CRD42020159869.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130664) and is published in full in Health Technology Assessment; Vol. 29, No. 18. See the NIHR Funding and Awards website for further award information.

Keywords: BEHAVIOUR CHANGE; EXERCISE; HEALTH BEHAVIOUR; INTERMITTENT CLAUDICATION; MAINTENANCE; META-ANALYSIS; PERIPHERAL ARTERIAL DISEASE; PHYSICAL ACTIVITY; SYSTEMATIC REVIEW.

Plain language summary

Around 3.2 million people in the United Kingdom have a condition called peripheral arterial disease, where the arteries in the legs become clogged, leading to fatigue, pain or cramps (known as intermittent claudication) when people walk, but going away with rest. Consequently, over time, people walk less and sit more, leading to further health deterioration. Walking for the recommended 30 minutes a day to maintain health can be challenging because of pain, so we need to know if supporting people to change their behaviour in unsupervised walking could help. This project examined studies from other research teams who have looked into a variety of walking programmes, in terms of daily physical activity, how far people could walk without pain, self-reported walking difficulties, quality of life and ankle–brachial pressure index, which takes blood pressure readings from the ankles as an indication of any blockages. Finally, we aimed to understand the feasibility and acceptability of these programmes. Eleven studies were included in the review and programmes which included strategies to support people’s intentions to engage in physical activity showed an increase of around 473 more steps a day in the short term, compared to those that did not include that support. Over time, 6 months after the programmes finished, this dropped to 288 steps/day. These programmes also improved the distance people could walk before pain started or they had to rest, perceived walking difficulties and disease-specific quality of life. There were no changes in ankle–brachial pressure index. While supervised exercise ranks first in terms of short-term daily activity, behaviour-change-focused unsupervised walking programmes were better for medium-term outcomes and are feasible to set up and acceptable to the people taking part. They would be a suitable alternative or choice to supervised walking programmes.

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