Abstract
Background: People with intermittent claudication (IC) are significantly less active compared to their peers without IC, worsening future health outcomes. Supervised exercise training (SET) is not commonly available, but behaviour change techniques (BCTs) in unsupervised interventions can improve physical activity (PA). Specific BCTs, theoretical mechanisms, and contextual features linked to effectiveness remain unclear.
Objectives: To conduct an integrative synthesis of: effectiveness of BCT-based interventions (BBI) on daily PA and clinical/patient reported outcomes; BCTs and theoretical mechanisms within effective BBI; feasibility and acceptability. Primary outcomes: short-term (<6mths) and maintenance (>6mths) of daily PA. 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 BCT (coded using BCT taxonomy v1, and Theoretical Domains Framework). Systematic review 2: quantitative, qualitative, mixed-methods research on patient/provider experiences. Study quality assessed using Cochrane-RoB-2; ROBINS-I and MMAT.
Results: 53 articles (41 studies) were included in systematic review 1, and 28 articles (28 studies) in systematic review 2. Eleven randomised controlled trials (RCTs) demonstrated that BBI increased daily PA in the short term [increase of 0.20 SMD (95%CI: 0.07 to 0.33), ~473 steps/day] with high certainty. Evidence of maintenance of daily PA is unclear [increase of 0.12 SMD; ~288 steps/day]. BCTs aimed at improving patients' intentions to engage in PA were most effective. Network analysis suggests that BBI improved daily PA and may be better than SET in maintaining daily PA. BBIs were acceptable and had short/medium-term benefits to initial/absolute claudication distance/time, walking impairment scores, and disease-specific quality of life.
Conclusions: BBIs are effective, targeting intention to engage in PA, in improving daily PA and functional outcomes in the short term although evidence is limited for maintenance. There is a need for more RCTs examining daily PA and clinical outcomes, including longer-term follow-up, with detailed descriptions of BCTs, costs, and provider views.
Study registration: The is registered as PROSPERO CRD42020159869
Objectives: To conduct an integrative synthesis of: effectiveness of BCT-based interventions (BBI) on daily PA and clinical/patient reported outcomes; BCTs and theoretical mechanisms within effective BBI; feasibility and acceptability. Primary outcomes: short-term (<6mths) and maintenance (>6mths) of daily PA. 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 BCT (coded using BCT taxonomy v1, and Theoretical Domains Framework). Systematic review 2: quantitative, qualitative, mixed-methods research on patient/provider experiences. Study quality assessed using Cochrane-RoB-2; ROBINS-I and MMAT.
Results: 53 articles (41 studies) were included in systematic review 1, and 28 articles (28 studies) in systematic review 2. Eleven randomised controlled trials (RCTs) demonstrated that BBI increased daily PA in the short term [increase of 0.20 SMD (95%CI: 0.07 to 0.33), ~473 steps/day] with high certainty. Evidence of maintenance of daily PA is unclear [increase of 0.12 SMD; ~288 steps/day]. BCTs aimed at improving patients' intentions to engage in PA were most effective. Network analysis suggests that BBI improved daily PA and may be better than SET in maintaining daily PA. BBIs were acceptable and had short/medium-term benefits to initial/absolute claudication distance/time, walking impairment scores, and disease-specific quality of life.
Conclusions: BBIs are effective, targeting intention to engage in PA, in improving daily PA and functional outcomes in the short term although evidence is limited for maintenance. There is a need for more RCTs examining daily PA and clinical outcomes, including longer-term follow-up, with detailed descriptions of BCTs, costs, and provider views.
Study registration: The is registered as PROSPERO CRD42020159869
| Original language | English |
|---|---|
| Journal | Health Technology Assessment |
| Publication status | Accepted/In press - 29 Oct 2024 |
Keywords
- behaviour change
- exercise
- intermittent claudication
- health behaviour
- physical activity
- maintenance
- meta-analysis
- systematic review
- peripheral arterial disease
