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20th April 2022
Use of a behavioural change model programme has been shown to significantly increase the 6-minute walking distance among patients with peripheral artery disease (PAD) compared with usual care according to the results of a randomised trial.
Atherosclerotic lower extremity peripheral artery disease (PAD) is recognised as an important cause of cardiovascular morbidity and mortality, affecting more than 230 million people worldwide. A common symptom of PAD is intermittent claudication which causes pain in the lower limbs when walking and has been shown to severely impact the quality of life of patients. Management of intermittent claudication (IC) involves provision of a supervised exercise programme (SEP); however, a 2016 systematic review identified how only approximately 1 in 3 screened IC patients were suitable for and willing to undertake a SEP.
One important aspect of an intervention to support an exercise programme is full engagement from patients and this is influenced to some extent by their beliefs about and understanding of, the value the intervention. Using a behavioural change model, research has shown that both treatment beliefs and illness perceptions associated with intention, are potential intervention targets. As a result, for the present study, the UK team undertook the Motivating Structured Walking Activity in People With Intermittent Claudication (MOSAIC) trial which was designed to explore whether a home-based, walking exercise behavioural change programme delivered to patients from trained physical therapists, improved walking capacity compared to usual care, in patients with PAD and IC.
Participants were recruited from vascular clinics at several London hospitals and enrolled if they were older than 50 years of age, with PAD and randomised 1:1, to receive the behavioural change intervention or usual care. The behavioural change intervention involved in-person sessions delivered over a 3-month period whereas usual care involved the standard care provided by the patient’s vascular specialists. The primary outcome was the 6-minute walk distance at a 3-month follow-up. There were several secondary outcomes, one of which was the Walking Estimated Limitation Calculated by History (WELCH) questionnaire that ranged from 0 to 100, with higher scores reflecting better performance.
Behavioural change impact on walking distance
A total of 190 participants with a mean age of 67.9 years (70% male), were equally randomised to the behavioural programme or usual care. After 3 months, outcome data were available for 85% of participants.
At 3 months, the 6-minute walking distance increased from 352.9 m to 380.6 m in the intervention group and from 369.8 m to 372.1 m in the usual care group (adjusted between-group difference = 16.7 m, 95% CI 4.2 m to 29.2 m p = 0.009).
The WELCH scores also increased in the behavioural change group (between group difference = 7.4, 95% CI 2.5 – 12.3, p = 0.003) although not all of the secondary outcomes were significantly different.
The authors concluded that their behavioural change intervention was effective and called for future studies to determine the durability of these findings.
Bearne LM et al. Effect of a Home-Based, Walking Exercise Behavior Change Intervention vs Usual Care on Walking in Adults With Peripheral Artery Disease: The MOSAIC Randomized Clinical Trial JAMA 2022