This study aimed to evaluate the effect of behaviour-change interventions on daily physical activity (PA) in people with intermittent claudication.
A systematic search of 11 databases from inception to 30/11/2022 was conducted, plus weekly email alerts of new literature until 31/8/2023. Studies comparing BCT-based interventions with any control were included. Primary analysis involved a pairwise random-effects meta-analysis. Risk of bias was assessed using the Cochrane-RoB-2 and ROBINS-I tools. Certainty of evidence was evaluated with the GRADE system. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. Outcome measures were short-term (6 months) change in daily PA, and 15 maintenance of the daily PA (6 months or longer) reported as standardized mean differences (SMDs) 16 with 95% confidence intervals (95%CIs).>6 months) change in daily PA, and maintenance of the daily PA (6 months or longer) reported as standardized mean differences (SMDs) with 95% confidence intervals (95%CIs).
Forty-one studies (4,339 patients; 26 RCTs/3,357 patients; 15 non-RCTs/982 patients; participants mean age 60.3 to 73.8, 29.5% female) were included. Eleven RCTs (15 comparisons, 952 participants) suggested that BCT-based interventions increased daily PA in the short term compared to non-supervised exercise training (SET) [increase of 0.20 SMD (95%CI: 0.07 to 0.33), ~473 steps/day] with high certainty. Evidence of maintenance of daily PA (≥6 months) is unclear [increase of 0.12 SMD (95%CI: -0.04 to 0.29); ~288 steps/day; 6 RCTs, 8 comparisons, 899 participants], with moderate certainty. For daily PA, compared to SET it was inconclusive both for 6months change [-0.13 SMD, 95%CI: -0.43 to 0.16); 3RCTs, 269 participants; low certainty] and ≥6months [-0.04 SMD, 95%CI: -0.55 to 0.47); 1 RCT, 89 participants; very low certainty]. It was unclear whether the number of BCTs or any BCT domain were independently related to an increase in PA.
BCT-based interventions improve short-term daily PA in people with PAD/IC compared to non-SET controls. Evidence for maintenance of the improved PA at 6 months or longer and comparison with SET is uncertain. BCT-based interventions are effective choices for enhancing daily PA in PAD/IC. Future research should use a comprehensive classification system such as the BCT ontology in describing and reporting of the BCTs implemented in interventions to facilitate the identification and coding of the BCTs and subsequently linking intervention effectiveness to the specific BCTs used.
Clinicians could consider recommending BCT-based interventions to patients with IC as a strategy for improving the PA uptake in the population group.
Intermittent Claudication
Behaviour Change Interventions
