Effect of Behavior-change Interventions on Daily Physical Activity in Patients with Intermittent Claudication: The OPTIMA Systematic Review with Meta-Analysis

Ukachukwu O Abaraogu; Philippa Dall; Chris Seenan; Sarah Rhodes; Trish Gorely; Joanna McParland; Julie Brittenden; Ebuka M Anieto; Lorna Booth; Cathy Gormal; Jeremy Dearling; Candida Fenton; Sarah Audsley; Kimberley Fairer; Lindsay Bearne; Dawn A Skelton

doi:10.1093/eurjpc/zwae296

Effect of Behavior-change Interventions on Daily Physical Activity in Patients with Intermittent Claudication: The OPTIMA Systematic Review with Meta-Analysis

Eur J Prev Cardiol. 2024 Sep 12:zwae296. doi: 10.1093/eurjpc/zwae296. Online ahead of print.

Authors

Ukachukwu O Abaraogu^{1

2

3}, Philippa Dall¹, Chris Seenan¹, Sarah Rhodes⁴, Trish Gorely⁵, Joanna McParland¹, Julie Brittenden⁶, Ebuka M Anieto^{1

7}, Lorna Booth¹, Cathy Gormal⁸, Jeremy Dearling⁸, Candida Fenton⁹, Sarah Audsley¹⁰, Kimberley Fairer^{11

12}, Lindsay Bearne¹³, Dawn A Skelton¹

Affiliations

¹ Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow UK.
² Division of Biological Sciences and Health, School of Health and Life Sciences, University of the West of Scotland, UK.
³ Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Enugu Nigeria.
⁴ Division of Population Health, Health Services Research & Primary Care University of Manchester.
⁵ Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness UK.
⁶ Institute of Cardiovascular Research, University of Glasgow, Glasgow UK.
⁷ School of Allied Health Sciences, University of Suffolk, Ipswich, UK.
⁸ Patient and Public Involvement Representative.
⁹ Nessie Evidence Synthesis, University of Edinburgh, Edinburgh UK.
¹⁰ Sport, Exercise and Rehabilitation, Northumbria University.
¹¹ Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford UK.
¹² Croydon University Hospital, Croydon Health Services NHS Trust, London UK.
¹³ Population Health Research Institute St George's School of Health and Medical Sciences, City St George's, University of London.

PMID: 39268729
DOI: 10.1093/eurjpc/zwae296

Abstract

Aims: The study aimed to synthesize evidence of daily physical activity (PA) following Behavior-change technique (BCT)-based interventions compared to any control in individuals with peripheral arterial disease/intermittent claudication (PAD/IC); and examine the relationship between BCTs and daily PA.

Methods: 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 maintenance of the daily PA (6 months or longer) reported as standardized mean differences (SMDs) with 95% confidence intervals (95%CIs).

Results: Forty-one studies (4,339 patients; 26 RCTs/3,357 patients; 15 non-RCTs/982 patients; study 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-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; 6RCTs, 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.

Conclusion: 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.

Keywords: Behaviour change interventions; Behaviour change techniques; Intermittent claudication; Peripheral arterial disease; physical activity.

Plain language summary

This study evaluated the effect of behavior-change interventions on daily physical activity (PA) in people with intermittent claudication. In individuals with intermittent claudication, behavior-change interventions improve short -term physical activity compared to controls, but additional research is needed to ascertain their sustained benefits at 6-months or longer, as well as their benefit compared to SET.Behavior-change technique (BCT) based interventions may support patients to engage in daily physical activity.