Abstract
BackgroundWalking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population.AimTo systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC.MethodsA systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework.ResultsEighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention.ConclusionsThis review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418.
Highlights
Intermittent claudication(IC), defined as exertional leg pain which goes away with rest, is a common symptom in patients with peripheral arterial disease (PAD)
This review has identified multidimensional factors influencing walking in patients with intermittent claudication (IC)
Within the social cognitive framework, these factors fall within patient level factors, walking related factors, and environmental factors
Summary
Intermittent claudication(IC), defined as exertional leg pain which goes away with rest, is a common symptom in patients with peripheral arterial disease (PAD). IC in patients with PAD reduces walking capacity, quality of life and is associated with increased cardiovascular risk [1,2]. Walking exercise is the most effective conservative management for reducing leg symptoms[7], and a supervised exercise program (SEP)[5,8,9,10] or a home-based exercise program (HEP) is recommended[11].The rationale for recommending walking exercise in IC includes both the benefit of symptom relief and cardiovascular risk management [10,12,13,14]. Walking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered selfmanagement intervention to promote walking in this population
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