Motivators and Barriers to Walking in Older Adults With Peripheral Artery Disease

Motivational Interviewing, Readiness for Change, Walking, and Functional Ability in Older Adults

Regular exercise in older adults can slow the physical, psychological, and functional decline that is associated with aging. Understanding what may contribute to the initiation and adherence of exercise within the older adult population might help identify interventions that would successfully increase physical activity. The purpose of the current study was to determine if motivational interviewing would increase readiness for change, daily steps, and functional ability among older adult participants. The Senior Fitness Test (SFT) and pedometers were used to assess functional ability and daily steps within two groups of older adults. All participants who completed the 8-week study, on average, demonstrated an increase in daily steps as well as overall fitness. Posttest analyses revealed that the outcome for the intervention group did not exceed the control group, with the exception of the 8-foot up-and-go test, a test within the SFT that measures agility and dynamic balance (p = 0.035). One-on-one, individualized socialization sessions may have contributed to the overall improvement noted in both groups. [Journal of Gerontological Nursing, 48(3), 23-29.].

Relationship Between Psychological Factors and Wound Occurrence in Patients With Peripheral Arterial Disease in the Leg

This prospective study investigated psychological factors affecting wound healing in patients with peripheral arterial disease (PAD). Fifty patients with PAD in a local hospital were enrolled. The Geriatric Depression Scale short version, Type-D scale 14, Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), Functional Independence Measure, Self-efficacy for Managing Chronic Disease Scale, Barriers Self-Efficacy Scale, and Mini Nutritional Assessment were applied to assess physical and psychological factors. Wound occurrence and healing were evaluated at 6 months after discharge, and 34 and 30 patients could be followed, respectively. The patient group with wound occurrence showed poorer mental component score (MCS) and better role/social component score (RCS) category scores of SF-36, and a higher stage in the Fontaine classification, than those without wound occurrence. On comparing Fontaine classification-matched subgroups, patients with wound occurrence showed poorer general health factor and MCS and better RCS of SF-36 than those without wound occurrence. Logistic analysis showed that MCS and RCS predicted wound occurrence and needs for local medical treatment, respectively. Among the psychological factors tested, MCS was a major factor associated with wound occurrence in the present study, with wide variation in clinical conditions and factors associated with PAD. Psychological factors were important as biological, physical, and social factors for patients with PAD during the long-term follow-up period, and an appropriate battery to evaluate psychological factors focused on patients with PAD should be developed.

Barriers and Levels of Physical Activity in Patients With Symptomatic Peripheral Artery Disease: Comparison Between Women and Men

This cross-sectional study compared physical activity levels and barriers between 212 men and women with symptomatic peripheral artery disease. Physical activity was objectively measured by an accelerometer. Barriers to physical activity were obtained using a validated questionnaire. Women reported higher amounts of light physical activity (p < .001) and lower moderate-vigorous physical activity (p < .001) than men. Women more often reported barriers such as "not having anyone to accompany" (p = .006), "lack of money" (p = .018), "fear of falling or worsening the disease" (p = .010), "lack of security" (p = .015), "not having places to sit when feeling leg pain" (p = .021), and "difficulty in getting to a place to practice physical activity" (p = .015). In conclusion, women with symptomatic peripheral artery disease presented with lower amounts of moderate-vigorous activity and more barriers to activity than men. Strategies to minimize the barriers, including group actives and nonpainful exercises, are recommended for women with peripheral artery disease.

Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program

BACKGROUND

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 self-management intervention to promote walking in this population.

AIM

To systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC.

METHODS

A 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.

RESULTS

Eighteen 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.

CONCLUSIONS

This 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.