Cardiovascular

Beyond 'Walk Walk Walk': Barriers and facilitators of physical activity in individuals with claudication.

TL;DR

Barriers to physical activity in individuals with claudication are complex and multi-level, requiring system-wide strategies including patient education, peer-supported and personalized programmes, standardized national guidance, expanded supervised exercise programme access, and reducing geographic disparities in service provision.

Key Findings

Intrapersonal barriers to physical activity in claudication included comorbidities, walking-related pain, and psychological challenges.

  • Study used a phenomenological design with purposive sampling.
  • Five individuals with claudication and three healthcare professionals participated, out of a target sample size of 18.
  • Data were coded in NVivo 12 and analyzed thematically using a deductive approach mapped to the Behaviour Change Wheel (BCW) and Socioecological Model (SEM).
  • Walking-related pain was identified as a core intrapersonal barrier specific to the claudication experience.

Intrapersonal facilitators of physical activity in claudication included motivation and goal setting.

  • Motivation and goal setting were identified through thematic analysis mapped to the BCW and SEM frameworks.
  • These facilitators were identified at the intrapersonal level of the Socioecological Model.
  • Data were derived from an online focus group/workshop that was recorded and transcribed verbatim.

Lack of social support was identified as an interpersonal-level barrier, while peer support and social connection were interpersonal facilitators.

  • Interpersonal factors were identified as a distinct level within the Socioecological Model framework.
  • Peer support and social connection were highlighted as positive facilitators at the interpersonal level.
  • Both patients and healthcare professionals contributed perspectives on interpersonal dynamics through the online focus group/workshop.

Organizational-level barriers to physical activity included lack of guidance, limited access to supervised exercise programmes (SEPs), poor communication, financial challenges, and variability in healthcare access.

  • Five distinct organizational-level barriers were identified through thematic analysis.
  • Limited access to supervised exercise programmes (SEPs) was a specifically named organizational barrier.
  • Geographic disparities in service provision were identified as contributing to variability in healthcare access.
  • Financial challenges were identified as an organizational-level barrier to participation in physical activity.

Organizational-level facilitators of physical activity included alternative exercise options and access to resources and education.

  • Alternative exercise options were identified as a facilitator at the organizational level, suggesting that non-walking forms of exercise may be important.
  • Access to resources and education was identified as an organizational facilitator.
  • These facilitators were mapped to the BCW and SEM frameworks using a deductive analytical approach.

Recommended behaviour change interventions for claudication physical activity included enablement, environmental restructuring, persuasion, education, training, and modelling.

  • Six intervention types were identified through mapping findings to the Behaviour Change Wheel (BCW).
  • Recommendations were derived from a deductive analysis linking identified barriers and facilitators to BCW intervention functions.
  • These intervention recommendations addressed barriers and facilitators identified across intrapersonal, interpersonal, and organizational levels.

Basic walking advice provided to individuals with claudication during routine clinic visits has very limited efficacy, resulting in little or no change in physical activity behaviour.

  • This finding provided the rationale for exploring multi-level barriers and facilitators.
  • The study title 'Beyond Walk Walk Walk' directly references the inadequacy of simple walking advice.
  • Individuals with claudication have significantly reduced capacity for walking, which leads to worsening prognosis and decline in overall health status.

The study achieved a smaller sample than targeted, with only 8 of the 18 target participants recruited.

  • Five individuals with claudication and three healthcare professionals participated.
  • The target sample size was 18 individuals.
  • Purposive sampling was used for participant recruitment.
  • Data collection was conducted via an online focus group/workshop format.

What This Means

This research suggests that people with claudication — a condition causing leg pain during walking due to poor blood circulation — face a wide range of obstacles to being physically active, and that simply telling them to 'walk more' during clinic appointments does very little to help. The study used in-depth focus group discussions with both patients and healthcare professionals to uncover these obstacles, organizing them into personal, social, and system-level categories. Personal barriers included pain during walking, other health conditions, and psychological difficulties, while social barriers included a lack of support from family or others. At the healthcare system level, barriers included poor access to supervised exercise programmes, financial costs, lack of clear guidance, and inconsistency in services depending on where someone lives. The study also identified what helps people become more active. On a personal level, having clear goals and motivation made a difference. Socially, connecting with peers who have similar experiences was beneficial. At the system level, having access to educational resources and alternative forms of exercise beyond walking were seen as helpful. Based on these findings, the researchers recommended specific types of behaviour change interventions, such as providing better education, restructuring environments to make activity easier, and using role models or peer-supported programmes. This research suggests that improving physical activity levels in people with claudication requires coordinated action at multiple levels simultaneously — it is not enough to address only one barrier in isolation. Practical implications include the need for standardized national guidance for healthcare providers, expanded access to supervised exercise programmes, and efforts to reduce geographical inequalities in care, so that where a person lives does not determine the quality of support they receive.

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Citation

Anieto E, Dall P, Abaraogu U, Anieto I, Ramsay C, Gormal C, et al.. (2026). Beyond 'Walk Walk Walk': Barriers and facilitators of physical activity in individuals with claudication.. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. https://doi.org/10.1016/j.jvn.2026.02.005