Beyond 'walk walk walk': barriers and facilitators of physical activity in individuals with claudication

Background:
Individuals with claudication have significantly reduced capacity for walking, which leads to worsening prognosis and decline in overall health status. Basic walking advice is usually provided to individuals with claudication during their routine clinic visits, which has very limited efficacy, resulting in little or no change in physical activity behaviour.

Objective:
This study explored barriers and facilitators to physical activity (PA) in individuals with claudication, using the Behaviour Change Wheel (BCW) and the Socioecological Model (SEM) for behavioural diagnosis.

Methods:
The study used a phenomenological design. A purposive sampling was used, and five individuals with claudication and three healthcare professionals participated in the study, out of a target sample size of 18 individuals. An online focus group/workshop was conducted, recorded, and transcribed verbatim. Data were coded in NVivo 12 and analyzed thematically. A deductive approach was used to map themes to BCW and SEM frameworks.

Results:
Intrapersonal barriers included comorbidities, walking-related pain, and psychological challenges; facilitators were motivation and goal setting. At the interpersonal level, lack of social support was a barrier, while peer support and social connection were facilitators. Organizational-level barriers included lack of guidance, limited access to supervised exercise programmes (SEPs), poor communication, financial challenges, and variability in healthcare access; facilitators included alternative exercise options and access to resources and education. Recommended interventions include enablement, environmental restructuring, persuasion, education, training, and modelling.

Conclusions:
Barriers to PA in claudication are complex and multi-level. Addressing them requires system-wide strategies, including patient education, peer-supported and personalized programmes, standardized national guidance, expanded SEP access, and reducing geographic disparities in service provision.