Construction and application of an exercise management program for patients with peripheral artery disease based on the Behaviour Change Wheel Theory

doi:10.3761/j.issn.0254-1769.2026.14.007

Abstract

Abstract:

Objective To develop and evaluate an exercise management program for patients with peripheral artery disease（PAD） based on the Behaviour Change Wheel（BCW） theory，and to provide a practical reference for the standardized management of exercise rehabilitation in clinical practice. Methods Guided by the BCW theory，we developed an exercise management program through a process involving evidence synthesis，expert consultation，and pilot testing. Using a convenience sampling method，80 PAD patients（admitted between July 2023 and June 2024） were enrolled. Among them，40 patients admitted from January to June 2024 were assigned to an intervention group，and 40 admitted from July to December 2023 served as a control group. The intervention group received the BCW-based program，employing integrated strategies targeting capability，opportunity，and motivation. The control group received routine exercise advice. Both groups underwent a 12-week intervention. Exercise adherence，the 6-minute walk distance（6MWD），and Vascular Quality of Life（VascuQoL） scores were assessed at baseline and after 12 weeks. Results All 80 patients completed the study. After the 12-week intervention，the exercise adherence rates in the intervention group and the control group were 87.50%（35/40） and 25.00%（10/40），respectively. The 6MWD were（345.53 ± 101.68） m and（286.63 ± 120.75） m，respectively. The VascuQoL were（5.84 ± 0.69） points and（4.64 ± 1.04） points，respectively. All differences between the 2 groups were statistically significant（P<0.05）. Conclusion The exercise management program based on the BCW theory effectively improved exercise adherence，walking capacity，and quality of life in PAD patients，demonstrating its scientific validity and clinical feasibility.

Key words: Peripheral Artery Disease, Behaviour Change Wheel Theory, Exercise Adherence, Walking Ability, Quality of Life, Rehabilitation Nursing

摘要：

目的构建基于行为改变轮（behaviour change wheel，BCW）理论的外周动脉疾病（peripheral artery disease，PAD）患者运动管理方案并评价其应用效果，为临床PAD患者运动康复的规范化管理提供实践参考。方法以BCW理论为指导，通过证据总结、专家会议及预试验构建PAD患者运动管理方案。采用便利抽样法，选取2023年7月—2024年6月在厦门市某三级甲等医院血管外科住院的80例PAD患者为研究对象，其中2024年1—6月入院的40例为试验组，2023年7—12月入院的40例为对照组。试验组实施基于BCW理论的PAD患者运动管理方案，对照组接受常规运动训练，两组均干预12周。分别于干预前、干预12周后测评两组的运动依从性、6 min步行距离（6 minute walk distance，6 MWD）及血管生活质量量表得分并比较差异。结果 80例均完成研究。干预12周后，试验组、对照组的运动依从性分别为87.50%（35/40）、25.00%（10/40），6 MWD分别为（345.53±101.68）（286.63±120.75）m，血管生活质量量表得分分别为（5.84±0.69）（4.64±1.04）分，两组比较，差异均具有统计学意义（P<0.05）。结论基于BCW理论的PAD患者运动管理方案能有效提升PAD患者的运动依从性，改善其步行能力与生活质量。

关键词: 外周动脉疾病, 行为改变轮理论, 运动依从性, 步行能力, 生活质量, 康复护理

YANG Qin, LAI Yuting, ZHAO Yuming, HUANG Yan, LIU Lu, YANG Meiwu, XU Wenxiang, TIAN Xuebing. Construction and application of an exercise management program for patients with peripheral artery disease based on the Behaviour Change Wheel Theory[J]. Chinese Journal of Nursing, 2026, 61(14): 1922-1929.

杨琴, 赖玉婷, 赵玉明, 黄妍, 刘璐, 杨美吴, 许文香, 田雪冰. 基于行为改变轮理论的外周动脉疾病患者运动管理方案的构建与应用研究[J]. 中华护理杂志, 2026, 61(14): 1922-1929.

Figures/Tables 3

References 28

[1]	Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors,1990-2019:update from the GBD 2019 study[J]. J Am Coll Cardiol, 2020, 76(25):2982-3021. DOI URL
[2]	McDermott MM. Medical management of functional impairment in peripheral artery disease:a review[J]. Prog Cardiovasc Dis, 2018, 60(6):586-592. DOI PMID
[3]	Primary P, Abramson BL, Al-Omran M, et al. Canadian Cardiovascular Society 2022 guidelines for peripheral arterial disease[J]. Can J Cardiol, 2022, 38(5):560-587. DOI PMID
[4]	Mazzolai L, Belch J, Venermo M, et al. Exercise therapy for chronic symptomatic peripheral artery disease:a clinical consensus document of the European Society of Cardiology Work-ing Group on aorta and peripheral vascular diseases in col-laboration with the European society of Vascular Medicine and the European Society for Vascular Surgery[J]. Eur J Vasc Endovasc Surg, 2024:S1078- S5884(24)00011-X.
[5]	Thangada ND, Zhang DX, Zhao LH, et al. Safety and efficacy of home-based walking exercise for peripheral artery disease[J]. J Vasc Surg, 2025, 81(2):441-449.e1. DOI URL
[6]	Peñín-Grandes S, López-Ortiz S, Maroto-Izquierdo S, et al. Winners do what they fear:exercise and peripheral arterial disease-an umbrella review[J]. Eur J Prev Cardiol, 2024, 31(4):380-388. DOI URL
[7]	Seed SA, Harwood AE, Sinclair J, et al. A systematic review of exercise prescription in patients with intermittent claudication: does pain matter?[J]. Ann Vasc Surg, 2021, 77:315-323. DOI PMID
[8]	杨琴, 黄妍, 赵玉明, 等. 外周动脉疾病患者运动训练审查指标的制订及障碍因素分析[J]. 中华现代护理杂志, 2024, 30(4):469-474.
	Yang Q, Huang Y, Zhao YM, et al. Review indicators and barriers of exercise training in patients with peripheral arterial disease[J]. Chin J Mod Nurs, 2024, 30(4):469-474.
[9]	Hallak AO, Hallak FZ, Hallak YO, et al. Exercise therapy in the management of peripheral arterial disease[J]. Mayo Clin Proc Innov Qual Outcomes, 2023, 7(5):476-489. DOI PMID
[10]	Kim M, Kim C, Kim E, et al. Effectiveness of mobile health-based exercise interventions for patients with peripheral artery disease:systematic review and meta-analysis[J]. JMIR Mhealth Uhealth, 2021, 9(2):e24080. DOI URL
[11]	谢钰莹, 郭丽娜, 郭园丽, 等. COM-B模型在慢性病患者健康行为中的应用进展及启示[J]. 中国慢性病预防与控制, 2024, 32(11):871-876.
	Xie YY, Guo LN, Guo YL, et al. Application progress and enlightenment of COM-B model in health behavior of patients with chronic diseases[J]. Chin J Prev Control Chronic Dis, 2024, 32(11):871-876.
[12]	Reid H, Smith R, Williamson W, et al. Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare[J]. BMC Public Health, 2022, 22(1):1784. DOI PMID
[13]	卢秋芳, 梁营, 吴国凤, 等. 基于行为改变轮理论的云技术精准饮食干预在维持性血液透析患者中的应用效果[J]. 内科, 2025, 20(1):97-101.
	Lu QF, Liang Y, Wu GF, et al. Application effect of behavior change wheel theory-based precision dietary intervention through cloud technology in maintenance hemodialysis patients[J]. Intern Med, 2025, 20(1):97-101.
[14]	杨琴, 赵玉明, 黄妍, 等. 外周动脉疾病患者运动训练的最佳证据总结[J]. 中华护理杂志, 2022, 57(21):2661-2668.
	Yang Q, Zhao YM, Huang Y, et al. Summary of the best evidence for exercise training in patients with peripheral artery disease[J]. Chin J Nurs, 2022, 57(21):2661-2668.
[15]	廖燕银, 丘永芳, 郑远如. 基于行为改变轮理论的延续性护理对产妇盆底肌功能的影响[J]. 循证护理, 2025, 11(10):2102-2105.
	Liao YY, Qiu YF, Zheng YR. Effect of continuous nursing on pelvic floor muscle function of parturients based on behavior change wheel theory[J]. Chin Evid Based Nurs, 2025, 11(10):2102-2105.
[16]	林洁, 孙志明. SAS、PASS、Stata三种常用软件样本量计算方法及结果差异的比较[J]. 中国医药导报, 2015, 12(18):133-137.
	Lin J, Sun ZM. Comparing the differences between SAS,PASS and Stata for sample size calculation[J]. China Med Her, 2015, 12(18):133-137.
[17]	阎寅至, 闻芳, 王敏, 等. 造血干细胞移植患儿运动康复分级护理方案的构建与应用研究[J]. 中华护理杂志, 2025, 60(9):1036-1042. DOI
	Yan YZ, Wen F, Wang M, et al. Construction and application of a graded nursing program for exercise rehabilitation in children with hematopoietic stem cell transplantation[J]. Chin J Nurs, 2025, 60(9):1036-1042. DOI
[18]	中华医学会心血管病学分会, 中国康复医学会心肺预防与康复专业委员会, 中华心血管病杂志编辑委员会. 六分钟步行试验临床规范应用中国专家共识[J]. 中华心血管病杂志, 2022, 50(5):432-442.
	Cardiovascular Branch of the Chinese Medical Association,Professional Committee of Cardiopulmonary Prevention and Rehabilitation of the Chinese Society of Rehabilitation Medi-cine,Editorial Committee of the Chinese Journal of Cardiova-scular Diseases. The consensus of Chinese experts on the application of clinical norms for the six-minute walking test[J]. Chin J Cardiol, 2022, 50(5):432-442.
[19]	Morgan MBF, Crayford T, Murrin B, et al. Developing the Vascular Quality of Life Questionnaire:a new disease-specific quality of life measure for use in lower limb ischemia[J]. J Vasc Surg, 2001, 33(4):679-687. DOI PMID
[20]	朱经谱, 张婷, 倪其泓, 等. 中文版可视化血管生活质量量表评价我国下肢动脉疾病患者生活质量[J]. 中国介入影像与治疗学, 2023, 20(5):274-277.
	Zhu JP, Zhang T, Ni QH, et al. Chinese version Visual Vascular Quality of Life Questionnaire for evaluating life quality of patients with peripheral artery disease in China[J]. Chin J Interv Imag Ther, 2023, 20(5):274-277.
[21]	刘昌伟. 下肢动脉硬化性闭塞症治疗指南[J]. 中国实用外科杂志, 2008, 28(11):923-924.
	Liu CW. Guidelines for the treatment of arteriosclerosis obliterans of lower limbs[J]. Chin J Pract Surg, 2008, 28(11):923-924.
[22]	李雨威, 李珍燕, 李娇, 等. 基于行为改变轮理论的随访管理在原位回肠新膀胱重建术后患者中的应用效果[J]. 护理管理杂志, 2024, 24(9):743-749.
	Li YW, Li ZY, Li J, et al. The effect of follow-up management based on behavior change wheel theory in patients after orthotopic neobladder[J]. J Nurs Adm, 2024, 24(9):743-749.
[23]	王杉珊, 吴婉英, 梁冠冕, 等. 胃癌患者术后抗阻运动方案的构建与应用研究[J]. 中华护理杂志, 2025, 60(13):1573-1580. DOI
	Wang SS, Wu WY, Liang GM, et al. Construction and application of a postoperative resistance exercise program for gastric cancer patients[J]. Chin J Nurs, 2025, 60(13):1573-1580. DOI
[24]	Dua A, Gologorsky R, Savage D, et al. National assessment of availability,awareness,and utilization of supervised exercise therapy for peripheral artery disease patients with intermittent claudication[J]. J Vasc Surg, 2020, 71(5):1702-1707. DOI URL
[25]	刘念, 尹岩, 李伟, 等. 基于行为改变轮理论的稳定期COPD患者肺康复自我管理[J]. 护理学杂志, 2025, 40(21):73-78.
	Liu N, Yin Y, Li W, et al. Self-management of pulmonary rehabilitation in stable COPD patients based on the Behavioral Change Wheel Theory[J]. J Nurs Sci, 2025, 40(21):73-78.
[26]	Coca-Martinez M, Carli F, Gill HL. Multimodal prehabilitation to improve quality of life and functional capacity in peripheral arterial disease:a case series[J]. Arch Rehabil Res Clin Transl, 2021, 3(3):100139.
[27]	McDermott MM, Spring B, Tian L, et al. Effect of low-intensity vs high-intensity home-based walking exercise on walk distance in patients with peripheral artery disease:the LITE randomized clinical trial[J]. JAMA, 2021, 325(13):1266-1276. DOI PMID
[28]	Kawamura K, Ejiri K, Toda H, et al. Association between home-based exercise using a pedometer and clinical prognosis after endovascular treatment in patients with peripheral artery disease[J]. J Cardiol, 2023, 81(2):222-228. DOI PMID