JMIR Publications

ABSTRACT

Background:

Structured community-based exercise programs provide an alternative to supervised exercise therapy for chronic symptomatic peripheral artery disease (PAD). mHealth may facilitate exercise delivery and behavioral support, but its effects on walking function and everyday activity remain uncertain.

Objective:

To evaluate the effects of mHealth-delivered structured community-based exercise programs on functional status, health-related quality of life (HRQoL), and physical activity (PA) in adults with chronic symptomatic PAD, and to characterize exercise prescriptions, mHealth delivery components, and behavior change techniques (BCTs).

Methods:

CINAHL, CENTRAL, MEDLINE, and Embase were searched from inception to September 25, 2026, with citation searching through October 25, 2026. English-language randomized controlled trials evaluating mHealth-delivered structured community-based exercise programs in adults with chronic symptomatic PAD were eligible; passive monitoring-only interventions were excluded. Risk of bias was assessed using RoB 2. Random-effects meta-analyses used restricted maximum likelihood estimation and Hartung–Knapp CIs, with Wald-type CIs for analyses involving only two comparisons. Sensitivity analyses examined alternative mid-intervention assessments from longer trials. GRADE assessed certainty for post-intervention walking outcomes.

Results:

Eight studies involving 2,488 participants were included, of which seven contributed to meta-analysis. At intervention end, Walking Impairment Questionnaire (WIQ) distance favored mHealth-delivered structured community-based exercise programs (g = 0.30, 95% CI 0.21 to 0.38; MD = 9.04 points, 95% CI 4.48 to 13.60), as did WIQ stair climbing (g = 0.17, 95% CI 0.02 to 0.32), and total score (g = 0.29, 95% CI 0.20 to 0.38). WIQ speed, 6-minute walk distance (6MWD) (g = 0.44, 95% CI −0.32 to 1.20), HRQoL, and daily step counts showed no statistically significant post-intervention effects. Limited follow-up evidence favored intervention for WIQ outcomes, HRQoL physical component summary, and step counts (MD = 906.70 steps per day, 95% CI 176.36 to 1637.04). Telephone calls or video conferencing and wearable electronic devices were the most common delivery modes. Seventeen BCTs across nine groupings were identified; ‘Action planning’, ‘Feedback on behavior’, and ‘Instruction on how to perform a behavior’ were identified in all eight studies. Five studies were at low risk of bias across assessed outcomes; three had high-risk judgments for at least one outcome. Certainty was high for WIQ distance but very low for 6MWD.

Conclusions:

mHealth-delivered structured community-based exercise programs may improve patient-reported walking ability, particularly perceived walking distance, while effects on performance-based walking capacity, HRQoL, and habitual PA remain uncertain. Patient-reported walking ability and performance-based walking capacity should be assessed as complementary outcomes, and habitual PA as a distinct therapeutic target. Future interventions should specify exercise intensity and progression and integrate individualized feedback and behavioral support rather than merely use digital devices. Given the limited evidence base and follow-up data, larger trials are needed to determine sustained effects and effective intervention components. Clinical Trial: PROSPERO CRD420251163968; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1163968