Date of Award


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)

Institution Granting Degree

The Ohio State University

Cedarville University School or Department


First Advisor

Karen Ahijevych


Health and environmental sciences, intervention, peripheral arterial disease, exercise, smoking


Lower extremity peripheral arterial disease (PAD), which results from peripheral atherosclerosis, affects up to 10 million people in the United States alone. Claudication, defined as walking-induced pain in one or both legs relieved by rest, is the primary symptom of lower extremity PAD. Vascular nurses play a critical role in the collaborative care of PAD patients by offering counseling to change unhealthy behaviors, yet patients experience problems in actually overcoming sedentary lifestyle and nicotine addiction--the cornerstones of lifestyle management for PAD. Therefore, the purpose of the current study was to identify factors that promote the adoption and maintenance of exercise and smoking cessation behaviors with PAD patients. A pretest-posttest control group design with a 12-week exercise and smoking cessation intervention was implemented, with outcome measures assessed at baseline, 3 and 6 months post enrollment. The model used for developing this intervention study was the Transtheoretical Model of Behavior Change (TTM), combined with principles of nicotine addiction and exercise determinants. In addition, functional status was measured. The intervention group did have a significant increase (p < .05) from baseline in claudication pain time (CPT) at 3 and 6 months, and in maximal walking time (MWT) at 3 months only. There was a significant difference between groups (p < .05) for exercise stage of change at 3 months, but not at 6 months. In addition, baseline exercise self-efficacy significantly correlated with 3 month exercise stage of change for the usual care group but not for the intervention group. The implication being that a low baseline self-efficacy can be overcome with an intensive nursing intervention. There were no significant changes in either smoking decisional balance or smoking stage of change over time by group. As a result, all smokers data (n = 15) were collapsed and analyzed, with differences and trends discussed, and themes identified. Results from this study support the premise that a nurse-managed, theory based exercise adoption intervention is effective in helping claudicants adopt a routine exercise program. In addition, when combined with a critical health event, this intervention may contribute to claudicants' successful smoking cessation.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.