In a surprising twist, counseling sessions that encourage walking may significantly reduce heart risks for those with blocked leg arteries — more than the walking itself. Here’s what the new findings mean for patients with peripheral artery disease (PAD).

In a new study from James Cook University, researchers found that a brief, counseling-based intervention designed to encourage walking could cut major cardiovascular events—such as heart attacks and strokes—nearly in half for people with peripheral artery disease (PAD). PAD, which involves the narrowing of blood vessels in the legs due to plaque buildup, affects over 200 million people worldwide and can drastically increase the risk of heart attacks, strokes, and even death.

The team, led by Professor Jonathan Golledge, devised a simple intervention: four counseling sessions encouraging participants to aim for regular walking. But as they discovered, it wasn’t just the physical act of walking that helped these patients; instead, the counseling itself seemed to play a crucial role in improving mental well-being, which in turn positively impacted physical health outcomes.

Unpacking the Study: How Counseling Was Designed and Delivered

The trial involved 200 patients with PAD across three Australian cities. The patients were divided into two groups: one received counseling designed to encourage walking, and the other served as a control group with no such intervention. Those in the intervention group attended two one-hour in-person sessions and two 15-minute follow-up phone calls with health professionals, focusing on setting manageable walking goals of 40 minutes, three times per week.

“We wanted to find out if four brief counseling sessions could encourage people with blocked leg arteries to walk, and examined this in a 200 patient randomized clinical trial,” said Professor Golledge.

Participants were physically monitored and in addition, were given tools to better understand and manage their anxiety, depression, and other mental challenges often linked to living with PAD. The team measured both physical and psychological responses throughout the study, observing that while physical activity levels did not show a dramatic increase, the quality of life did.

“They were monitored both physically and mentally. The intervention did not significantly improve their daily step count or change
conventional cardiovascular risk factors.”

“The counseling did improve participants’ quality of life and remarkably halved the risk of heart attack, stroke and death. This effect was
associated with a reduction in participants’ anxiety and depression.”

Surprisingly, the improvement in quality of life was found to matter as much as physical exercise.

Essentially, it’s not just about the physical activity that lowers the risk of heart issues — this study underscores the importance of psychological well-being. While previous research on PAD primarily focused on exercise intensity and frequency, this study found that it was likely a shift in patients’ mental attitudes toward their health that made a difference.

“Improving quality of life, rather than simply walking more, may be the critical factor in reducing heart risks,” said Professor Golledge. For individuals facing the relentless symptoms of PAD—pain, limited mobility, and associated emotional challenges—the counseling sessions may have given them tools for acceptance and self-management, ultimately reducing their psychological burden.

Counseling May Lead to a Healthier Heart

From a medical standpoint, it’s unusual to find such a strong link between counseling and physical health outcomes like a heart attack or stroke. The study shows that focusing on mental and emotional wellness can be as impactful as physical health interventions, a promising perspective that could pave the way for a “mind-body” approach in cardiology.

In the study, counseling addressed both the emotional struggles and physical barriers people with PAD face, such as the severe leg pain that often prevents physical activity. “It’s possible this led to more acceptance and reduced psychological distress, which then led to less perceived physical disability and pain,” Golledge explained. The reduced perception of pain and disability may have helped participants feel less constrained by their condition, potentially motivating them to stay active or simply reducing stress, which itself is a major risk factor for cardiovascular disease.

The BIP trial represents a novel approach, showing how mental health interventions may hold promise for reducing heart risks. “If validated, this would be a completely novel approach to reducing cardiovascular risk, which we think is super exciting,” Golledge said. Future studies may seek to expand upon these findings, exploring how a counseling intervention focused on physical and emotional resilience can protect cardiovascular health.

The implications extend beyond PAD patients, offering hope for other chronic cardiovascular conditions where mental health plays an unacknowledged yet pivotal role. It’s an approach that aligns with emerging research indicating that the mental and emotional aspects of physical diseases may often be just as important as treating the physical symptoms themselves. Indeed, quality of life is a key outcome increasingly prioritized by healthcare providers, especially as populations age and chronic conditions become more common.

This Could Change Textbooks

For psychologists, this study highlights the potential of counseling in managing chronic physical illnesses and shows how psychological support can affect health in ways traditionally seen as separate from mental wellness. The results may serve as an important realization for psychologists and allied health professionals.

Everyone, from experienced clinicians to those training to become a psychologist, can learn something useful from this example, recognizing the potential impact of psychological interventions on physical health outcomes . While broader studies are required for validation, the study’s findings emphasize the need for a more integrated, “mind-body” approach to health, wherein mental health interventions become a routine part of disease management.

This insight could help shape psychology curricula, training programs, and the approach of professionals already in practice. Psychologists and psychology students alike may want to explore how they can support patients with chronic conditions like PAD, working closely with medical professionals to deliver interventions that can address the psychological barriers to physical well-being.

Future Directions: Telehealth and Expanding Access to Care

Moving forward, Professor Golledge and his team plan to integrate this counseling model with telehealth, making it more accessible to those who might struggle with in-person sessions. For PAD patients who face limited mobility or travel restrictions, telehealth counseling could provide a valuable lifeline, ensuring that support is available to those most in need.

They also hope to explore whether combining telehealth with virtual exercise guidance could enhance both mental well-being and physical health outcomes. This approach could reach even more patients, especially in remote or underserved areas, offering a comprehensive strategy that combines mental resilience with practical support for physical health.

Journal Reference: Jonathan Golledge et al, Counseling Intervention and Cardiovascular Events in People With Peripheral Artery Disease,
JAMA Surgery (2024). DOI: 10.1001/jamasurg.2024.3083