Our findings expand upon the positive results reported in the GOALS primary outcomes paper  in which the GMCB intervention group achieved a statistically and clinically significant change in the 6-minute walk after 6 months of treatment as compared to a health education control condition. In the current study, the intervention group was found to experience statistically significant improvement in walking self-efficacy, satisfaction with physical function, pain acceptance, and social functioning. It is important to note that change in these outcomes was essentially independent of change in 6-minute walk performance, demonstrating that patients with PAD realize multiple benefits with this type of intervention. Also, as shown in the forest plots, the effects were consistent across a number of potential moderating variables. Change in these outcomes is consistent with the both the content/goals of the group-mediated intervention and is supported by other published work in this area [10, 20].
These results are consistent with a growing body of literature on older adult populations with various chronic health conditions demonstrating that physical activity interventions enhance participants’ confidence in their capacity for performing various mobility-related activities [21, 22]. The physical activity intervention also increased their satisfaction with physical function,  an important outcome expectation for older adults who participate in lifestyle interventions . The positive effects observed for pain acceptance and social functioning in the intervention group are equally noteworthy. It is well known that diseases accompanied by chronic pain in the lower extremities such as osteoarthritis  and peripheral artery disease [4, 12, 24] cause people to restrict their activities of daily living and can lead to social isolation [25–27]. The GOALS intervention provided mastery experiences in which participants were encouraged to be active despite pain and discomfort, to observe the temporary nature of symptoms, and to soften into the localized and general muscular tension that accompanies these symptoms. They were encouraged to reflect on and take pride in their accomplishments. Self-regulatory skills were taught in a group-mediated setting that was nurturing, facilitated bonding between group members, and provided multiple opportunities for guidance.
While objective change in function is the primary medical objective of promoting physical activity for patients with PAD, what is often primary in the minds of older adults who choose to become more physically active are opportunities for social engagement, managing symptoms that accompany chronic disease, and preserving or enhancing their confidence with activities of daily living . Indeed, such outcomes are critical to program adherence and to the promotion of well-being . They may function as important mediators for long-term sustainability of gains resulting from lifestyle-related programs [30, 31] and are vital to patient-centered care, a direction in medicine of rapidly growing importance.