Feasibility and acceptability of a remote community exercise and lifestyle change intervention in patients with smaller abdominal aortic aneurysms

This feasibility study aims to determine whether a six-month remote, community-based exercise and lifestyle program, in addition to usual care, can be implemented effectively for both men and women with small AAAs and to collect the key health parameters needed for designing a future definitive trial. For patients with small abdominal aortic aneurysms (AAAs), structured exercise and lifestyle interventions delivered remotely may improve cardiovascular health and slow aneurysm progression. Yet robust data on the feasibility and acceptability of remote intervention remain lacking. AAAs occur in approximately 5–7.5% of men aged 65 and older, with a smaller but more severe risk profile in women; once an AAA surpasses 5.5 cm in diameter, the risk of rupture escalates significantly, resulting in high morbidity and mortality. Although current management strategies focus on routine ultrasound surveillance and general lifestyle advice, many patients struggle to adopt or sustain the recommended behavioural changes that could mitigate cardiovascular risk. In this study, 70 participants with AAAs measuring under 5.5 cm will be randomly assigned (1:1) to an intervention or a control group. The intervention group will engage in twice-weekly exercise sessions (aerobic and resistance training, delivered via video conferencing) and weekly behaviour change counselling (addressing smoking cessation, dietary modifications, alcohol reduction, and mental well-being) over three months, followed by monthly support calls for an additional three months. A quarter of the intervention group (n=8/9) will have a follow-up for an extra six months, totalling 12 months of support. Control participants will receive usual care per standard AAA guidelines. Feasibility outcomes will focus on the ability to recruit and retain participants, adherence to scheduled sessions, and completion rates. For possible primary outcomes, we will collect office blood pressure, cardiovascular risk prediction, wearable device–monitored physical activity, functional capacity, mental wellbeing, quality of life and maximal grip strength. Qualitative methods, including semi-structured interviews with participants and focus groups with healthcare professionals, will identify barriers, facilitators, and practical considerations for wider implementation. A preliminary economic evaluation will examine the intervention delivery costs and set the stage for cost-effectiveness analyses. Data collection will occur at baseline, three months, and six months, with the entire project spanning 36 months from setup and ethical approvals to final analyses and dissemination. If both feasible and acceptable, these findings will inform a larger, fully powered trial assessing long-term clinical outcomes such as AAA growth, cardiovascular health, and cost-effectiveness. By integrating proactive, personalised support into routine AAA surveillance pathways, this research can potentially improve overall patient health outcomes and address health inequalities, particularly in underserved regions. Study findings will be disseminated through peer-reviewed publications, conference presentations, and close collaboration with healthcare stakeholders—including the NHS AAA Screening Programme—to facilitate the integration of evidence-based lifestyle interventions into standard care and potentially extend benefits to other vascular conditions.