Home-based walking programme improves speed and endurance for patients with peripheral arterial disease

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In a trial that included nearly 200 participants with peripheral arterial disease, a home-based exercise intervention with a group-mediated cognitive behavioural intervention component improved walking performance and physical activity in patients with peripheral arterial disease, according to a study in the July issue of JAMA.

“Few medical therapies improve the functional impairment associated with lower extremity peripheral arterial disease. Supervised treadmill exercise increases maximal treadmill walking distance by 50% to 200% in individuals with peripheral arterial disease. However, supervised exercise is typically not covered by medical insurance and requires regular transportation to the exercise centre. Few patients with peripheral arterial disease participate in supervised treadmill exercise therapy,” according to background information in the article.

“Home-based walking exercise is a promising alternative to supervised exercise. However, several clinical trials of home-based exercise in people with peripheral arterial disease have been small and inconclusive. Recent, larger randomised trials have yielded mixed results. Current clinical practice guidelines state that there is insufficient evidence to recommend home-based walking exercise for people with peripheral arterial disease. Most physicians do not recommend home-based walking exercise,” the authors wrote.

Mary M McDermott, Northwestern University Feinberg School of Medicine, Chicago, USA, and colleagues, conducted a study to determine whether a home-based walking exercise programme that uses a group-mediated cognitive behavioural intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with peripheral arterial disease with and without intermittent claudication. The randomised clinical trial, conducted between July 2008 and December 2012, included 194 patients with peripheral arterial disease (72% without classic symptoms of intermittent claudication). The primary measured outcome was six-month change in six-minute walk performance.

The researchers found that, at six-month follow-up, participants in the intervention group improved their six-minute walking distance compared with the control group by 1,173 to 1,312 feet vs. 1,159 to 1,123 feet for those in the control group, an average difference of 176 feet. Also, participants in the intervention group, compared with the control group, significantly improved their maximal treadmill walking time (7.91 to 9.44 minutes vs. 7.56 to 8.09 minutes), improved their pain-free walking time, increased their physical activity, and improved their Walking Impairment Questionnaire (WIQ) distance score and WIQ speed score.

Participants randomised to the intervention group were about three times more likely to achieve a small meaningful improvement (66 feet) in the six-minute walk and approximately six times more likely to achieve a large meaningful improvement (164 feet).

“Based on these findings, clinical practice guidelines should advise clinicians to recommend home-based walking programmes with a weekly group-mediated cognitive behavioural intervention component for patients with peripheral arterial disease who do not have access to supervised exercise,” the authors wrote. “These findings have implications for the large number of patients with peripheral arterial disease who are unable or unwilling to participate in supervised exercise programmes.”

 

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