title: Eligibility of patients with peripheral arterial disease for participation in a community-based walking exercise program: a single-centre experience.
abstract: OBJECTIVE
  Eligibility of patients with peripheral arterial disease (PAD) for exercise therapy is the most important requirement for predicting their training group adherence.
  
  
  METHODS
  In this prospective, exploratory study over a period of 1 year, a total of 462 PAD patients of an angiological outpatient routine care setting were consecutively recruited to the study. As non-eligibility criteria for exercise therapy were defined: resting pain or gangrene (Fontaine stage III and IV PAD), the inability to complete treadmill exercise, or premature treadmill discontinuation due to non-vascular walking pain. Also, PAD patients without subjective walking limitation (Fontaine stage I PAD) were assessed as unwilling, i.e. non-eligible for exercise training adherence. Criterion for patients eligibility was the occurrence of intermittent claudication on treadmill test (Fontaine stage II PAD).
  
  
  RESULTS
  A total of 346 patients (age median 71 years, males 58.5%) were candidates for conservative therapy. Of them, 166 subjects (48%) were assessed as eligible for participation in walking exercise program. 180 of the patients (52%) were deemed as non-eligible to perform walking exercise therapy. 115 patients (33%) were physically limited by critical limb ischemia (Fontaine stage III and IV PAD), severe comorbid cardiovascular disease or orthopaedic disorder. In 65 PAD patients (19%) the subjective walking capacity was not restricted. Social, logistical or other factors were found in 27 patients (8%) to be barriers for exercise training commencement.
  
  
  CONCLUSIONS
  In half of the PAD patients whose attendance in a community-based walking exercise program would be a therapeutically reasonable activity, a range of vascular and non-vascular factors are obstacles for participation. Further research is needed to investigate what measures might enhance the proportion of exercise therapy participants.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital, Heidelberg, Germany. uwe.mueller-buehl@med.uni-heidelberg.de
authors.forename: U
authors.initials: U
authors.lastname: Müller-Bühl
authors.forename: P
authors.initials: P
authors.lastname: Engeser
authors.forename: R
authors.initials: R
authors.lastname: Leutgeb
authors.forename: J
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000368:Aged; D003153:Community Health Services; D004608:Eligibility Determination; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D009042:Motivation; D010349:Patient Compliance; D018579:Patient Selection; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D016138:Walking