title: Community-based walking exercise for peripheral artery disease: An exploratory pilot study.
abstract: Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease (PAD), but few exercise programs in community settings have been effective. The aim of this study was to determine the efficacy of a community-based walking exercise program with training, monitoring and coaching (TMC) components to improve exercise performance and patient-reported outcomes in PAD patients. This was a randomized, controlled trial including PAD patients (n=25) who previously received peripheral endovascular therapy or presented with stable claudication. Patients randomized to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks. Patients in the control group did not receive treatment beyond standard advice to walk. The primary outcome in the intent-to-treat (ITT) analyses was peak walking time (PWT) on a graded treadmill. Secondary outcomes included claudication onset time (COT) and patient-reported outcomes assessed via the Walking Impairment Questionnaire (WIQ). Intervention group patients (n=10) did not significantly improve PWT when compared with the control group patients (n=10) (mean ± standard error: +2.1 ± 0.7 versus 0.0 ± 0.7 min, p=0.052). Changes in COT and WIQ scores were greater for intervention patients compared with control patients (COT: +1.6 ± 0.8 versus -0.6 ± 0.7 min, p=0.045; WIQ: +18.3 ± 4.2 versus -4.6 ± 4.2%, p=0.001). This pilot using a walking program with TMC and an ITT analysis did not improve the primary outcome in PAD patients. Other walking performance and patient self-reported outcomes were improved following exercise in community settings. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size.
authors.affiliation: School of Physical Therapy and Rehabilitation Science, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, MT, USA The International Heart Institute of Montana Foundation, Saint Patrick Hospital, Providence Medical Group, Missoula, MT, USA Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Ryan.Mays@mso.umt.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Mays
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA CPC Clinical Research, Aurora, CO, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Hiatt
authors.affiliation: Mater Private Heart and Vascular Centre, Dublin, Ireland.
authors.forename: Ivan P
authors.initials: IP
authors.lastname: Casserly
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA CPC Clinical Research, Aurora, CO, USA.
authors.forename: R Kevin
authors.initials: RK
authors.lastname: Rogers
authors.affiliation: Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Main
authors.affiliation: Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Kohrt
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Judith G
authors.initials: JG
authors.lastname: Regensteiner
mesh_terms: D000368:Aged; D003120:Colorado; D003153:Community Health Services; D003376:Counseling; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015397:Program Evaluation; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: activity monitors; claudication; environmental audit; unsupervised exercise