title: Unsupervised exercise and mobility loss in peripheral artery disease: a randomized controlled trial.
abstract: BACKGROUND
  Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease (PAD). Among people with PAD, we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control.
  
  
  RESULTS
  One hundred ninety-four PAD participants were randomized. During months 1 to 6, the intervention group met weekly with other PAD participants and a facilitator. Group support and self-regulatory skills were used to help participants adhere to walking exercise. Ninety-percent of exercise was conducted at or near home. The control group attended weekly lectures. During months 6 to 12, each group received telephone contact only. Primary outcomes have been reported. Here we compare changes in exploratory outcomes of mobility loss (the inability to climb a flight of stairs or walk one-quarter mile without assistance), walking velocity, and the Short Physical Performance Battery. Compared to controls, fewer participants randomized to the intervention experienced mobility loss at 6-month follow-up: 6.3% versus 26.5%, P=0.002, odds ratio=0.19 (95% CI=0.06 to 0.58) and at 12-month follow-up: 5.2% versus 18.5%, P=0.029, odds ratio=0.24 (95% CI=0.06 to 0.97). The intervention improved fast-paced 4-m walking velocity at 6-month follow-up (P=0.005) and the Short Physical Performance Battery at 12-month follow-up (P=0.027), compared to controls.
  
  
  CONCLUSIONS
  In exploratory analyses, a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique identifier: NCT00693940.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.) Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (J.M.G.).
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.affiliation: Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA (M.H.C.).
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.affiliation: National Institute on Aging, Bethesda, MD (L.F.).
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
authors.forename: Bonnie
authors.initials: B
authors.lastname: Spring
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, CA (L.T.).
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.).
authors.forename: Kathryn
authors.initials: K
authors.lastname: Domanchuk
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (M.K.) Jesse Brown Veterans Affairs Medical Center, Chicago, IL (M.K.).
authors.forename: Melina
authors.initials: M
authors.lastname: Kibbe
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
authors.forename: Lihui
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.) Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
authors.forename: Donald
authors.initials: D
authors.lastname: Lloyd Jones
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
authors.forename: Yihua
authors.initials: Y
authors.lastname: Liao
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC (J.R.).
authors.forename: W Jack
authors.initials: WJ
authors.lastname: Rejeski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015444:Exercise / Q000502:physiology* / Q000523:psychology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D058729:Peripheral Arterial Disease / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology / Q000523:psychology
keywords: exercise; mobility; peripheral artery disease; randomized controlled trial