title: Structured Home-Based Exercise Versus Invasive Treatment: A Mission Impossible? A Pilot Randomized Study in Elderly Patients With Intermittent Claudication.
abstract: We compared the effects of an original structured home-based exercise program and revascularization in elderly patients with peripheral arterial disease over a 4-month period. Twenty-seven participants (n = 21; age = 68 ± 7 years) with moderate to severe claudication were randomized into (1) a test in-train out group (Ti-To; n = 18) that performed a home-based walking program prescribed and controlled at the hospital or (2) a revascularization group (Rev; n = 9) that underwent an endovascular and/or surgical procedure. The primary end point was quality of life as evaluated by the physical component summary (PCS) score of the Medical Outcomes Study Short Form 36 questionnaire. Secondary outcome measures included initial claudication distance (ICD) and absolute claudication distance (ACD), 6-minute walk distance (6MWD) and pain-free walk distance (PFWD), ankle-brachial index (ABI), and cost per walking meter gained. The PCS score significantly increased for both treatments at follow-up without a significant intergroup difference, as did ICD, ACD, and PFWD. The 6MWD and ABI significantly improved in the Rev group, and the Ti-To group exhibited a markedly lower cost per meter gained. The comparable effects of the 2 treatments need to be confirmed in a larger, randomized controlled trial.
authors.affiliation: Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lamberti
authors.affiliation: Unit of Translational Surgery, Hospital University of Ferrara, Ferrara, Italy mlgnmr@unife.it.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Malagoni
authors.affiliation: Unit of Vascular and Endovascular Surgery, Hospital University of Ferrara, Ferrara, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ficarra
authors.affiliation: Department of Rehabilitation Medicine, Hospital University, Ferrara, Italy.
authors.forename: Nino
authors.initials: N
authors.lastname: Basaglia
authors.affiliation: Clinica Medica, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredini
authors.affiliation: Unit of Translational Surgery, Hospital University of Ferrara, Ferrara, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Zamboni
authors.affiliation: Unit of Vascular and Endovascular Surgery, Hospital University of Ferrara, Ferrara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mascoli
authors.affiliation: Department of Biomedical Sciences and Surgical Specialties, Section of Sport Sciences, University of Ferrara, Ferrara, Italy Department of Rehabilitation Medicine, Hospital University, Ferrara, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Manfredini
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics; D005081:Exercise Therapy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D017048:Health Care Costs; D018575:Home Care Services, Hospital-Based / Q000191:economics; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D007558:Italy; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics; D000070857:Walk Test; D016138:Walking
keywords: endovascular procedures; exercise; intermittent claudication; peripheral arterial disease; quality of life; vascular surgical procedures