title: Supervised exercise therapy in the management of peripheral arterial disease - an assessment of compliance.
abstract: BACKGROUND
  Supervised exercise therapy (SET) is an effective option in the management of peripheral arterial disease (PAD). Unfortunately, poor compliance remains prevalent. This study aimed to assess patient exercise compliance and to identify factors influencing symptomatic improvement and SET participation.
  
  
  METHODS
  Data regarding attendance at SET for this cohort study were extracted from a prospectively maintained database of patients with claudication attending SET at Dublin City University. All patients had ankle brachial index confirmed PAD with associated intermittent claudication. Exercise performance and symptomatic data were gathered retrospectively using patient charts and interviews.
  
  
  RESULTS
  Ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (± 10.1) with 18 % being female. Median follow-up was 25.1 months (IQ range 17.0-31.6). Overall, the mean number of sessions attended per patient was 19.5. Exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Furthermore, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolaemia (p = 0.020) or ischaemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) was identified as a predictor of compliance to SET.
  
  
  CONCLUSIONS
  Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and personalised exercise prescriptions may result in improvements in function and compliance.
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Aherne
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Elrasheid A H
authors.initials: EAH
authors.lastname: Kheirelseid
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Boland
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Shane
authors.initials: S
authors.lastname: Carr
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Thekra
authors.initials: T
authors.lastname: Al-Zabi
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Khalid
authors.initials: K
authors.lastname: Bashar
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Daragh
authors.initials: D
authors.lastname: Moneley
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Austin
authors.initials: A
authors.lastname: Leahy
authors.affiliation: 2 Department of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland.
authors.forename: Noel
authors.initials: N
authors.lastname: McCaffrey
authors.affiliation: 1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: Naughton
mesh_terms: D000368:Aged; D003153:Community Health Services; D015897:Comorbidity; D016208:Databases, Factual; D004522:Educational Status; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D007494:Ireland / Q000453:epidemiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome
keywords: Peripheral arterial disease; claudication; compliance; supervised exercise therapy