title: A Three Month Home Exercise Programme Augmented with Nordic Poles for Patients with Intermittent Claudication Enhances Quality of Life and Continues to Improve Walking Distance and Compliance After One Year.
abstract: OBJECTIVE
  The objective of this study was to collect 1 year follow-up information on walking distance, speed, compliance, and cost in patients with intermittent claudication who took part in a previously reported 12 week randomised clinical trial of a home exercise programme augmented with Nordic pole walking versus controls who walked normally. A second objective was to look at quality of life and ankle brachial pressure indices (ABPIs) after a 12 week augmented home exercise programme.
  
  
  METHODS
  Thirty-two of the 38 patients who completed the original trial were followed-up after 6 and 12 months. Frequency, duration, speed, and distance of walking were recorded using diaries and pedometers. A new observational cohort of 29 patients was recruited to the same augmented home exercise programme. ABPIs, walking improvement, and quality of life questionnaire were recorded at baseline and 12 weeks (end of the programme).
  
  
  RESULTS
  Both groups in the follow-up study continued to improve their walking distance and speed over the following year. Compliance was excellent: 98% of the augmented group were still walking with poles at both 6 and 12 months, while 74% of the control group were still walking at the same point. The augmented group increased their mean walking distance to 17.5 km by 12 months, with a mean speed of 4.2 km/hour. The control group only increased their mean walking distance from 4.2 km to 5.6 km, and speed to 3.3 km/hour. Repeated ANOVA showed the results to be highly significant (p = .002). The 21/29 patients who completed the observational study showed a statistically significant increase in resting ABPIs from baseline (mean ± SD 0.75 ± 0.12) to week 12 (mean ± SD 0.85 ± 0.12) (t = (20) -8.89, p = .000 [two-tailed]). All their walking improvement and quality of life parameters improved significantly (p = .002 or less in the six categories) over the same period and their mean health scores improved by 79%.
  
  
  CONCLUSIONS
  Following a 12 week augmented home exercise programme, most patients with intermittent claudication continued to significantly improve their walking distance and walking speed at 1 year compared with normal walking. Quality of life and ABPIs improved significantly after only 12 weeks and it is postulated that the improvement in ABPI was due to collateral development. These results justify the belief that an augmented home exercise programme will be as clinically effective as existing supervised exercise programmes, with the added benefits of lower cost and better compliance. Funding for a multicentre trial comparing an augmented home exercise programme with existing supervised exercise programme is now urgently required.
authors.affiliation: Sheffield Nordic Walking Research, STEPS Physiotherapy and Circulation Clinics, 32 Southbourne Road, Sheffield S10 2QN, UK. Electronic address: stepsphysio@btinternet.com.
authors.forename: C
authors.initials: C
authors.lastname: Oakley
authors.affiliation: Sheffield Nordic Walking Research, STEPS Physiotherapy and Circulation Clinics, 32 Southbourne Road, Sheffield S10 2QN, UK.
authors.forename: C
authors.initials: C
authors.lastname: Spafford
authors.affiliation: Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Beard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D006699:Home Care Services; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: Ankle brachial pressure index; Exercise therapy; Home exercise programme; Intermittent claudication; Nordic Poles; Nordic pole walking; Peripheral arterial disease; Quality of life