Unsupervised walking regimen may improve fitness in patients with PAD

A home-based walking exercise program significantly improved walking endurance, physical activity, and speed in patients with peripheral artery disease (PAD), according to a recent trial.

To determine whether a home-based walking exercise program could improve functional performance in patients with PAD with and without intermittent claudication, researchers in Chicago studied 194 patients, including 72.2% without classic symptoms of intermittent claudication, from July 2008 to December 2012. Participants were randomized into two groups to assess their six-month change in six-minute walk performance, the primary outcome measure. The control group attended weekly 60-minute group sessions in which health care professionals provided lectures on managing hypertension, cancer screening and vaccinations. The intervention group added a home-based, group-mediated cognitive behavioral walking routine.

Secondary outcomes included change in treadmill walking, accelerometer-measured physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey. Results appeared in the July 3 Journal of the American Medical Association.

Participants in the intervention group significantly increased their six-minute walk distance from 357.4 m before the intervention to 399.8 m after, compared to 353.3 m and 342.2 m for those in the control group (mean difference between groups, 53.5 m [95% CI, 33.2 m to 73.8 m]; P<0.001). Maximum treadmill walking time in the intervention group increased from 7.91 min to 9.44 min compared to the control group's improvement from 7.56 min to 8.09 min (mean difference, 1.01 min [95% CI, 0.07 min to 1.950 min]; P=0.04). Accelerometer-measured physical activity over seven days (in activity units) in the intervention group improved from 778.0 to 866.1 compared to the control group's 671.6 to 645.0 (mean difference, 114.7 [95% CI, 12.82 to 216.5]; P=0.03).

The WIQ distance score in the intervention group went from 35.3 to 47.4 compared to the control group's 33.3 to 34.4 (mean difference, 11.1 [95% CI, 3.9 m to 18.1]; P=0.003), and the WIQ speed score in the intervention group went from 36.1 to 47.7 compared to the control group's 35.3 to 36.6 (mean difference, 10.4 [95% CI, 3.4 to 17.4]; P=0.004).

The researchers noted that these findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs. “Supervised treadmill exercise is associated with a 50% to 200% improvement in maximal treadmill walking performance in PAD,” the authors wrote. “However, most patients with PAD do not participate in supervised exercise. Medical insurance typically does not pay for supervised exercise for patients with PAD and traveling to exercise sessions is burdensome. Home-based exercise could provide a feasible therapeutic option that is accessible to most patients with PAD.”