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Original Investigation
July 3, 2013

Home-Based Walking Exercise Intervention in Peripheral Artery Disease: A Randomized Clinical Trial

Author Affiliations
  • 1Northwestern University Feinberg School of Medicine Department of Medicine, Chicago, Illinois
  • 2Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, Illinois
  • 3University of Maryland Department of Epidemiology, Baltimore
  • 4University of California at San Diego
  • 5Stanford University Department of Health Research and Policy, Stanford, California
  • 6National Institute on Aging Division of Intramural Research, Baltimore, Maryland
  • 7Northwestern University Department of Surgery, Chicago, Illinois
  • 8Wake Forest University, Departments of Health and Exercise Science and Geriatric Medicine, Winston-Salem, North Carolina
JAMA. 2013;310(1):57-65. doi:10.1001/jama.2013.7231
Abstract

Importance  Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program.

Objective  To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication.

Design, Setting, and Patients  Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012.

Interventions  Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition.

Main Outcomes and Measures  The primary outcome was 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey.

Results  Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P < .001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004).

Conclusion and Relevance  A home-based walking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs.

Trial Registration  clinicaltrials.gov Identifier: NCT00693940

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