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Original Investigation
April 24, 2018

Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease: The HONOR Randomized Clinical Trial

Author Affiliations
  • 1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 4Weinberg College of Arts and Sciences, Northwestern University, Evanston, Illinois
  • 5Department of Preventative Cardiology, New York University School of Medicine, New York, New York
  • 6Center for Aging Science and Care Innovation, University of Minnesota School of Nursing, Minneapolis
  • 7Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco
  • 8Department of Vascular Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
  • 9Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego
  • 10Division of Intramural Research, National Institute on Aging, Baltimore, Maryland
  • 11Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
  • 12Department of Epidemiology, University of Maryland, Baltimore
  • 13Department of Surgery, University of Michigan, Ann Arbor
  • 14Department of Surgery, University of North Carolina School of Medicine, Chapel Hill
  • 16Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
  • 17Department of Medicine, University of Chicago Medical School, Chicago, Illinois
  • 18Department of Surgery, University of Chicago Medical School, Chicago, Illinois
  • 19Department of Health Research and Policy, Stanford University, Stanford, California
  • 20Department of Health and Exercise Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
JAMA. 2018;319(16):1665-1676. doi:10.1001/jama.2018.3275
Key Points

Question  Among patients with lower-extremity peripheral artery disease (PAD), does a home-based exercise intervention that consists of a wearable activity monitor and telephone coaching improve walking performance?

Findings  In this randomized clinical trial of 200 participants with PAD, a wearable activity monitor combined with telephone coaching did not significantly improve 6-minute walk distance at 9 months (5.5 m in the intervention group vs 14.4 m in the usual care group).

Meaning  These results do not support home-based exercise interventions of wearable devices combined with telephone coaching to improve walking performance in patients with PAD.

Abstract

Importance  Clinical practice guidelines support home-based exercise for patients with peripheral artery disease (PAD), but no randomized trials have tested whether an exercise intervention without periodic medical center visits improves walking performance.

Objective  To determine whether a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching improves walking ability over 9 months in patients with PAD.

Design, Setting, and Participants  Randomized clinical trial conducted at 3 US medical centers. Patients with PAD were randomized between June 18, 2015, and April 4, 2017, to home-based exercise vs usual care for 9 months. Final follow-up was on December 5, 2017.

Interventions  The exercise intervention group (n = 99) received 4 weekly medical center visits during the first month followed by 8 months of a wearable activity monitor and telephone coaching. The usual care group (n = 101) received no onsite sessions, active exercise, or coaching intervention.

Main Outcomes and Measures  The primary outcome was change in 6-minute walk distance at 9-month follow-up (minimal clinically important difference [MCID], 20 m). Secondary outcomes included 9-month change in subcomponents of the Walking Impairment Questionnaire (WIQ) (0-100 score; 100, best), SF-36 physical functioning score, Patient-Reported Outcomes Measurement Information System (PROMIS) mobility questionnaire (higher = better; MCID, 2 points), PROMIS satisfaction with social roles questionnaire, PROMIS pain interference questionnaire (lower = better; MCID range, 3.5-4.5 points), and objectively measured physical activity.

Results  Among 200 randomized participants (mean [SD] age, 70.2 [10.4] years; 105 [52.5%] women), 182 (91%) completed 9-month follow-up. The mean change from baseline to 9-month follow-up in the 6-minute walk distance was 5.5 m in the intervention group vs 14.4 m in the usual care group (difference, −8.9 m; 95% CI, −26.0 to 8.2 m; P = .31). The exercise intervention worsened the PROMIS pain interference score, mean change from baseline to 9 months was 0.7 in the intervention group vs −2.8 in the usual care group (difference, 3.5; 95% CI, 1.3 to 5.8; P = .002). There were no significant between-group differences in the WIQ score, the SF-36 physical functioning score, or the PROMIS mobility or satisfaction with social roles scores.

Conclusions and Relevance  Among patients with PAD, a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching, compared with usual care, did not improve walking performance at 9-month follow-up. These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD.

Trial Registration  clinicaltrials.gov Identifier: NCT02462824

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