Home-based walking program an effective treatment for peripheral artery disease

Image: PD

1. Home-based therapy intervention that provides a support structure via a group program increases the distance and speed at which patients with PAD can ambulate.

2. There are very limited medical treatments for peripheral artery disease. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: This study sought to provide evidence for the promotion of home-based walking regimens as treatment for patients with peripheral artery disease, with and without intermittent claudication. Previous studies of walking programs have yielded ambivalent results. The intervention was a weekly group session that included education and motivation for the patients as well as supervised walking sessions. Patients in the experimental group were advised to walk at least 5 times per week and received phone calls at home to check up on their status. The control group also met weekly, but was given minimal input on their walking regimen. After 6 months, patients from the experimental group had significantly greater endurance and speed during a 6-minute walking test. The experimental group also performed better when other scales of endurance and strength were used.

While the intervention yielded positive results, it was a strict regimen that provided patients with many avenues of support and encouragement that may not be available to all patients. This study also did not project potential costs of the demonstrated interventions. According to the authors, there are very few, if any, real medical treatments for peripheral artery disease. Perhaps with additional studies, a home-based walking program will be both effective and attractive for reimbursements, given that treadmill based supervised programs are not generally covered by insurance companies

Click to read the study published today in JAMA

Relevant Reading: Exercise Rehabilitation for the Patient with Intermittent Claudication: A highly Effective yet Underutilized Treatment

In Depth [randomized control trial]: Inclusion criteria were based on ankle-brachial indices of patients that served as a proxy for peripheral artery disease. The experimental group was required to attend weekly group sessions that included both educational and physical training. They were encouraged to walk for at least 50 minutes on 5 separate days per week. The control group met once a week in group sessions where they were given lectures concerning general public health topics. At the end of the 6 month long trial, it was found that patients in the experimental group increased their walking distance by 53.5 (p< .001) meters, increased their total walk time by 1.01 (p=.04) minutes, pain-free treadmill walking time by 1.02 (p=.02) minutes, and physical activity over 7 days by 114.7 (.03) activity units. Patients in the experimental group also had improved Walking Impairment Questionnaire (WIQ) distance scores (11.1 p=.003), stair-climbing scores (7.9, p=.05), and speed scores (10.4, p=.004).

By Ravi Shah and Brittany Hasty

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