Home-based, physical therapist-led behavior change program boosted walking distance in patients with PAD
The randomized trial, which connected patients with intermittent claudication due to peripheral artery disease (PAD) with physical therapists, found an increase in mean six-minute walk distance but no improvement in patient-reported quality of life.
A home-based, walking exercise behavior change intervention among patients with intermittent claudication due to peripheral artery disease (PAD) resulted in an increase in mean six-minute walk distance, a study found.
Researchers studied 190 adults with PAD and intermittent claudication from six hospitals in the United Kingdom between 2018 and 2020. Participants were randomized 1:1 to undergo usual care or receive a walking exercise behavior change intervention delivered by physical therapists trained to use a motivational approach to increase participants' intention and commitment to walking exercise. The primary outcome was six-minute walking distance at three months with a minimal clinically important difference from eight to 20 meters. Results were published April 12 by JAMA.
Of the 190 patients, 148 (78%) completed three months of follow-up. At three months after baseline, the six-minute walking distance changed from 352.9 m to 380.6 m in the intervention group and from 369.8 m to 372.1 m in the usual care group (adjusted mean between-group difference, 16.7 m; 95% CI, 4.2 m to 29.2 m; P=0.009). Of the eight secondary outcomes, five showed no statistically significant differences, including those that measured quality of life.
At six months of follow-up, baseline Walking Estimated Limitation Calculated by History questionnaire scores changed from 18.0 to 27.8 in the intervention group and remained at 20.7 in the usual care group (adjusted mean between-group difference, 7.4 [95% CI, 2.5 to 12.3]; P=0.003), scores on the Brief Illness Perceptions Questionnaire changed from 45.7 to 38.9 in the intervention group and from 44.0 to 45.8 in the usual care group (adjusted mean between-group difference, −6.6 [95% CI, −9.9 to −3.4]; P<0.001), and scores on the attitude component of the Theory of Planned Behavior Questionnaire changed from 14.7 to 15.4 in the intervention group and from 14.6 to 13.9 in the usual care group (adjusted mean between-group difference, 1.4 [95% CI, 0.3 to 2.5]; P=0.02).
The authors noted that the effect size in this study was smaller than in prior effective home-based walking exercise interventions for PAD. Possible reasons could have included social restrictions during the COVID-19 pandemic, insufficient walking intensity by participants, and possible poor training of the physical therapists, which was done by phone.
“Improving quality of life is a key clinical and health priority,” the authors wrote, noting that “improvement in mental health may lag behind improvements in physical function” and that “other comorbidities can also affect quality of life.”
An accompanying editorial noted that a highly effective home-based exercise program has the potential to help millions of people with PAD, including those in rural areas without access to supervised exercise therapy and those unable to travel. “By avoiding the need for an exercise facility or a coach during each exercise session, home-based exercise programs are likely to be less costly than supervised exercise,” the editorial stated. “Given the absence of alternative highly effective noninvasive therapies for PAD, developing home-based exercise into first-line therapy for PAD is an imperative.”