DIY PAD therapy: Home-based exercise program improves mobility

Peripheral artery disease (PAD) patients may see long-term, improved mobility and endurance with an exercise program that they can do at home. Participants saw a sustained improvement over baseline at 12 months, increasing their six-minute walk distance by about a third of a football playing field.

“A number of studies have shown that supervised exercise interventions have significantly improved walking performance in people with PAD,” Mary M. McDermott, MD, of Northwestern University said in an interview with Cardiovascular Business. “But Medicare doesn’t cover supervised exercises and so it’s very difficult for the patients to come regularly to exercise.”

To overcome those barriers, McDermott and colleagues designed and tested the Group Oriented Arterial Leg Study (GOALS) study. “This program is very important because it’s mainly a home-based exercise program,” she explained.

During the 12-month study, McDermott and her colleagues randomized 194 PAD patients into two groups. The Group Mediated Cognitive Behavioral (GMCB) intervention group received 90-minute weekly training sessions in the six-month phase 1 and were encouraged to walk up to 50 minutes a day five days a week. The control group received educational lectures each week over the same period.

Data were collected on age, height, weight, body mass index, initial physical activity, quality of life, intermittent claudication (IC) and responses to a walking impairment questionnaire. Both groups were tested at baseline, six months and 12 months for distance walked in six minutes utilizing a standard 100-meter corridor.

GMCB participants had increased their six-minute walk distance from 355.4 meters at baseline to 381.9 meters at 12 months. By comparison, the control group’s distance decreased, from 353.1 meters to 345.6 meters. The mean difference was 34.1 meters.

“It shows that the home-based exercise program is effective, so there’s a new opportunity or a new therapy to help patients with PAD to prevent mobility loss and improve their walking,” McDermott said.

Earlier interventions required supervised, one-on-one treadmill visits three times a week. Beyond providing an at-home exercise regimen, the GMCB model provided fewer overall supervised visits in the initial period and created a support group of patients who worked with other patients, sharing experiences and encouragement to develop an exercise habit among a peer group.

“Significantly, when the once-weekly meeting was removed and the patients were being contacted by telephone, as little as once a month for the last three months, they still had maintained the gains of the first six months,” McDermott said, “That’s never been shown before, that even after you take away the main intervention, the patients continued to do well.”

Clinical applications of this study are not yet available, but the potential is encouraging.

“This study was a big step away from supervision. Clinical guidelines recommend three days a week versus the one day a week of this intervention,” McDermott said, “Wouldn’t it be nice to get an intervention that would be fewer onsite visits? The more patients can do this at home on their own, the more scalable it is for daily practice.”

This study was published May 21 in the Journal of the American Heart Association.