Effects of a Home-Based Walking Intervention on Mobility and Quality of Life in People With Diabetes and Peripheral Arterial Disease

Abstract

OBJECTIVEDetermine the efficacy of a home-based walking intervention to improve walking ability and quality of life in people with diabetes and peripheral arterial disease (PAD).RESEARCH DESIGN AND METHODSWe conducted a randomized, controlled, single-blind trial within university-affiliated clinics in our local community. We randomized 145 participants (45 women) with diabetes and PAD to our intervention—a 6-month behavioral intervention targeting levels of readiness to engage in routine walking for exercise—versus attention control. Our primary outcome was 6-month change in maximal treadmill walking distance. Secondary outcomes included 3-month change in maximal walking distance, lower limb function (i.e., walking impairment scores), quality of life (Medical Outcomes Short Form Survey), exercise behaviors, depressive symptoms, and self-efficacy at 3 and 6 months.RESULTSThe mean age of participants was 66.5 (SD 10.1) years. Intervention and control groups did not differ significantly in 6-month change in maximal treadmill walking distance (average [SE] 24.5 [19.6] meters vs. 39.2 [19.6] meters; P = 0.60). Among secondary outcomes, for the intervention and control groups, respectively, average walking speed scores increased by 5.7 [2.2] units and decreased by 1.9 [2.8] units (P = 0.03); the mental health quality of life subscale score increased by 3.2 [1.5] and decreased by 2.4 [1.5] units (P = 0.01).CONCLUSIONSA home-based walking intervention did not improve walking distance but did improve walking speed and quality of life in people with diabetes and PAD. Clinicians should consider recommending home-based walking therapy for such patients.

Arterial Stiffness and Walk Time in Patients with End-Stage Renal Disease

“…Because exercise interventions have been successful in improving ventricular capabilities in coronary artery disease populations [37], individuals in heart failure [5], and ESRD patients, [38,39] further investigation should examine the potential role ventricular and vascular cross-talk may play in mediating both overall cardiovascular morbidity as well as functional improvement in ESRD . Indeed, in other patients whose walking ability is also related to arterial stiffness (patients with peripheral arterial disease), a home-based walking program improved both mobility and quality of life [40], and a 12-week exercise intervention attenuated overall cardiovascular morbidity and mortality [41]. …”

Outcomes for Clinical Studies Assessing Drug and Revascularization Therapies for Claudication and Critical Limb Ischemia in Peripheral Artery Disease

“…7 Since then, trials of medical therapy have used standardized measures of functional performance as primary end points such as walking times or distances measured by standardized treadmill protocols or a 6-minute corridor walk. [18][19][20][21][22][23][24][25][26][27][28][29][30] Studies of patients with critical limb ischemia using revascularization or angiogenesis trials focus on limb loss (amputation) and ulcer healing. [31][32][33] However, most percutaneous revascularization trials [34][35][36][37][38][39][40][41][42] but not all 38,[40][41][42] tend to focus on arterial patency and the need for repeat revascularization procedures.…”

Medical Therapy in Peripheral Artery Disease and Critical Limb Ischemia

“…Routine exercise has been shown to improve endothelial function, skeletal muscle metabolism and gait efficiency, and supervised exercise (SE) programs have been associated with improved exercise tolerance and quality of life in patients with PAD [25,26].…”