Structured Home-Based Exercise Versus Invasive Treatment

Abstract

We compared the effects of an original structured home-based exercise program and revascularization in elderly patients with peripheral arterial disease over a 4-month period. Twenty-seven participants (n = 21; age = 68 ± 7 years) with moderate to severe claudication were randomized into (1) a test in-train out group (Ti-To; n = 18) that performed a home-based walking program prescribed and controlled at the hospital or (2) a revascularization group (Rev; n = 9) that underwent an endovascular and/or surgical procedure. The primary end point was quality of life as evaluated by the physical component summary (PCS) score of the Medical Outcomes Study Short Form 36 questionnaire. Secondary outcome measures included initial claudication distance (ICD) and absolute claudication distance (ACD), 6-minute walk distance (6MWD) and pain-free walk distance (PFWD), ankle-brachial index (ABI), and cost per walking meter gained. The PCS score significantly increased for both treatments at follow-up without a significant intergroup difference, as did ICD, ACD, and PFWD. The 6MWD and ABI significantly improved in the Rev group, and the Ti-To group exhibited a markedly lower cost per meter gained. The comparable effects of the 2 treatments need to be confirmed in a larger, randomized controlled trial.

Don’t stop walking: an in-home rehabilitation program for peripheral artery disease patients during the COVID-19 pandemic.

“…Interestingly, the hemodynamic parameters also showed a similar pattern (slightly improved or stable), con rming previous observations [6,25,30].…”

“…The characteristics of the program may also explain the outcomes. Unlike home-based programs where patients are generally advised to walk at a self-selected pace or to maximal ischemic leg pain [8,30,31], this program is performed at a lower speed for short bouts in the absence of ischemic pain [5,6,25]. These facts facilitate execution in limited spaces and favor adherence.…”

“…The exercise program ends when the patients reach a pain-free walking distance that is normal for their sex and age or when a stable satisfactory performance is attained. Additional details on the exercise program are reported elsewhere [5,25].…”

“…A team member called all the patients enrolled to check their health status and to update the exercise program. The scheduled training program progression [5,25], was con rmed if the patients reported regular program execution in the absence of general or peripheral symptoms. Otherwise, the progression was delayed in the presence of incomplete execution or limiting symptoms, with the patients being advised to repeat part of the previous program in the following weeks.…”

“…The cutoff was arbitrarily chosen considering an ideal duration of the program of 6 to 9 months[5] and a timeframe possibly associated with physiological adaptations to the program[25,27]. Pre versus Post comparisons of all outcomes were performed by paired samples t tests or Wilcoxon rank tests according to the data distribution.…”