Home-based Walking Exercise Intervention in Peripheral Artery Disease: a Randomized Clinical Trial

Overview

Journal JAMA

Publisher American Medical Association

Specialty General Medicine

Date 2013 Jul 4

PMID 23821089

Citations 131

Authors

Mary M McDermott

Kiang Liu

Jack M Guralnik

Michael H Criqui

Bonnie Spring

Lu Tian

Kathryn Domanchuk

Luigi Ferrucci

Donald Lloyd-Jones

Melina Kibbe

Huimin Tao

Lihui Zhao

Yihua Liao

W Jack Rejeski

Affiliations

Soon will be listed here.

Abstract

Importance: Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program.

Objective: To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication.

Design, Setting, And Patients: Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012.

Interventions: Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition.

Main Outcomes And Measures: The primary outcome was 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey.

Results: Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P < .001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004).

Conclusion And Relevance: A home-based walking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs.

Trial Registration: clinicaltrials.gov Identifier: NCT00693940.

Citing Articles

A 6-Minute Limb Function Assessment for Therapeutic Testing in Experimental Peripheral Artery Disease Models.

Palzkill V, Tan J, Moparthy D, Tice A, Ferreira L, Ryan T JACC Basic Transl Sci. 2025; 10(1):88-103.

PMID: 39906594 PMC: 11788496. DOI: 10.1016/j.jacbts.2024.08.011.

A Hybrid Rehabilitation Program for Adults with Peripheral Artery Disease (HY-PAD): A Pre-Post Intervention Study to Assess Its Feasibility.

Terada T, Hausen M, Mir H, Reed J, Coutinho T CJC Open. 2025; 7(1):110-119.

PMID: 39872645 PMC: 11763241. DOI: 10.1016/j.cjco.2024.09.017.

Evaluation of Peripheral Circulatory Changes Following Hydrotherapy and Controlled Physical Training in Patients with Atherosclerotic Lower Limb Ischemia.

Kapusta J, Kapusta A, Babicki M, Irzmanski R Life (Basel). 2025; 14(12.

PMID: 39768286 PMC: 11677352. DOI: 10.3390/life14121578.

Brazilian Society of Angiology and Vascular Surgery guidelines on peripheral artery disease.

Erzinger F, Polimanti A, Pinto D, Murta G, Cury M, da Silva R J Vasc Bras. 2024; 23:e20230059.

PMID: 39493832 PMC: 11530000. DOI: 10.1590/1677-5449.202300592.

Addressing Psychosocial Care Needs in Women with Peripheral Artery Disease.

Mubarak E, Cleman J, Romain G, Mena-Hurtado C, Smolderen K Curr Cardiol Rep. 2024; 26(10):1085-1095.

PMID: 39073508 DOI: 10.1007/s11886-024-02106-6.

References

McDermott M, Liu K, Ferrucci L, Tian L, Guralnik J, Liao Y . Decline in functional performance predicts later increased mobility loss and mortality in peripheral arterial disease. J Am Coll Cardiol. 2011; 57(8):962-70. PMC: 3222682. DOI: 10.1016/j.jacc.2010.09.053. View

Richardson M, Leon A, Jacobs Jr D, Ainsworth B, Serfass R . Ability of the Caltrac accelerometer to assess daily physical activity levels. J Cardiopulm Rehabil. 1995; 15(2):107-13. DOI: 10.1097/00008483-199503000-00003. View

McDermott M, Ohlmiller S, Liu K, Guralnik J, Martin G, Pearce W . Gait alterations associated with walking impairment in people with peripheral arterial disease with and without intermittent claudication. J Am Geriatr Soc. 2001; 49(6):747-54. DOI: 10.1046/j.1532-5415.2001.49151.x. View

Fakhry F, van de Luijtgaarden K, Bax L, den Hoed P, Hunink M, Rouwet E . Supervised walking therapy in patients with intermittent claudication. J Vasc Surg. 2012; 56(4):1132-42. DOI: 10.1016/j.jvs.2012.04.046. View

Gardner A, Parker D, Montgomery P, Scott K, Blevins S . Efficacy of quantified home-based exercise and supervised exercise in patients with intermittent claudication: a randomized controlled trial. Circulation. 2011; 123(5):491-8. PMC: 3154843. DOI: 10.1161/CIRCULATIONAHA.110.963066. View

Greig C, Butler F, Skelton D, Mahmud S, Young A . Treadmill walking in old age may not reproduce the real life situation. J Am Geriatr Soc. 1993; 41(1):15-8. DOI: 10.1111/j.1532-5415.1993.tb05941.x. View

McDermott M, Hahn E, Greenland P, Cella D, Ockene J, Brogan D . Atherosclerotic risk factor reduction in peripheral arterial diseasea: results of a national physician survey. J Gen Intern Med. 2002; 17(12):895-904. PMC: 1495143. DOI: 10.1046/j.1525-1497.2002.20307.x. View

Collins T, Lunos S, Carlson T, Henderson K, Lightbourne M, Nelson B . Effects of a home-based walking intervention on mobility and quality of life in people with diabetes and peripheral arterial disease: a randomized controlled trial. Diabetes Care. 2011; 34(10):2174-9. PMC: 3177730. DOI: 10.2337/dc10-2399. View

McDermott M, Ades P, Guralnik J, Dyer A, Ferrucci L, Liu K . Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA. 2009; 301(2):165-74. PMC: 3268032. DOI: 10.1001/jama.2008.962. View

10.

Criqui M, Denenberg J, Bird C, Fronek A, Klauber M, Langer R . The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing. Vasc Med. 1996; 1(1):65-71. DOI: 10.1177/1358863X9600100112. View

11.

McDermott M, Domanchuk K, Liu K, Guralnik J, Tian L, Criqui M . The Group Oriented Arterial Leg Study (GOALS) to improve walking performance in patients with peripheral arterial disease. Contemp Clin Trials. 2012; 33(6):1311-20. PMC: 3502883. DOI: 10.1016/j.cct.2012.08.001. View

12.

Guralnik J, Ferrucci L, Simonsick E, Salive M, Wallace R . Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332(9):556-61. PMC: 9828188. DOI: 10.1056/NEJM199503023320902. View

13.

Rooke T, Hirsch A, Misra S, Sidawy A, Beckman J, Findeiss L . 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice.... J Am Coll Cardiol. 2011; 58(19):2020-45. PMC: 4714326. DOI: 10.1016/j.jacc.2011.08.023. View

14.

Swerts P, Mostert R, Wouters E . Comparison of corridor and treadmill walking in patients with severe chronic obstructive pulmonary disease. Phys Ther. 1990; 70(7):439-42. DOI: 10.1093/ptj/70.7.439. View

15.

Ware Jr J, Kosinski M, Keller S . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34(3):220-33. DOI: 10.1097/00005650-199603000-00003. View

16.

McDermott M, Ades P, Dyer A, Guralnik J, Kibbe M, Criqui M . Corridor-based functional performance measures correlate better with physical activity during daily life than treadmill measures in persons with peripheral arterial disease. J Vasc Surg. 2008; 48(5):1231-7, 1237.e1. PMC: 2885131. DOI: 10.1016/j.jvs.2008.06.050. View

17.

Garg P, Liu K, Tian L, Guralnik J, Ferrucci L, Criqui M . Physical activity during daily life and functional decline in peripheral arterial disease. Circulation. 2009; 119(2):251-60. PMC: 2888033. DOI: 10.1161/CIRCULATIONAHA.108.791491. View

18.

Dormandy J, Rutherford R . Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000; 31(1 Pt 2):S1-S296. View

19.

Hirsch A, Haskal Z, Hertzer N, Bakal C, Creager M, Halperin J . ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for.... Circulation. 2006; 113(11):e463-654. DOI: 10.1161/CIRCULATIONAHA.106.174526. View

20.

Menard J, Smith H, Riebe D, Braun C, Blissmer B, Patterson R . Long-term results of peripheral arterial disease rehabilitation. J Vasc Surg. 2004; 39(6):1186-92. DOI: 10.1016/j.jvs.2004.01.034. View