Efficacy of Quantified Home-Based Exercise and Supervised Exercise in Patients With Intermittent Claudication: A Randomized Controlled Trial

• Published in: Circulation (New York, N.Y.) Vol. 123; no. 5; pp. 491 - 498
• Main Authors: GARDNER, Andrew W, PARKER, Donald E, MONTGOMERY, Polly S, SCOTT, Kristy J, BLEVINS, Steve M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 08-02-2011
• Subjects: Aged; Ambulatory Care; Basic instruction program; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Exercise Therapy - methods; Female; Home Care Services; Humans; Intermittent Claudication - rehabilitation; Male; Medical sciences; Middle Aged; Pain; Patient Compliance; Peripheral Arterial Disease; Pharmacology. Drug treatments; Treatment Outcome; Vasodilator agents. Cerebral vasodilators; Walking; Physical exercise; Human; Claudication; peripheral artery disease; Intermittent; exercise physiology; Cardiovascular disease
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.110.963066

This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent claudication after a home-based exercise program, a supervised exercise program, and usual-care control.
Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased claudication onset time (P<0.001) and peak walking time (P<0.01), whereas only home-based exercise increased daily average cadence (P<0.01). No changes were seen in the control group (P>0.05). The changes in claudication onset time and peak walking time were similar between the 2 exercise groups (P>0.05), whereas the change in daily average cadence was greater with home-based exercise (P<0.05).
A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise.