A home-based walking exercise program that included a cognitive behavioral intervention component for patients with peripheral artery disease (PAD), with or without intermittent claudication, improved walking performance and physical activity, according to a randomized, controlled clinical trial published July 2 in the Journal of the American Medical Association.

The Group Oriented Arterial Leg Study (GOALS) randomized 194 patients with PAD to either a home-based group-mediated cognitive behavioral walking intervention that included both group support and self-regulatory skills, or to a health-education control group. Participants in the home-based group-mediated behavioral intervention program met once a week for 90 minutes with other PAD patients for six months in groups led by a trained facilitator. They spent 45 minutes in discussions designed to motivate participants to adhere to home-based walking exercise, followed by 45 minutes of walking on an indoor track. The control group attended group sessions with other PAD patients for 60 minutes every week for six months to listen to lectures on how to manage hypertension, and other topics. The study included 72.2 percent of patients who did not have classic symptoms of intermittent claudication and 27.8 percent who did.

At six months of follow-up, the home-based exercise and cognitive behavioral intervention group of patients significantly expanded their six-minute walking performance by 53.5 meters compared with 11.1 meters in the control group of patients (p < 0.001).

The participants in the intervention group also improved maximal treadmill walking time by 1.01 minutes over controls (p = 0.04), pain-free walking time by 1.02 minutes over controls (p = 0.02), physical activity as measured by accelerometer over seven days by 114.7 activity units over controls, a Walking Impairment Questionnaire (WIQ) distance score by 11.1 points over controls (p = 0.04) and a WIQ speed score by 10.4 points over controls (p = 0.004).

"Based on these findings, clinical practice guidelines should advise clinicians to recommend home-based walking programs with a weekly group-mediated cognitive behavioral intervention component for patients with PAD who do not have access to supervised exercise," the authors concluded.

Keywords: Intermittent Claudication, Cognition, Follow-Up Studies, Exercise Therapy, Peripheral Arterial Disease, Pain, Surveys and Questionnaires, Hypertension