Home-Based Exercise Program for PAD

Apr 26, 2018
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Authors:
McDermott MM, Spring B, Berger JS, et al.
Citation:
Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease: The HONOR Randomized Clinical Trial. JAMA 2018;319:1665-1676.
Summary By:
Elizabeth A. Jackson, MD, FACC

Study Questions:

Does a home-based exercise program improve walking performance for patients with peripheral artery disease (PAD)?

Methods:

This was a randomized controlled trial conducted at three US medical centers. Patients with PAD were randomized to home-based exercise versus usual care for 9 months. Final follow-up was completed in December 2017. Those participants randomized to exercise received 4 weekly visits to the medical center during the first month followed by 8 months of using a wearable activity monitor and receiving telephone coaching. Those in a comparator arm received usual care. The primary outcome was change in 6-minute walk distance at 9-month follow-up. Secondary outcomes included changes in subcomponents of the Walking Impairment Questionnaire (WIQ), Short Form-36 (SF-36) physical function score, and Patient-Reported Outcomes Measurement Information System (PROMIS) mobility score, PROMIS satisfaction with social roles, and pain interference questionnaire scores.

Results:

A total of 99 participants were randomized to the exercise intervention and 101 to the usual care arm. Among the 200 participants (mean age 70 years, 52.5% women), a total of 182 participants completed the 9-month follow-up. The mean change from baseline to 9-month follow-up in the 6-minute walk distance was 5.5 meters in the intervention group and 14.4 meters in the usual care group. The exercise intervention worsened the PROMIS pain interference score; mean change from baseline to 9 months was 0.7 in the intervention group versus -2.8 in the usual care group. There were no significant between-group differences in the WIQ score, the SF-36 physical functioning score, or the PROMIS mobility or satisfaction with social roles scores.

Conclusions:

The authors concluded that a home-based exercise intervention with a wearable activity monitor and telephone counseling did not improve walking performance as compared to usual care.

Perspective:

Given the barriers for patients to attend supervised rehabilitation programs, finding effective interventions for improving physical activity for all patients with PAD is warranted. Understanding why patients did not improve with this home-based program is warranted as well.

Keywords: Counseling, Exercise, Exercise Therapy, Geriatrics, Pain, Peripheral Arterial Disease, Personal Satisfaction, Secondary Prevention, Telephone, Vascular Diseases, Walking


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