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Efficacy of Quantified Home-Based Exercise and Supervised Exercise in Patients With Intermittent Claudication: A Randomized Controlled Trial
Study Questions:
Is a home-based exercise program for claudication as effective as a supervised exercise program in improving claudication measures, exercise performance, and daily ambulatory activity?
Methods:
This was a prospective, controlled clinical trial in which 119 patient claudicants were randomized to either home-based exercise (29), supervised exercise (33), or usual-care control (30). All wore step activity monitors during exercise sessions (3 days/week) and both active arms of the study consisted of intermittent walking to near maximal claudication pain for 12 weeks. Primary outcome measures included claudication onset time (COT) and peak walking time (PWT) on treadmill exercise tests. Secondary outcomes were daily ambulatory cadences. Patients in the home-based exercise program were allowed to walk at a self-selected pace. Subsequently, patients in this study arm required an additional 5 minutes of exercise at each stage to equalize total volume of exercise when compared to the supervised group.
Results:
Patient demographics and dropout rates were similar between all three groups. Adherence to the home-based exercise program was similar to that of supervised exercise (p = 0.712) and both exceeded 80%. There were no changes in COT, PWT, or ambulatory cadence in the control group. Both exercise programs increased COT (p < 0.001) and PWT (p < 0.01), but only the home-based program resulted in increased ambulatory cadences (p < 0.01). When both home-based and supervised exercise programs were directly compared, there were no differences in COT or PWT. There was a significant increase in ambulatory cadence in the home-based compared to the supervised exercise group (p < 0.05).
Conclusions:
Home-based exercise is efficacious in improving claudication measures, exercise performance, and daily ambulatory activity in patients with intermittent claudication. Compared to a supervised exercise program, home-based exercise results in increased daily ambulatory cadence, and may result in superior community-based ambulation.
Perspective:
A structured program of supervised ambulation has been repeatedly shown in trials to improve claudication symptoms. In fact, supervised claudicant exercise programs have been associated with results equivalent to stenting in a couple of published trials. Unfortunately, third-party payers have been reluctant to pay for supervised exercise programs for claudicants, as they will for patients requiring cardiac rehabilitation. Further, my personal experience with instructing a claudicant to go forth and exercise is that this approach only occasionally results in success. Thus, it is truly heartening to see that a home-based exercise program for claudicants may result in equivalent, if not greater, benefit to patients as a supervised exercise program.
Keywords: Outcome Assessment, Health Care, Intermittent Claudication, Walking, Exercise, Exercise Therapy, Pain, Exercise Test
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