Is Home-Based Walking an Alternative to Supervised Treadmill Training For PAD?
A significantly greater improvement in six-minute walk distance (6MWD) was seen with home-based walking exercise compared with supervised treadmill exercise in patients with peripheral artery disease (PAD), but not maximum treadmill walking distance, according to a meta-analysis published Sept. 21 in JAMA Network Open.
Thangada, et al., noting that few patients with lower extremity PAD participate in supervised treadmill exercise, although covered by the Centers for Medicare and Medicaid Services, examined data from five randomized clinical trials of exercise therapy for PAD published between 2009 to 2022, using individual participant patient data. Three of the trials, with 370 participants, compared supervised treadmill exercise with nonexercise controls, while two trials, with 349 patients, compared an effective home-based walking intervention with nonexercise control. Participants’ mean age was 68.8 years and 46.5% were women.
The home-based walking exercise comprised walking in or around home for up to five days a week, starting with 15-20 minutes a day and increasing as possible to 50 minutes. Supervised treadmill exercise comprised three sessions a week for up to 50 minutes with an exercise physiologist at an exercise center.
Results showed a significant improvement in the 6MWD with both home-based walking and supervised treadmill exercise (by 50.7 m and 32.9 m, respectively), compared with nonexercise control (p<0.001 for both). When comparing the two exercise programs, researchers found a significantly greater improvement in 6MWD with home-based walking than supervised treadmill exercise, with a between-group difference of 23.8 m (p=0.02), as well as in the Walking Impairment Questionnaire walking speed score. However, there was significantly less improvement in maximum treadmill walking distance, with a between-group difference of –132.5 m (p<0.001).
“These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD,” write the authors. This strategy addresses common barriers to participating in supervised treadmill exercise, including the inconvenience of travel, lack of available exercise facilities and the required co-pay.
Keywords: Walking, Peripheral Arterial Disease, Medicare, Medicaid
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