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Effects of a Home-Based Walking Intervention on Mobility and Quality of Life in People With Diabetes and Peripheral Arterial Disease: A Randomized, Controlled Trial
Study Questions:
What is the efficacy of a home-based walking intervention to improve walking ability and quality of life in people with diabetes and peripheral arterial disease (PAD)?
Methods:
This was a multisite controlled, single-blind trial in which 145 patients (45 women) with diabetes and PAD were randomized to the intervention (a 6-month behavioral intervention targeting levels of readiness to engage in routine walking for exercise) versus attention control. Primary outcome was 6-month change in maximal treadmill walking distance. Secondary outcomes included 3-month change in maximal walking distance, lower limb function (i.e., walking impairment scores), quality of life (Medical Outcomes Short Form Survey), exercise behaviors, depressive symptoms, and self-efficacy at 3 and 6 months.
Results:
The mean age of participants was 66.5 (standard deviation, 10.1) years. Intervention and control groups did not differ significantly in 6-month change in maximal treadmill walking distance (average [standard error] 24.5 [19.6] m vs. 39.2 [19.6] m; p = 0.60). Among secondary outcomes, for the intervention and control groups, respectively, average walking speed scores increased by 5.7 [2.2] units and decreased by 1.9 [2.8] units (p = 0.03); the mental health quality of life subscale score increased by 3.2 [1.5] and decreased by 2.4 [1.5] units (p = 0.01).
Conclusions:
A home-based walking intervention did not improve walking distance, but did improve walking speed and quality of life in people with diabetes and PAD. Clinicians should consider recommending home-based walking therapy for such patients.
Perspective:
While the results are disappointing, the improvement in walking speed and quality of life are impressive, considering that all the patients were diabetics. The program included counseling for exercise intervention (delivered biweekly), two walking training sessions with an instructor (delivered within 2 weeks of randomization), and individual and group walking in the community. This would be considerably less costly compared to onsite supervised PAD rehabilitation.
Keywords: Self Efficacy, Walking, Cardiovascular Diseases, Peripheral Arterial Disease, Single-Blind Method, Mental Health, Diabetes Mellitus, Peripheral Vascular Diseases, Exercise Test
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