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Home-Based Walking and Supervised Treadmill Exercise in PAD
Quick Takes
- Home-based exercise therapy for PAD is associated with significantly improved 6-minute walking distance compared to control therapy.
- Home-based exercise therapy has greater improvement in 6-minute walking distance than supervised treadmill exercise therapy for patients with PAD.
Study Questions:
Does home-based walking exercise improve 6-minute walk (6MW) more than supervised treadmill exercise in people with peripheral artery disease (PAD)?
Methods:
The authors performed an individual participant-level data meta-analysis from five randomized clinical trials. The included studies were published between 2009–2022. Three of the studies compared supervised treadmill exercise to nonexercised controls and two studies compared home-based walking exercise to nonexercised controls. The primary outcome of interest is the change in 6MW distance at 6 months. Other key outcome measures include maximal treadmill walking distance and the Walking Impairment Questionnaire (WIQ) at 6-month follow-up.
Results:
Among the five randomized clinical trials, 719 participants with PAD (mean age 58.8 years, 46.5% female) were included. Compared to nonexercised controls, supervised treadmill exercise was associated with a significant improvement in 6WM by 32.9 m (95% confidence interval [CI], 20.6-45.6 m). Compared to nonexercised controls, home-based walking exercise was associated with a significant improvement in 6WM by 50.7 m (95% CI, 34.8–66.7 m). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (23.8 m, 95% CI, 3.6–44.0 m) and mean WIQ scores (2.70 vs. 9.67). However, home-based walking exercise is associated with less improvement in maximal treadmill walking distance than supervised treadmill exercise (-132.5 m, 95% CI. -192.9 to -72.1 m).
Conclusions:
The authors concluded that home-based walking exercise was associated with greater improvement in 6MW as compared to supervised treadmill exercise for patients with PAD.
Perspective:
For patients with PAD, claudication symptoms that limit the ability to walk are a significant quality-of-life hinderance. While revascularization can improve claudication symptoms, several studies have shown that supervised treadmill exercise offers additional benefit. However, access to supervised treadmill exercise therapy is limited and requires significant health care resources and patient time investment. Formal home-based walking exercise has recently been shown to have benefit in patients with PAD, notably with better improvement in 6MW distance than supervised treadmill exercise therapy. While a home-based walking exercise program may be more scalable than supervised treadmill exercise, clinicians should recognize that these randomized trials included detailed exercise protocols with a coach or other support mechanisms for participants. Given the overall cardiovascular benefits of increased exercise, health systems should invest in the staff and infrastructure necessary to support and scale up home-based exercise therapy programs for patients with PAD.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Exercise
Keywords: Exercise, Patient Care Team, Peripheral Arterial Disease, Peripheral Vascular Diseases, Physical Therapy Modalities
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