Home-based walking exercise intervention in peripheral artery disease: A randomized clinical trial

Mary M. McDermott, Kiang Liu, Jack M. Guralnik, Michael H. Criqui, Bonnie Spring, Lu Tian, Kathryn Domanchuk, Luigi Ferrucci, Donald Lloyd-Jones, Melina Kibbe, Huimin Tao, Lihui Zhao, Yihua Liao, W. Jack Rejeski

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program. OBJECTIVE: To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication. DESIGN, SETTING, AND PATIENTS: Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012. INTERVENTIONS: Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition. MAIN OUTCOMES AND MEASURES: The primary outcomewas 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey. RESULTS: Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P <.001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004). CONCLUSION AND RELEVANCE: A home-basedwalking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00693940.

Original languageEnglish (US)
Pages (from-to)57-65
Number of pages9
JournalJournal of the American Medical Association
Volume310
Issue number1
DOIs
StatePublished - 2013
Externally publishedYes

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Peripheral Arterial Disease
Walking
Randomized Controlled Trials
Exercise
Intermittent Claudication
Group Homes
Control Groups
Health Surveys
Health Education
Practice Guidelines
Mental Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

McDermott, M. M., Liu, K., Guralnik, J. M., Criqui, M. H., Spring, B., Tian, L., ... Rejeski, W. J. (2013). Home-based walking exercise intervention in peripheral artery disease: A randomized clinical trial. Journal of the American Medical Association, 310(1), 57-65. https://doi.org/10.1001/jama.2013.7231

Home-based walking exercise intervention in peripheral artery disease : A randomized clinical trial. / McDermott, Mary M.; Liu, Kiang; Guralnik, Jack M.; Criqui, Michael H.; Spring, Bonnie; Tian, Lu; Domanchuk, Kathryn; Ferrucci, Luigi; Lloyd-Jones, Donald; Kibbe, Melina; Tao, Huimin; Zhao, Lihui; Liao, Yihua; Rejeski, W. Jack.

In: Journal of the American Medical Association, Vol. 310, No. 1, 2013, p. 57-65.

Research output: Contribution to journalArticle

McDermott, MM, Liu, K, Guralnik, JM, Criqui, MH, Spring, B, Tian, L, Domanchuk, K, Ferrucci, L, Lloyd-Jones, D, Kibbe, M, Tao, H, Zhao, L, Liao, Y & Rejeski, WJ 2013, 'Home-based walking exercise intervention in peripheral artery disease: A randomized clinical trial', Journal of the American Medical Association, vol. 310, no. 1, pp. 57-65. https://doi.org/10.1001/jama.2013.7231
McDermott, Mary M. ; Liu, Kiang ; Guralnik, Jack M. ; Criqui, Michael H. ; Spring, Bonnie ; Tian, Lu ; Domanchuk, Kathryn ; Ferrucci, Luigi ; Lloyd-Jones, Donald ; Kibbe, Melina ; Tao, Huimin ; Zhao, Lihui ; Liao, Yihua ; Rejeski, W. Jack. / Home-based walking exercise intervention in peripheral artery disease : A randomized clinical trial. In: Journal of the American Medical Association. 2013 ; Vol. 310, No. 1. pp. 57-65.
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AU - McDermott, Mary M.

AU - Liu, Kiang

AU - Guralnik, Jack M.

AU - Criqui, Michael H.

AU - Spring, Bonnie

AU - Tian, Lu

AU - Domanchuk, Kathryn

AU - Ferrucci, Luigi

AU - Lloyd-Jones, Donald

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AU - Tao, Huimin

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AU - Liao, Yihua

AU - Rejeski, W. Jack

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N2 - IMPORTANCE: Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program. OBJECTIVE: To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication. DESIGN, SETTING, AND PATIENTS: Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012. INTERVENTIONS: Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition. MAIN OUTCOMES AND MEASURES: The primary outcomewas 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey. RESULTS: Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P <.001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004). CONCLUSION AND RELEVANCE: A home-basedwalking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00693940.

AB - IMPORTANCE: Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program. OBJECTIVE: To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication. DESIGN, SETTING, AND PATIENTS: Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012. INTERVENTIONS: Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition. MAIN OUTCOMES AND MEASURES: The primary outcomewas 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey. RESULTS: Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P <.001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004). CONCLUSION AND RELEVANCE: A home-basedwalking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00693940.

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