Community trial of home-based exercise therapy for intermittent claudication

Abstract

Peripheral arterial disease (PAD) is a common disease, and intermittent claudication (IC) is a life-changing symptom. Exercise therapy has been demonstrated to be an effective treatment for IC in a supervised setting; however, most insurance carriers do not reimburse for exercise therapy. As a result, non-supervised programs have largely replaced supervised programs, despite limited evidence of their benefit. In this retrospective study of the results of our routine care, we analyzed the outcomes of a structured 6-month home-based exercise program for IC. A total of 120 patients with PAD and IC were enrolled in a home-based exercise program. Forty-one patients fulfilled program requirements, for a 34.2% completion rate. Those who completed the program demonstrated an 86.4% improvement in their initial claudication distance and a 19.8% improvement in their absolute claudication distance. No patient factors identified those who did not complete the program versus those who completed the program and thus attained the observed benefit. We did observe that 47% of those who did not complete the program dropped-out by not keeping their follow-up appointment. Although patients who completed our program improved from baseline, it was less dramatic than reported in studies of supervised programs. The design of home-based programs should include mechanisms that maximize compliance in returning for follow-up appointments.

Keywords

exercise therapy intermittent claudication peripheral arterial disease

References

1 Ciaccia JM . Benefits of a structured peripheral arterial vascular rehabilitation program. J Vasc Nurs 1993; 11: 1–4.

2 Bendermacher BL Willigendael EM Teijink JA Prins MH . Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev 2006; 2: CD005263.

3 Aquino R Johnnides C Makaroun M . Natural history of claudication: long-term serial follow-up study of 1244 claudicants. J Vasc Surg 2001; 34: 962–970.

4 Falcone RA Hirsch AT Regensteiner JG . Peripheral arterial disease rehabilitation: a review. J Cardiopulm Rehabil 2003; 23: 170–175.

5 Gardner AW Poehlman ET . Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA 1995; 274: 975–980.

6 Degischer S Labs KH Hochstrasser J Aschwanden M Tschoepl M Jaeger KA . Physical training for intermittent claudication: a comparison of structured rehabilitation versus home-based training. Vasc Med 2002; 7: 109–115.

7 Leng GC Fowler B Ernst E . Exercise for intermittent claudication. Cochrane Database Syst Rev 2000; 2: CD000990.

8 Stewart KJ Hiatt WR Regensteiner JG Hirsch AT . Exercise training for claudication. N Engl J Med 2002; 347: 1941–1951.

9 Regensteiner JG Steiner JF Hiatt WR . Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg 1996; 23: 104–115.

10.

10 Gardner AW Katzel LI Sorkin JD Goldberg AP . Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease: a randomized controlled trial. J Cardiopulm Rehabil 2002; 22: 192–198.

11.

11 Menard JR Smith HE Riebe D Braun CM Blissmer B Patterson RB . Long-term results of peripheral arterial disease rehabilitation. J Vasc Surg 2004; 39: 1186–1192.

12.

12 McDermott MM Liu K Ferrucci L . Physical performance in peripheral arterial disease: a slower rate of decline in patients who walk more. Ann Intern Med 2006; 144: 10–20.

13.

13 Savage P Ricci MA Lynn M . Effects of home versus supervised exercise for patients with intermittent claudication. J Cardiopulm Rehabil 2001; 21: 152–157.

14.

14 Regensteiner JG Meyer TJ Krupski WC Cranford LS Hiatt WR . Hospital vs home-based exercise rehabilitation for patients with peripheral arterial occlusive disease. Angiology 1997; 48: 291–300.

15.

15 Patterson RB Pinto B Marcus B Colucci A Braun T Roberts M . Value of a supervised exercise program for the therapy of arterial claudication. J Vasc Surg 1997; 25: 312–318 discussion 318–319.

16.

16 Creager MA Dzau VJ . Vascular diseases of the extremities. In: E Braunwald AS Fauci DL Kasper SL Hauser JL Jameson RM Stone , (eds). Harrison’s principles of internal medicine. 15th edition. New York: McGraw-Hill, 2001, 1434–1442.

17.

17 McPhail IR Spittell PC Weston SA Bailey KR . Intermittent claudication: an objective office-based assessment. J Am Coll Cardiol 2001; 37: 1381–1385.

18.

18 Beebe HG Dawson DL Cutler BS . A new pharmacological treatment for intermittent claudication: results of a randomized, multicenter trial. Arch Intern Med 1999; 159: 2041–2050.

19.

19 Bendermacher BL Willigendael EM Nicolai SP . Supervised exercise therapy for intermittent claudication in a community-based setting is as effective as clinic-based. J Vasc Surg 2007; 45: 1192–1196.