At-Home Exercise vs Usual Care for Improving Walking Performance in PAD

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The 2 patient groups did not differ in terms of the Walking Impairment Questionnaire, Short Form 36 physical functioning, or PROMIS mobility scores.
The 2 patient groups did not differ in terms of the Walking Impairment Questionnaire, Short Form 36 physical functioning, or PROMIS mobility scores.

Compared with usual care, an at-home exercise intervention using a wearable activity monitor (eg, FitBit) and telephone coaching did not improve walking performance in patients with peripheral artery disease (PAD), as reported in a study published in the Journal of the American Medical Association.

In the HONOR clinical trial (Home-Based Monitored Exercise for PAD; ClinicalTrials.gov Identifier: NCT02462824), investigators randomly assigned patients with PAD to undergo either an at-home exercise intervention (n=99) or usual care (n=101). Patients in the home-based exercise intervention group underwent 4 weekly medical center visits for the first month following enrollment and were then instructed to exercise at home using a wearable activity monitor and receive telephone coaching for 8 months.

Individuals in the usual care group underwent no intervention; however, they did participate in monthly telephone interviews to obtain data on adverse effects. In addition, patients randomly assigned to usual care participated in a telephone interview every 3 months to obtain data on the frequency of walking exercise. Change in 6-minute walking distance at 9-month follow-up was designated as the primary outcome in the total study population.

Of the 182 participants who remained in the study until completion, the mean change from baseline in the 6-minute walk distance at 9-month follow-up was 5.5 meters and 14.4 meters in the home-based exercise intervention and usual care group, respectively (difference, −8.9 meters; 95% CI, −26.0 to 8.2 meters; P =.31). According to the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference questionnaire, pain interference worsened in participants randomly assigned to the exercise intervention vs those who received usual care (mean change from baseline to follow-up, 0.7 vs −2.8, respectively; difference, 3.5; 95% CI, 1.3-5.8; P =.002).

The 2 groups did not differ in terms of the Walking Impairment Questionnaire score (between-group difference for mean change from baseline to follow-up, 5.8; 95% CI, −3.0 to 14.7; P =.20), Short Form 36 physical functioning score (between-group difference, −1.4; 95% CI, −3.7 to 1.0; P =.24), or the PROMIS mobility scores (between-group difference, 0.4; 95% CI −0.8 to 1.7; P =.47).

Limitations of this study include the lack of identification of PAD location (eg, aortoiliac vs superficial femoral) as well as the lack of objective measurement of physical activity frequency and intensity.

The findings from this study may be partly explained by “patients with PAD who are interested in home-based exercise without medical center visits throughout the intervention may be less committed than patients who agree to participate in supervised exercise.”

Reference

McDermott MM, Spring B, Berger JS, et al. Effect of a home-based exercise intervention of wearable technology and telephone coaching on walking performance in peripheral artery disease: the HONOR randomized clinical trial. JAMA. 2018;3

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