Clinical Effectiveness of a Supervised Exercise Therapy Program for Treatment of Peripheral Artery Disease: A Translational Study.

Abstract

National guidelines for the treatment and management of symptomatic peripheral artery disease (PAD) recommend supervised exercise therapy (SET) as a first line of therapy. However, it is unknown how these expert opinion-based SET guidelines work in clinical practice as SET programs become established following the 2017 Centers for Medicare & Medicaid Services coverage announcement. The purpose of this prospective, nonrandomized translational study was to evaluate the clinical effectiveness of a SET program and specifically walking exercise modalities that did not incorporate a treadmill (TM). Participants enrolled in a 12-wk SET program housed in four rural Midwest cardiac rehabilitation settings and were prescribed an exercise program by an exercise physiologist or nurse based on current SET guidelines. Groups included TM walking, total body recumbent stepping (TBRS), TM walking + TBRS, and multimodal. Pre- and post-tests of walking capacity, physical function, and quality of life were administered. The sample (n = 93) was all White, with 55% female representation, age of 73.7 ± 9.0 yr, and mild-moderate PAD (ankle-brachial index = 0.71 ± 0.19). Collectively, SET significantly improved the 6-min walk test (32.1 ± 6.6 m; P < .01). Within-group changes in the 6-min walk test were seen for all groups except the multimodal group; there were no significant between-group differences in change scores ( P = .30). No significant between-group changes were seen for the TM walking, TBRS, and TM walking + TBRS groups for physical function measures. This study demonstrates the clinical effectiveness of SET programs following current guidelines and potential utilization of non-TM walking modalities in SET programs.