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.