Abstract
African American individuals are 2 times more likely than non-Hispanic white individuals to have peripheral artery disease (PAD). Structured community-based exercise therapy improves walking distance among patients with PAD, but these patients require motivation to adhere to therapy. To assess whether motivational interviewing (MI) is more efficacious than Patient-Centered Assessment and Counseling for Exercise (PACE) or control to improve walking distance in African American patients with PAD. In this 3-group randomized clinical trial, 174 African American patients with PAD were studied from May 1, 2012, to November 30, 2016, at health care centers, churches, and health fairs in Wichita, Kansas; Kansas City, Kansas, and Kansas City, Missouri. Patients were randomized in a 1:1:1 fashion to 1 of 3 groups (57 to MI, 57 to PACE, and 60 to control). The 2 counseling interventions were delivered biweekly for 3 months and monthly for 3 months followed by a 6-month maintenance phase with limited contact. Control participants received a mailing at 3 and 9 months. The primary outcome was 6-month change in 6-minute walking performance. Secondary outcomes included 12-month change in walking performance and 6- and 12-month changes in quality of life. A total of 174 African American patients (mean [SD] age, 64.2 [11.2] years; 128 [74.0%] female) were studied. At 6 months, mean (SE) change in walking distance by group was as follows: MI, -3.42 (4.55) m; PACE, 2.74 (6.00) m; and control, -0.18 (4.40) m. At 12 months, mean (SE) change in walking distance by group was as follows: MI, -7.75 (5.50) m; PACE, 13.75 (6.13) m; and control, -1.08 (5.73) m. Comparing each of the intervention arms (MI and PACE) with the control arm, no statistically significant increases in walking distance at 6 months (MI: change, -2.10 m; 95% CI, -16.54 to 12.35 m; PACE: change, 2.31 m; 95% CI, -11.36 to 15.97 m) or 12 months (MI: change, -5.56 m; 95% CI, -21.18 to 10.06 m; PACE: change, 14.24 m; 95% CI, -1.85 to 30.34 m) were found. Compared with MI, PACE resulted in a statistically significant increase in walking distance at 12 months of 19.80 m (95% CI, 3.33-36.28 m). In a cohort of African American patients with PAD, MI was not efficacious in improving walking distance at 6 or 12 months. The results of this study do not support the use of MI to improve walking performance in African American patients with PAD. ClinicalTrials.gov Identifier: NCT01321086.
Highlights
African American individuals are more than 2 times as likely as non-Hispanic white individuals to have peripheral artery disease (PAD)—atherosclerosis of the abdominal aorta and arteries of the lower extremities.[1]
Comparing each of the intervention arms (MI and PatientCentered Assessment and Counseling for Exercise (PACE)) with the control arm, no statistically significant increases in walking distance at 6 months (MI: change, −2.10 m; 95% CI, −16.54 to 12.35 m; PACE: change, 2.31 m; 95% CI, −11.36 to 15.97 m) or 12 months (MI: change, −5.56 m; 95% CI, −21.18 to 10.06 m; PACE: change, 14.24 m; 95% CI, −1.85 to 30.34 m) were found
Compared with motivational interviewing (MI), PACE resulted in a statistically significant increase in walking distance at 12 months of 19.80 m
Summary
African American individuals are more than 2 times as likely as non-Hispanic white individuals to have peripheral artery disease (PAD)—atherosclerosis of the abdominal aorta and arteries of the lower extremities.[1] African American individuals with PAD experience greater walking impairment (defined as a reduction in walking distance, speed, and/or stair climbing) and more severe disease compared with non-Hispanic white individuals.[2] These identified disparities are largely attributed to lower levels of physical activity in African American individuals.[2] Reduced physical activity is associated with an increased risk of mobility loss and a higher risk of functional decline, with subsequent inability to perform activities of daily living. Structured community-based exercise therapy, walking therapy conducted outside a rehabilitation setting and with minimal supervision, is potentially an excellent therapy for PAD, but patients must be motivated to walk. Because of low levels of physical activity, African American patients with PAD may benefit from motivational strategies to promote community-based walking therapy
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