Abstract
Background— This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Methods and Results— Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar ( P =0.712) and exceeded 80%. Both exercise programs increased claudication onset time ( P <0.001) and peak walking time ( P <0.01), whereas only home-based exercise increased daily average cadence ( P <0.01). No changes were seen in the control group ( P >0.05). The changes in claudication onset time and peak walking time were similar between the 2 exercise groups ( P >0.05), whereas the change in daily average cadence was greater with home-based exercise ( P <0.05). Conclusions— A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise. Clinical Trial Registration— URL: http://www.ClinicalTrials.Gov . Unique identifier: NCT00618670.
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