Long-Term Effects of Structured Home-Based Exercise Program on Functional Capacity and Quality of Life in Patients With Intermittent Claudication

Abstract

Fakhry F, Spronk S, de Ridder M, den Hoed PT, Hunink MGM. Long-term effects of structured home-based exercise program on functional capacity and quality of life in patients with intermittent claudication. Objectives To evaluate effects of a structured home-based exercise program on functional capacity and quality of life (QoL) in patients with intermittent claudication (IC) after 1-year follow-up, and to compare these results with those from a concurrent control group who received supervised exercise training (SET). Design Comparative longitudinal cohort study. Setting Referral center. Participants Patients (N=142) with IC. Interventions Structured home-based exercise training or SET. Main Outcome Measures The maximum (pain-free) walking distance and the ankle-brachial index (ABI) (at rest and postexercise) were measured at baseline and after 6 and 12 months' follow-up. Additionally, QoL was evaluated using a self-administered questionnaire consisting of the Euroqol-5D (scale 0–1), rating scale (scale 0–100), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36; scale 0–100), and the Vascular Quality of Life Questionnaire (VascuQol; scale 1–7). Comparison of the groups was performed with adjustment for the nonrandomized setting using propensity scoring. Results One hundred forty-two patients with IC started the structured home-based exercise program, of whom 95 (67%) completed 12 months' follow-up. The mean relative improvement compared with baseline was statistically significant after 12 months' follow-up for the maximum and pain-free walking distance (342%, 95% confidence interval [CI], 169–516; P<.01 and 338%, 95% CI, 42–635; P=.03, respectively) and for the ABI postexercise (mean change, .06; 95% CI, .01–.10; P=.02). For the QoL outcomes, the improvement compared with baseline was statistically significant after 12 months for the VascuQol (mean change, .42; 95% CI, .20–.65; P<.01) and for the SF-36 physical functioning (mean change, 5.17; 95% CI, .77–9.56; P=.02). Compared with the structured home-based exercise program, patients in the control group showed significantly better results in the mean relative improvement of maximum and pain-free walking distance and change in the ABI at rest after 12 months' follow-up. Conclusions Structured home-based exercise training is effective in improving both functional capacity and QoL in patients with IC and may be considered as a feasible and valuable alternative toSET, since supervised exercise programs are not often available.