Abstract
BackgroundCurrent guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice.ObjectiveThe aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises.MethodsA total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests.ResultsAll patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients’ questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered.ConclusionsPatients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking.Trial RegistrationClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546
Highlights
BackgroundLower extremity artery disease (LEAD) is a chronic disease characterized by progressive atherosclerotic narrowing of the lower limb arteries
Insufficient blood flow to active muscles during exercise may result in complaints of intermittent claudication (IC), which often presents as cramping or burning-like pain during physical activities
In this context, supervised exercise and walking in particular are cornerstone therapies that result in clinically significant improvements in pain-free walking distance (PFWD) and maximal walking distance (MWD) [7]
Summary
BackgroundLower extremity artery disease (LEAD) is a chronic disease characterized by progressive atherosclerotic narrowing of the lower limb arteries. Recent guidelines emphasize the importance of a first-line lifestyle-oriented approach when consulting with IC [6] In this context, supervised exercise and walking in particular are cornerstone therapies that result in clinically significant improvements in pain-free walking distance (PFWD) and maximal walking distance (MWD) [7]. Current guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). Objective: The aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy.
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