Supervised Exercise Therapy (SET) in the Management of Peripheral Arterial Disease: Factors Determining Compliance and Functional Outcome

Abstract

Introduction: Peripheral arterial disease (PAD) is a common condition associated with considerable morbidity. Supervised exercise therapy (SET) has emerged as an effective option in the management of this patient cohort. Unfortunately, poor compliance remains prevalent. Aim: The aim of this study was to assess factors influencing symptomatic improvement and SET participation. Methods: This single-centre retrospective cohort study was inclusive of all patients with confirmed PAD referred for SET between October 2010 and December 2013. Patient demographics and compliance data were extracted from medical records with phone interviews establishing subjective outcomes. Results: A total of ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (±10.1) with 18% being female. Median follow-up was 25.1 months (IQ range 17.0–31.6). Overall, the mean number of sessions attended was 19.5. Regarding symptomatic improvement exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Concerning compliance, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolemia (p = 0.020) or ischemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) and quality of symptoms (p = 0.018) were identified as predictors of compliance to SET. Conclusion: Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and optimization may result in improvements in function and compliance.