The Impact of Nordic Pole Walk Advice Alone or in Combination with Exercise Strategies on Daily Physical Activity in Patients with Intermittent Claudication. A Randomized Clinical Trial.

Abstract

The impact of exercise interventions on physical activity remains undetermined in intermittent claudication, which is why it is important to include objectively measured physical activity as an additional endpoint. The aim of this pre-specified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on physical activity inpatients with intermittent claudication. In total, 166 patients with intermittent claudication (mean age = 72 [SD = 7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA + SEP, or WA + HSEP. All patients received Nordic poles and standardized WA (≥30min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. Physical activity was measured with an accelerometer-based activPAL3 monitor for 7days at baseline and 3, 6, and 12months. Physical activity outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30minutes and > 60minutes. At 1year, no intergroup differences were observed in any of the physical activity variables, whereas significant intergroup differences were observed at 3months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD = 10.85] min) was significantly different from the mean change for WA (-3.20 [SD = 6.24] min). At 6months, the number of sitting bouts (>60min) for SEP was significantly different from WA (mean change = 0.24 [SD = 0.69] versus -0.23 [SD = 0.81]). This study indicates that the addition of 6months of HSEP or SEP does not improve physical activity at 1year, as compared to unsupervised WA alone. Factors of importance for increasing physical activity in patients with intermittent claudication require further investigation. At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily physical activity in patients with intermittent claudication compared with unsupervised Nordic pole walk advice alone. Future studies may explore the role of behavior change techniques to increase physical activity in this patient group.