A comparative study of home based exercise on symptomatic peripheral arterial disease

Abstract

Peripheral arterial disease (PAD) is a prevalent atherosclerotic disorder characterised by exertional limb pain, loss of limb and a high mortality rate - those patients with an ABPI of<0.40 have a 5-year probability of survival of only 44%. Intermittent
claudication, the exercise-induced ischaemic pain in the lower extremities, has been reported in 20% to 40% of patients with PAD. People with PAD have significant disability that also affects psychosocial and emotional aspects of their lives. Exercise
is often advocated to improve the functional ability of this patient group.
Purpose: This study was performed to test the relative effectiveness of three homebased exercise programme for enhancing walking ability. It also examined the acceptability to patients of two assessment tools used for measuring PAD: the STRESST'ER foot pump and the PADHOC walking test.
Methods: Patients with intermittent claudication were randomised to either a leg exercise programme and written instructions on improving walking distance, or an arm exercise programme and written instructions on improving walking distance or just the written instructions on improving walking distance. The exercise programme for all three groups was 12 weeks duration. Walking distance to initial claudication pain (ICP), maximum walking distance (MWD), and changes in ankle-brachial pressure index (ABPI) were assessed at baseline, 6 weeks and programme completion (3months). The Medical Outcomes Study Short Form 36 (SF-36) and the Claudication Scale (CLAIJ-S) were administered at baseline and 3 months to assess effects on
quality of life.
Results: Forty-six men and 13 women were recruited into the study. Fifty one (41 male and 10 female) completed the 12-week exercise programmes. Sixteen patients completed the leg exercise programme, 16 patients completed the arm exercise
programme and 19 patients completed the written walking programme (the control group). Statistical analysis (Kruskal-Wallis) showed no significant difference in all the above measures between the three groups at 3 months. There was also no evidence of any clinical significance. Regarding the two assessment tools, the PADHOC was found to be marginally more socially acceptable than the STRESST'ER to patients.
Descriptive analysis of the quality of life data showed poor quality of life scores for this patient population, but there was insufficient evidence to conclude that exercise impacted on quality of life for those studied participants.
Conclusion: Whilst there is evidence to support some forms of exercise for patients with peripheral arterial disease, this study did not find one superior method of homebased exercise to achieve improvements in walking distance. Performing the exercises in a more structured environment, or on a different population, may have yielded a different outcome. Perhaps the most important issue to have arisen from undertaking this study, is that undertaking an RCT to determine the benefits of exercise, should not have been the methodology of choice. The abundance of government health related documents published since undertaking the trial give valuable evidence as to why and how individual exercise regimes could produce a more meaningful outcome for patients than participating in an RCT.