Don’t stop walking: the in-home rehabilitation program for peripheral artery disease patients during the COVID-19 pandemic

Abstract

We studied the outcomes of peripheral artery disease (PAD) patients enrolled in a structured in-home walking program right before the lockdown due to the SARS-CoV-2 epidemic emergency, to determine whether this intervention ensured the maintenance of mobility even in the case of movement restrictions. We selectively studied 83 patients (age 72 ± 11, males n = 65) enrolled in the program within 9-month before the lockdown. The usual intervention was based on two daily 8-min sessions of slow intermittent in-home walking prescribed in circamonthly hospital visits. During the lockdown, the program was updated by phone. Six-minute (6MWD) and pain-free walking distance (PFWD) were measured pre-and post-lockdown as well as body weight (BW), blood pressure (BP), and anklebrachial index (ABI). Sixty-six patients were measured 117 ± 23 days after their previous visit. A safe, pain-free execution of the prescribed sessions was reported (median distance: 74 km). Overall, the 6MWD was stable, while PFWD improved (p < 0.001). The improvement was not related to age/gender, comorbidities, type of home but to the time of enrollment before lockdown. The new-entry subjects (≤ 3 months; n = 35) obtained significant improvements post-lockdown for 6MWD and PFWD, while those previously enrolled (> 3 months; n = 31) were stable. Decreased BW with stable BP and ABI values were also recorded, with better outcomes for new-entry subjects. In PAD patients, a structured walking program performed inside home and purposely guided by phone was adhered to by patients and favored mobility and risk factor control during the COVID-19 pandemic, regardless of walking ability, type of home and external conditions.

Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study

“…This aspect is even more important in patients with diabetes where the late perception of ischemic symptoms has been reported [ 42 ]. Furthermore, pain-free exercise together with other factors favored the adherence [ 15 , 24 , 43 – 45 ], with patients at different hemodynamic picture and physical capabilities performing a similar training load from 135 to 155 km/6 months.…”

Safety of home-based exercise for people with intermittent claudication: A systematic review

“… 23 – 26 , 39 , 46 There were nine programmes with exercise that was pain-free, near the pain threshold, or at maximal asymptomatic speed, which were classed as ‘low pain’. 26 , 28 , 32 , 33 , 42 – 45 , 47 Nine studies included exercise to moderate pain levels. 27 , 29 , 30 , 35 – 38 , 40 , 41 Two studies did not provide a clear description of the degree of claudication pain 22 , 34 and two did not report this information.…”

“…Twelve of the included studies were randomised controlled trials, [22][23][24][25][26][27][28][29][30][31][32][33] and the remaining 15 were nonrandomised. [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] The included studies comprised a total of 2351 participants, 1642 of whom received a home-based intervention, representing a total of 147,810 patient-hours.…”

Cardiac Rehabilitation in Patients with Peripheral Artery Disease—A Literature Review in COVID-19 Era

“…The pain-free walking distance improved improved directly proportional to the time since enlistment before the lockdown (p < 0.001) regardless of gender and comorbidities. Improvements were also observed regarding body weight, blood pressure and ankle-brachial index [88].…”