Hospital vs Home-Based Exercise Rehabilitation for Patients with Peripheral Arterial Occlusive Disease

Abstract

Supervised, hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease. However, it has been suggested that unsupervised, home-based exercise programs, which have been relatively little evaluated, would be equally efficacious as compared with hospital-based programs. The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise performance more than a home-based program. Of 20 consecutively enrolled patients with claudication, 10 were randomly placed into a supervised, hospital-based program and 10 into an unsupervised, home-based program for a three-month period. Exercise performance was evaluated by treadmill testing using a graded protocol. In addition, functional status was evaluated by the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study SF-20 questionnaire (MOS). Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit. Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with the program. Patients in the hospital-based group improved peak walking time by 137%, pain-free walking time by 150%, and peak oxygen consumption by 19% (all P < 0.05). Patients reported an improved walking distance and speed according to WIQ data (both P < 0.05). In addition, the MOS physical functioning score in the hospital-based group improved by 20 percentage points (P < 0.05). In contrast, patients in the home-based program did not improve exercise performance measured on the treadmill. Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home-based program (P < 0.05). The ability to walk distances was the only questionnaire measure that improved in persons who received the home-based program (P < 0.05). Preliminary results suggest that a supervised, hospital-based program is more effective for improving treadmill exercise performance than an unsupervised, home-based program.

Early Outcomes From a Randomized, Controlled Trial of Supervised Exercise, Angioplasty, and Combined Therapy in Intermittent Claudication

“…However, none of the included studies directly compared SEP and PTA. [17][18][19][20][21][22][23][24] There is no published literature of a three-way comparison between SEP, PTA, and SEP + PTA; thus, this study is the first of its kind.…”

Effects of remote feedback in home-based physical activity interventions for older adults: A systematic review

“…6) [20][21][22][23][24][25][26][27] and eight low-quality [7,[28][29][30][31][32][33][34]. Evidence in the 16 studies was conflicting though, as fewer than 75% reported consistent findings.…”

“…Effect sizes were À0.82 (À1.10 to 0.54) and 2.06 (0.98-3.13), illustrating the variability in effectiveness. Four out of 16 studies compared programs with feedback to an exercising control group without feedback [7,22,26,32]. Results show that physical activity programs with frequent remote feedback are equally effective in enhancing physical capacity measures as (supervised) exercise programs without remote feedback.…”

The effects of exercise training in patients with peripheral vascular disease - a review

“…36,38,39 Regensteiner et al 38 showed no improvement in MWD or PFWD in a home-based exercise programme after 12 weeks of training. Patterson et al 36 and Savage et al 39 found that although the home exercise groups improved, supervised exercise programmes improved PFWD more than home-based exercise programmes over a 3 -6-month period.…”

“…9,13 Intermittent claudication is the most common symptom of PVD; it causes severe walking intolerance and therefore impacts on the functional status and quality of life of the patient. 4,38 Therefore treatment has focused on alleviating the symptom of intermittent claudication and improving walking tolerance.…”