Preferred exercise modalities in patients with intermittent claudication

Abstract

Conventional supervised exercise programs (SEPs) for claudicants are traditionally based on time-constrained, group-based structured programs usually at a hospital site. Uptake of an SEP is poor, despite the high-level evidence demonstrating its clinical effectiveness; therefore, alternative forms of exercise programs are needed which are more acceptable to patients. This study aimed to explore a range of exercise modalities to determine patient preferences for exercise delivery on a national level. This was a questionnaire survey to identify and incorporate patient preferences when designing a multicenter nationwide health-service evaluation of patient preference to exercise in the United Kingdom's National Health Service (the PREFER study). Patients with documented stable intermittent claudication who were suitable for an SEP were given a questionnaire to fill out at their clinic visit. Data were recorded using the Bristol Online Survey tool (http://www.survey.bris.ac.uk/) and analyzed descriptively. Thirty complete questionnaires were analyzed. Participants were generally unilateral claudicants (80%) with symptoms for over 1 year (64%). Only 6 of the 30 patients had engaged in a lifelong routine of exercise. Eighty-seven percent of patients indicated that they had not taken part in an exercise program, but 73% of those indicated that they would be willing to participate to improve their walking. Most patients expressed a preference for a home exercise program (50%) followed by a hospital SEP. The majority of patients (43%) were happy to exercise 3 days per week using a walking-based program (53%). There was however no consensus on the duration or intensity of the exercise program. The SEP is the recommended first-line treatment for intermittent claudication patients; however, the vast majority of patients fail to engage with or complete an exercise program. This study demonstrates that exercise therapy should be individualized and take a patient-centered approach. Commissioning groups should incentivize hospitals and clinicians to engage with their patient populations to understand their needs and deliver an appropriate service.

Influence of the Physical Training on Muscle Function and Walking Distance in Symptomatic Peripheral Arterial Disease in Elderly

“…Research by De la Hayel et al [ 44 ], Malagoni et al [ 45 ], and Müller-Büh et al [ 46 ] shows that dropout rate from these training programs is as much as 34–44%. Based on the literature review, the main reasons of resignation are not attractive form of exercises (treadmill walking training, recommended by TASC II and ACC / AHA), lack of motivation, health problems, and being far from the place of residence to the centres in which the rehabilitation programs are dedicated for patients with PAD [ 47 ]. Despite this, in our study, the dropout rate from the programme was only 16%.…”

A randomized controlled feasibility trial of a home-based walking behavior–change intervention for people with intermittent claudication

“…Home-based exercise programmes offer structure and supervision beyond simple walking advice and may overcome barriers related to travel and accessibility [8], particularly among patients with limited mobility. In addition, most people with intermittent claudication report a preference for home-delivered exercise [9]. However, evidence from systematic reviews is limited and inconsistent, and suggests home-based exercise is not effective [10].…”

High INtensity Interval Training In pATiEnts with intermittent claudication (INITIATE): protocol for a multicentre, proof-of-concept, prospective interventional study

“…One review demonstrated that only 25% of screened patients are recruited to a programme, 19 with time cited as the most common barrier for participation. 20 Furthermore, the current recommendations for SEPs appear to adopt a 'one size fits all' approach which is not based on any objective measure of functional capacity, potentially limiting physiological and symptomatic benefits. One alternative that is both time-efficient and prescribed based on the gold-standard measure of cardiopulmonary exercise testing (CPET), is highintensity interval training (HIIT).…”

“…[21][22][23][24] HIIT has been highlighted as a potentially preferred treatment option in those with IC, though the evidence in this population is much more limited. 20 Initial systematic review evidence has indicated that HIIT has the potential to provide clinical and symptomatic benefits, though there was significant heterogeneity between published studies in terms of HIIT modality, frequency, intensity and duration. 25 The authors recommended that future appropriately designed studies consider shorter-term and low-volume HIIT programmes for patients with IC.…”