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 Researchers say the home-based program may be more
effective at keeping people motivated than hospital-based exercise
for a common and disabling problem, and may be a more cost-effective
first-line treatment.
“I was somewhat surprised that we achieved our results of a
continued difference between the intervention and control groups
because it is very difficult to get patients to adhere to an
exercise program long term even when it is supervised, and our
program was unsupervised, ” said Dr. Mary McDermott, who led the
research.
According to the National Institutes of Health, eight to 12 million
people or one in every 20 Americans over the age of 50 has
peripheral artery disease, or PAD, a condition caused by plaque
build-up in arteries, especially in the legs.
Having PAD significantly raises the chances of heart attack or
stroke.
McDermott, a physician and professor at Northwestern University in
Chicago told Reuters Health, “Symptoms of peripheral artery disease
are often not classic. A patient might just experience weakness in
their legs or tiredness and both the doctor and the patient might
think that it’s just a part of aging.”
While African Americans are twice as likely as whites to develop the
disease, other high risk groups include smokers, diabetics, people
with hypertension or high cholesterol and anyone who has had a heart
attack or stroke.
There are few treatments for PAD – implanted stents to open the
arteries or medication – and exercise. Past research has shown that
treadmill walking can improve blood flow and help people with PAD to
build up their endurance. But those studies focused on programs that
required patients to go to a hospital or clinic to exercise,
according to McDermott and her colleagues.
They wanted to see if a home-based program might improve motivation
to exercise by lessening the burden of traveling to a medical center
three times a week for supervised workouts.
The researchers recruited 194 participants with clogged arteries in
their legs and randomly assigned them to two groups for the
year-long experiment. One group took part in a structured home-based
exercise program, and the comparison group did not exercise.
Every participant took a six-minute test at the beginning of the
study period and again at the end to measure how quickly they could
pace back and forth along a 100-foot hallway.
For six months, the home-based exercise group met once a week at an
exercise center to receive instructions and guidance on exercise
they’d do at home once a day.
Those assigned to the comparison group also met weekly but at a
medical center and instead of exercise instruction, they received
health lectures.
For the second six months of the study, members of the exercise
group got a monthly telephone call from their group facilitator.
They were encouraged to push themselves by walking five times a
week, taking a quick rest when they experienced discomfort, slowly
building their way up to a 50-minute walk.
Members of the comparison group were contacted by a study
coordinator who went over information related to the health topics
in the lectures.
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At the end of the study, people in the exercise program walked
faster and farther than those in the comparison group, whose members
ended up performing worse than when they started, McDermott’s team
reports in the Journal of the American Heart Association.
The exercise group improved their six-minute walking distance by 87
feet, from 1166.0 ft. at the beginning of the study period to 1253
ft. at the end. Those in the comparison group, on average, walked a
distance 25 ft less than they had a year earlier.
McDermott thinks that even more than the monthly motivational phone
calls, developing the habit of walking for a set amount of time
every day probably had the strongest effect in the exercise group.
She believes that continuing the on-site training for a bit longer
or instituting ways for the participants to benefit from group
support might have resulted in even greater improvement.
“Some of the participants truly bonded with each other and became
very engaged in the exercise,” McDermott said.
Robert Patterson, a physician and clinical researcher at Brown
University, told Reuters Health that exercise, which is considered a
more conservative approach to managing peripheral artery disease,
should be the first prescription PAD patients receive.
“There are too many people getting what I consider unnecessary
stenting or too much stenting,” Patterson said. “They come in, they
complain, they get a stent that they will have for life.”
If a patient tries exercise first and doesn’t see substantial
results, they should then turn to the more aggressive approach of
stenting, he said.
“I ask my patients to set aside 40 minutes every day to walk. When
they first start I tell them they might walk 15 minutes and rest 25
minutes. After six or 12 weeks, they might be walking for 25 minutes
and resting for only 15, the effects (of walking) can be dramatic,”
he said.
If insurers were to get on board, Patterson adds, it would cost the
whole healthcare system less money and possibly reduce the
complications associated with people who get stents and must
constantly have those stents replaced.
“This study is important. This kind of paper gets at the issue of
how we provide this kind of long lasting improved performance to
patients in a cost effective fashion,” he said.
SOURCE: http://bit.ly/1k8Mi9b
Journal of the American Heart Association, May 21, 2014.
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