Unsupervised exercise and mobility loss in peripheral artery disease: a randomized controlled trial

Background: few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease (pad). among people with pad,we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control.methods and results: one hundred ninety-four pad participants were randomized. during months 1 to 6,the intervention group met weekly with other pad participants and a facilitator. group support and self-regulatory skills were used to help participants adhere to walking exercise. ninety-percent of exercise was conducted at or near home. the control group attended weekly lectures. during months 6 to 12,each group received telephone contact only. primary outcomes have been reported. here we compare changes in exploratory outcomes of mobility loss (the inability to climb a flight of stairs or walk one-quarter mile without assistance),walking velocity,and the short physical performance battery. compared to controls,fewer participants randomized to the intervention experienced mobility loss at 6-month follow-up: 6.3% versus 26.5%,p=0.002,odds ratio=0.19 (95% ci=0.06 to 0.58) and at 12-month follow-up: 5.2% versus 18.5%,p=0.029,odds ratio=0.24 (95% ci=0.06 to 0.97). the intervention improved fast-paced 4-m walking velocity at 6-month follow-up (p=0.005) and the short physical performance battery at 12-month follow-up (p=0.027),compared to controls.conclusions: in exploratory analyses,a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in pad patients.clinical trial registration: url: http://clinicaltrials.gov. unique identifier: nct00693940. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.