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Home-based walking program shows promise for intermittent claudication

Reuters Health - 12/04/2022 - A home-based walking program can provide clinically meaningful improvement in walking capacity in adults with peripheral artery disease (PAD) and intermittent claudication, according to results of a randomized controlled trial.

The Motivating Structured Walking Activity in People With Intermittent Claudication (MOSAIC) trial enrolled 190 adults with intermittent claudication due to PAD.

The 12-week intervention consisted of two hour-long, individual, in-person sessions during the first two weeks and two 20-minute telephone calls over weeks six to 12.

The four sessions were delivered by physical therapists who used motivational interviewing, guided by behavior-change principles, to help individuals set personalized walking exercise goals, monitor their progress, and identify and overcome challenges to sticking with the program.

At the three-month follow-up, 6-minute walk distance in the intervention group rose from 352.9 meters at baseline to 380.6 meters in the intervention group (mean increase 22.3 m) and from 369.8 meters to 372.1 meters in the usual care group (mean increase 9.2 meters).

The adjusted mean between-group difference of 16.7 meters was statistically significant (P=0.009), Dr. Lindsay M. Bearne, of Kingston University and St George's, University of London, United Kingdom, and colleagues report in JAMA.

"Currently, clinical practice guidelines from different countries and medical specialties unequivocally endorse supervised exercise as first-line therapy for PAD. However, most people with PAD do not participate in supervised exercise," writes the author of a JAMA editorial.

"Home-based walking exercise, defined by walking exercise conducted in or near the home without the presence of an exercise physiologist or nurse, circumvents the requirements for a facility and the inconvenience of traveling to a center for exercise and could increase participation in exercise activity by patients with PAD," Dr. Mary M. McDermott, with Northwestern University Feinberg School of Medicine in Chicago adds.

This effect of the MOSAIC trial intervention was "consistent with a statistically significant and modest but clinically meaningful improvement in 6-minute walk distance," Dr. McDermott notes.

"However, enthusiasm and evidence for home-based walking exercise for patients with PAD has been modest. Given the absence of alternative highly effective non-invasive therapies for PAD, developing home-based exercise into first-line therapy for PAD is an imperative," Dr. McDermott concludes.

SOURCE: https://bit.ly/3KD1ons JAMA, online April 12, 2022.

By Reuters Staff

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