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 perfor mance 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 perfor mance was evaluated by treadmill testing using a graded protocol. In addition, func tional 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 (continued on next page) 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.

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References

Dahllof A. , Bjorntorp P. , Holm J. , et al: Metabolic activity of skeletal muscle in patients with peripheral arterial insufficiency. Effect of physical training. Eur J Clin Invest 4:9-15, 1984.

Dahllof A. , Holm J. , Schersten T. , et al: Peripheral arterial insufficiency. Effect of physical training on walking tolerance, calf blood flow, and blood flow resistance. Scand J Rehab Med 8:19-26, 1976.

Hiatt WR , Regensteiner JG , Hargarten ME , et al: Benefit of exercise conditioning for patients with peripheral arterial disease. Circulation 81:602-609, 1990.

Hiatt WR , Wolfel EE , Meier R. , et al: Superiority of walking exercise vs. strength training for patients with peripheral arterial disease. Circulation 90: 1866-1874, 1994.

Holm J. , Dahllof A. , Bjorntorp P. , et al: Enzyme studies in muscles of patients with intermittent claudication. Effect of training Scand J Clin Lab Invest 31(suppl 128):201-205, 1973.

Larsen OA , Lassen NA : Effect of daily muscular exercise in patients with intermittent claudication . Lancet 2:1093-1096, 1966 .

Taylor LM , Porter JM : Natural history and nonoperative treatment of chronic lower extremity ischemia . In: Vascular Surgery, ed. 4, ed. by Rutherford RB. Philadelphia : WB Saunders Co, 1995 , pp 751-756.

Hiatt WR , Hirsch A. , Regensteiner JG , et al: Assessment of patients with peripheral arterial disease: Review of approaches and development of recommendations for therapeutic trials. Circulation 92:614-621, 1995.

Regensteiner JG , Steiner JF , Panzer RJ , et al: Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease . J Vasc Med Biol 2:142-152, 1990.

10.

Regensteiner JG , Steiner JF , Hiatt WR : Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg 23:104-115, 1996.

11.

Regensteiner JG , Hargarten ME , Rutherford RB , et al: Functional benefits of vascular surgery for patients with peripheral arterial disease. Angiology 44:1-9, 1993.

12.

Reifler DR , Feinglass J. , Slavensky R. , et al: Functional outcomes for patients with intermittent claudication: Bypass surgery versus angioplasty versus noninvasive management. J Vasc Med Biol 5:203-211, 1994.

13.

Stewart AL , Greenfield S. , Hays RD , et al: Functional status and well-being of patients with chronic conditions : Results from the Medical Outcomes Study. JAMA 262:907-913, 1989.

14.

Tarlov AR , Ware JE , Greenfield S. , et al: The medical outcomes study. An application of methods for monitoring the results of medical care. JAMA 262:925-930, 1989.

15.

Hiatt WR , Marshall JA , Baxter J. , et al: Diagnostic methods for peripheral arterial disease in the San Luis Valley Diabetes Study. J Clin Epidemiol 43:597-606, 1990.

16.

Ronnemaa T. , Mattila K. , Lehtonen A. , et al: A controlled randomized study on the effect of long-term physical exercise on the metabolic control in type 2 diabetic patients. Acta Med Scand 220:219-224, 1986.

17.

Heinzelmann F. , Bagley RW : Response to physical activity programs and their effects on health behavior. Public Health Rep 85:905-911, 1970.

18.

Massie JF , Shephard RJ : Physiological and psychological effects of training. Med Sci Sports Exerc 3:110-117, 1971.

19.

Brooks GA , Fahey TD : Conditioning for rhythmical athletic events. In: Exercise Physiology: Human Bioenergetics and Its Applications, ed. 1. New York: MacMillan, 1984, p 430.

20.

Neilsen SL , Larsen B. , Prahl M. , et al: Hospitalstraening contra hjemmetraening af patienter med claudicatio intermittens. Ugeskrift for Laeger 139: 2733-2736, 1977.

21.

Jonason TI , Ringqvist A. , Oman-Rydberg A. : Home-training of patients with intermittent claudication. Scand J Rehab Med 13:137-141, 1981.