Exercise Physiology Efficacy of Quantified Home-Based Exercise and Supervised Exercise in Patients With Intermittent Claudication A Randomized Controlled Trial

Background—This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Methods and Results—Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P 0.712) and exceeded 80%. Both exercise programs increased claudication onset time (P 0.001) and peak walking time (P 0.01), whereas only home-based exercise increased daily average cadence (P 0.01). No changes were seen in the control group (P 0.05). The changes in claudication onset time and peak walking time were similar between the 2 exercise groups (P 0.05), whereas the change in daily average cadence was greater with home-based exercise (P 0.05). Conclusions—A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise. Clinical Trial Registration—URL: http://www.ClinicalTrials.Gov. Unique identifier: NCT00618670. (Circulation. 2011;123:491-498.)