Abstract
Background:
Peripheral arterial disease (PAD) is a prevalent condition linked to atherosclerosis, often leading to intermittent claudication (IC), reduced mobility, and diminished quality of life. While supervised exercise programs are effective, home-based interventions offer a more accessible alternative, particularly in resource-limited settings.
Objective:
To evaluate the effectiveness of a structured home-based walking exercise program in improving ankle brachial index (ABI) and maximum pain-free walking distance (PFWD) among patients with PAD.
Methodology:
A quasi-experimental pre-test/post-test design was employed, involving 100 PAD patients purposively selected from GVN Hospital, Trichy, and KG Hospital, Coimbatore. Participants, aged 40–70 years, were assigned equally to control and experimental groups. The intervention group followed a four-week home-based walking program (30 min/day, five days/week), monitored via telephonic follow-ups and exercise diaries. PFWD was measured using the six-min walk test, and ABI was assessed pre- and post-intervention. Statistical analysis was conducted using SPSS v21, with significance set at P < 0.05.
Results:
Post-intervention, both groups showed statistically significant improvements in ABI and PFWD (P < 0.05). The experimental group demonstrated greater gains, with ABI increasing from 0.633 to 0.941 and PFWD from 145 m to 265.5 m. In contrast, the control group showed smaller improvements (ABI: 0.624 to 0.841; PFWD: 130.5 to 190.5 m).
Conclusion:
The home-based walking exercise program significantly improved ABI and PFWD in PAD patients, supporting its use as an effective, accessible intervention to enhance functional outcomes and quality of life. Broader implementation and further research on long-term adherence and impact are recommended.
Keywords: Six-min walk test, ankle brachial index, home-based exercise, maximum pain-free walking distance, peripheral arterial disease, walking program
INTRODUCTION
Peripheral arterial disease (PAD) represents a significant health concern globally due to its association with atherosclerosis and resultant debilitating symptoms, primarily affecting the mobility of patients. Characterized by a reduction in blood flow to the limbs, PAD can lead to intermittent claudication (IC), which manifests as muscle pain during exertion, consequently reducing patients’ overall quality of life.[1] This clinical trial investigates the effectiveness of a structured home-based walking exercise program on the maximum pain-free walking distance among patients diagnosed with PAD, aiming to enhance exercise tolerance and improve clinical outcomes.
PAD is classified as an under-recognized risk indicator for cardiovascular events. The ankle brachial index (ABI) serves as a primary diagnostic tool, where a score less than 0.90 indicates PAD.[2] Remarkably, approximately 60% of individuals with PAD remain asymptomatic, thus increasing their susceptibility to severe cardiovascular incidents, including myocardial infarction and strokes. Traditional treatment modalities emphasize lifestyle modification alongside supervised exercise therapy to alleviate claudication symptoms.[3]
Recent studies suggest that home-based exercise programs can significantly improve walking distance and ABI, despite lesser engagement than supervised programs.[4] For instance, Gardner et al. Collins et al. (2012) demonstrated that home-based walking provided comparable efficacy to structured rehabilitation, highlighting the potential of this intervention model within the constraints of healthcare accessibility.
Objectives
The objectives of the study are threefold:
To assess the maximum pain-free walking distance among PAD patients in experimental and control groups
To evaluate the effectiveness of the home-based walking exercise program
To compare walking distances between experimental and control groups post-intervention.
METHODOLOGY
A quasi-experimental, pre-test/post-test study design was adopted to evaluate the effectiveness of a home-based walking intervention among patients with IC. The study was conducted at GVN Hospital, Trichy, and included a purposive sample of 50 patients, aged between 40 and 70 years, all with physician-diagnosed IC. Eligible participants were required to have an ankle–brachial index (ABI) between 0.4 and 0.9, the ability to walk independently, and no history of recent vascular surgery. Patients were excluded if they presented with critical limb ischemia, recent myocardial infarction, severe cardiopulmonary disease, or cognitive impairment.
The intervention involved a structured home-based walking program consisting of 30-minute sessions, performed five days per week over four weeks. Each session comprised intermittent walking to near-maximal claudication pain, followed by rest periods, repeated throughout the duration. To ensure adherence and monitor progress, participants received weekly telephonic follow-ups and were instructed to maintain an exercise diary.
Pain-free walking distance (PFWD) was assessed before and after the intervention using the standardized six-min walk test (6MWT), in accordance with the American Thoracic Society guidelines.
Additionally, a parallel quasi-experimental study with a control group was carried out at KG Hospital, Coimbatore, to further validate the intervention. In this arm, 50 patients, aged 40–65 years, with PAD and claudication pain were purposively selected and equally assigned to either the experimental or control group. The experimental group received the same home-based walking intervention, while the control group received routine care. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Paired t-tests were used to compare pre- and post-intervention PFWD values, with a P < 0.05 considered statistically significant.
RESULTS
The study included 100 PAD patients, equally divided into control and experimental groups (n = 50 each). Most participants were aged 61–65 years (50%), male (80%), married, and from nuclear families. A majority had low income (₹0–5000) and lived in urban areas. Educational and occupational backgrounds varied. Clinically, most patients were of optimal or overweight body mass index, with obesity more common in the experimental group (20%). Half had both diabetes and hypertension, and 60% had PAD for over three years. Overall, demographic and clinical profiles were comparable between groups, supporting baseline equivalence.
Table 1 shows a significant improvement in ABI values in both groups, with the control group increasing from 0.624 to 0.841 and the experimental group from 0.633 to 0.941. The experimental group showed a greater mean difference (0.308 vs. 0.217), indicating a more marked improvement (P < 0.05).
Table 1.
Comparison of mean pre- and post-test ankle brachial index values among peripheral arterial disease patients in control and experimental groups (n=50 each)
| Group | Time | Mean ABI | Mean difference | Standard deviation | Paired “t” | P |
|---|---|---|---|---|---|---|
| Control group | Pre-test | 0.624 | 0.217 | 0.079 | 8.714 | <0.05 |
| Post-test | 0.841 | |||||
| Experimental group | Pre-test | 0.633 | 0.308 | 0.096 | 10.145 | <0.05 |
| Post-test | 0.941 |
ABI=Ankle brachial index
Table 2 represents significant improvements in maximum pain-free walking distance for both the control and experimental groups of PAD patients. The control group showed a mean increase of 60 m (130.5 to 190.5 m), while the experimental group demonstrated a larger mean increase of 120.5 m (145 to 265.5 m). Both groups had statistically significant changes (P < 0.05), with the experimental group showing a greater improvement.
Table 2.
Comparison of mean pre- and post-test maximum pain-free walking distance among peripheral arterial disease patients in control and experimental groups (n=50 each)
| Group | Time | Mean distance (m) | Mean difference | Standard deviation | Paired “t” | P |
|---|---|---|---|---|---|---|
| Control group | Pre-test | 130.5 | 60 | 41.633 | 4.557 | <0.05 |
| Post-test | 190.5 | |||||
| Experimental group | Pre-test | 145 | 120.5 | 55.899 | 6.817 | <0.05 |
| Post-test | 265.5 |
The study also compared ABI scores and maximum pain-free walking distance (6MWT) scores between the control and experimental groups. For ABI, the control group had a mean score of 0.841 with a standard deviation of 0.027, while the experimental group had a mean score of 0.941. The difference between these groups was statistically significant, with a t-value of 7.368 and a P < 0.05, indicating a significant improvement in the experimental group. In the 6MWT, the control group had a mean score of 190.5 with a standard deviation of 75, while the experimental group showed a significantly higher mean of 265.5, with a t-value of 2.097 and a P < 0.05, suggesting that the experimental group achieved a greater maximum pain-free walking distance.
DISCUSSION
Previous research has substantiated the beneficial impact of home exercise on walking performance. For instance, a randomized controlled trial indicated that patients in home-based programs demonstrated significant improvements, with gains in maximum walking distance of about 190 m compared to prior metrics.[5] Furthermore, dual mechanisms, including enhanced calf perfusion and reduced metabolic demands during walking, have been postulated to elucidate improvements in claudication symptoms and overall walking ability.[6]
Conversely, studies indicate limitations tied to inconsistent adherence and various patient backgrounds influencing exercise efficacy.[7] Thus, consideration of patient demographics is vital when assessing program outcomes, reinforcing the need for personalized exercise prescriptions.
CONCLUSION
The study confirmed that a structured home-based walking program improves walking ability and quality of life in PAD patients, supporting exercise therapy as a key treatment approach.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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