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Otsuka S1, Morisawa T2, Houjo Y1, Ishida A3, Tamaki A2
1Sakakibara Heart Institute of Okayama, Department of Rehabilitation, Okayama, Japan, 2Hyogo University of Health Sciences, Department of Rehabilitation, Kobe, Japan, 3Sakakibara Heart Institute of Okayama, Department of Cardiovascular Surgery, Okayama, Japan
Background: Peripheral arterial disease (PAD) patients after endovascular treatment (EVT) who did not show any significant improvement in the amount of physical activity is at high incidence of the cardiovascular events.
Thus, home-based exercise therapy based mainly on the amount of physical activity has attracted for patients with PAD. However, there were no reports evaluating only post-EVT patients with PAD.
Purpose: The purpose of this study was to examine the effectiveness of home-based exercise therapy after EVT for patients with PAD.
Methods: A pseudo-randomized clinical trial was performed including 30 patients (15 in the control group; 15 in the intervention group). Subsequently, home-based exercise therapy was performed for patients only in the intervention group for three months using the amount of physical activity (the number of steps to be walked) as an index. A two-way analysis of variance (Bonferroni's method) was performed to compare two factors, i.e., the number of steps walked and the 6-minute walk distance (6MWD) before surgery and three months after surgery in both groups. A paired t-test, an unpaired t-test, a χ2 test, and a Wilcoxon rank-sum test were used to compare the following parameters in both groups: patient backgrounds, Ankle-Brachial Pressure Index (ABI), Walking Impairment Questionnaire (WIQ), Self-Efficacy for Physical Activity (SEPA), Vascular Quality of Life Questionnaire (Vascu-QOL), the rate of change in the number of steps walked, and the rate of change in 6MWD. The significance level was defined as p 0.05 for all the analyses.
Results: The two-way analysis of variance confirmed an interaction effect in the number of steps walked (F (1, 28) =13.89, p=0.001). A multiple comparison test confirmed a significant increase between results of before surgery and three months after surgery in the intervention group (p 0.01). The rate of change in the number of steps walked at three months after surgery in the intervention group was significantly high (p 0.01). No interaction effects were observed in 6MWD (F (1, 28) =1.62, p=0.21), but a significant increase in 6MWD was confirmed by the multiple comparison test between before surgery and three months after surgery in the intervention group (p 0.01). A significant increase in ABI was observed between before and three months after surgery in both groups (p 0.01), but no significant differences in ABI were observed before and three months after surgery in both groups. The walking speed was significantly faster (p 0.01) and WIQ, SEPA, and Vascu-QOL were higher in the intervention group at three months after surgery (p 0.05), as compared with the control group.
Conclusion(s): A three-month period home-based exercise therapy for PAD patients who underwent EVT using the amount of physical activity as an index suggested a potential benefit that will increase the number of steps walked, 6MWD and QOL.
Implications: By using a specific number of steps to be walked as an index, we successfully achieved the improvement of the ability to walk after EVT over a short period of time, which consequently resulted in the improvement of the amount of physical activity and promoting behavior change in patients.
Keywords: peripheral artery disease, endovasucular treatment, home-based exercise
Funding acknowledgements: The authors declare no conflicts of interest associated with this manuscript.
Thus, home-based exercise therapy based mainly on the amount of physical activity has attracted for patients with PAD. However, there were no reports evaluating only post-EVT patients with PAD.
Purpose: The purpose of this study was to examine the effectiveness of home-based exercise therapy after EVT for patients with PAD.
Methods: A pseudo-randomized clinical trial was performed including 30 patients (15 in the control group; 15 in the intervention group). Subsequently, home-based exercise therapy was performed for patients only in the intervention group for three months using the amount of physical activity (the number of steps to be walked) as an index. A two-way analysis of variance (Bonferroni's method) was performed to compare two factors, i.e., the number of steps walked and the 6-minute walk distance (6MWD) before surgery and three months after surgery in both groups. A paired t-test, an unpaired t-test, a χ2 test, and a Wilcoxon rank-sum test were used to compare the following parameters in both groups: patient backgrounds, Ankle-Brachial Pressure Index (ABI), Walking Impairment Questionnaire (WIQ), Self-Efficacy for Physical Activity (SEPA), Vascular Quality of Life Questionnaire (Vascu-QOL), the rate of change in the number of steps walked, and the rate of change in 6MWD. The significance level was defined as p 0.05 for all the analyses.
Results: The two-way analysis of variance confirmed an interaction effect in the number of steps walked (F (1, 28) =13.89, p=0.001). A multiple comparison test confirmed a significant increase between results of before surgery and three months after surgery in the intervention group (p 0.01). The rate of change in the number of steps walked at three months after surgery in the intervention group was significantly high (p 0.01). No interaction effects were observed in 6MWD (F (1, 28) =1.62, p=0.21), but a significant increase in 6MWD was confirmed by the multiple comparison test between before surgery and three months after surgery in the intervention group (p 0.01). A significant increase in ABI was observed between before and three months after surgery in both groups (p 0.01), but no significant differences in ABI were observed before and three months after surgery in both groups. The walking speed was significantly faster (p 0.01) and WIQ, SEPA, and Vascu-QOL were higher in the intervention group at three months after surgery (p 0.05), as compared with the control group.
Conclusion(s): A three-month period home-based exercise therapy for PAD patients who underwent EVT using the amount of physical activity as an index suggested a potential benefit that will increase the number of steps walked, 6MWD and QOL.
Implications: By using a specific number of steps to be walked as an index, we successfully achieved the improvement of the ability to walk after EVT over a short period of time, which consequently resulted in the improvement of the amount of physical activity and promoting behavior change in patients.
Keywords: peripheral artery disease, endovasucular treatment, home-based exercise
Funding acknowledgements: The authors declare no conflicts of interest associated with this manuscript.
Topic: Cardiorespiratory; Disability & rehabilitation
Ethics approval required: Yes
Institution: Hyogo University of Health Sciences
Ethics committee: ethical committee of Hyogo University of Health Sciences
Ethics number: 16021
All authors, affiliations and abstracts have been published as submitted.
