Long-term effects of structured home-based exercise program on functional capacity and quality of life in patients with intermittent claudication

Abstract

Objectives: To evaluate effects of a structured home-based exercise program on functional capacity and quality of life (QoL) in patients with intermittent claudication (IC) after 1-year follow-up, and to compare these results with those from a concurrent control group who received supervised exercise training (SET).

Design: Comparative longitudinal cohort study.

Setting: Referral center.

Participants: Patients (N=142) with IC.

Interventions: Structured home-based exercise training or SET.

Main outcome measures: The maximum (pain-free) walking distance and the ankle-brachial index (ABI) (at rest and postexercise) were measured at baseline and after 6 and 12 months' follow-up. Additionally, QoL was evaluated using a self-administered questionnaire consisting of the Euroqol-5D (scale 0-1), rating scale (scale 0-100), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36; scale 0-100), and the Vascular Quality of Life Questionnaire (VascuQol; scale 1-7). Comparison of the groups was performed with adjustment for the nonrandomized setting using propensity scoring.

Results: One hundred forty-two patients with IC started the structured home-based exercise program, of whom 95 (67%) completed 12 months' follow-up. The mean relative improvement compared with baseline was statistically significant after 12 months' follow-up for the maximum and pain-free walking distance (342%, 95% confidence interval [CI], 169-516; P<.01 and 338%, 95% CI, 42-635; P=.03, respectively) and for the ABI postexercise (mean change, .06; 95% CI, .01-.10; P=.02). For the QoL outcomes, the improvement compared with baseline was statistically significant after 12 months for the VascuQol (mean change, .42; 95% CI, .20-.65; P<.01) and for the SF-36 physical functioning (mean change, 5.17; 95% CI, .77-9.56; P=.02). Compared with the structured home-based exercise program, patients in the control group showed significantly better results in the mean relative improvement of maximum and pain-free walking distance and change in the ABI at rest after 12 months' follow-up.

Conclusions: Structured home-based exercise training is effective in improving both functional capacity and QoL in patients with IC and may be considered as a feasible and valuable alternative toSET, since supervised exercise programs are not often available.