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Meta-Analysis
. 2023 Sep 5;6(9):e2334590.
doi: 10.1001/jamanetworkopen.2023.34590.

Home-Based Walking Exercise and Supervised Treadmill Exercise in Patients With Peripheral Artery Disease: An Individual Participant Data Meta-Analysis

Neela D Thangada  1 , Dongxue Zhang  1 , Lu Tian  2 , Lihui Zhao  1 , W Jack Rejeski  3 , Karen J Ho  1 , Luigi Ferrucci  4 , Bonnie Spring  1 , Melina R Kibbe  5   6 , Tamar S Polonsky  7 , Michael H Criqui  8 , Mary M McDermott  1   9
Affiliations
Meta-Analysis

Home-Based Walking Exercise and Supervised Treadmill Exercise in Patients With Peripheral Artery Disease: An Individual Participant Data Meta-Analysis

Neela D Thangada et al. JAMA Netw Open. .

Abstract

Importance: Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear.

Objective: To study whether home-based walking exercise improves 6-minute walk (6MW) more than supervised treadmill exercise in people with PAD (defined as Ankle Brachial Index ≤0.90).

Data sources: Data were combined from 5 randomized clinical trials of exercise therapy for PAD using individual participant data meta-analyses, published from 2009 to 2022.

Study selection: Of the 5 clinical trials, 3 clinical trials compared supervised treadmill exercise to nonexercise control (N = 370) and 2 clinical trials compared an effective home-based walking exercise intervention to nonexercise control (N = 349).

Data extraction and synthesis: Individual participant-level data from 5 randomized clinical trials led by 1 investigative team were combined. The 5 randomized clinical trials included 3 clinical trials of supervised treadmill exercise and 2 effective home-based walking exercise interventions.

Main outcomes and measures: Change in 6MW distance, maximum treadmill walking distance, and Walking Impairment Questionnaire at 6-month follow-up. The supervised treadmill exercise intervention consisted of treadmill exercise in the presence of an exercise physiologist, conducted 3 days weekly for up to 50 minutes per session. Home-based walking exercise consisted of a behavioral intervention in which a coach helped participants walk for exercise in or around home for up to 5 days per week for 50 minutes per session.

Results: A total of 719 participants with PAD (mean [SD] age, 68.8 [9.5] years; 46.5% female) were included (349 in a home-based exercise clinical trial and 370 in a supervised exercise trial). Compared with nonexercise control, supervised treadmill exercise was associated with significantly improved 6MW by 32.9 m (95% CI, 20.6-45.6; P < .001) and home-based walking exercise was associated with significantly improved 6MW by 50.7 m (95% CI, 34.8-66.7; P < .001). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (between-group difference: 23.8 m [95% CI, 3.6, 44.0; P = .02]) but significantly less improvement in maximum treadmill walking distance (between-group difference:-132.5 m [95% CI, -192.9 to -72.1; P < .001]).

Conclusions and relevance: In this individual participant data meta-analyses, compared with supervised exercise, home-based walking exercise was associated with greater improvement in 6MW in people with PAD. These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr McDermott reported receiving grants from the National Heart, Lung, and Blood Institute and funding from the National Institute on Aging and the American Heart Association during the conduct of the study; grants from Helixmith, and consulting fees from Cambrian, Dr McDermott received other support for research from Helixmith, Mars, ArtAssist, ReserveAge, and Chromadex. Dr Spring reported receiving research funding from the ActiGraph scientific advisory board. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Adjusted Results From Meta-Analysis of the Supervised Treadmill Exercise Randomized Clinical Trials
A, 6-minute Walk and treadmill outcomes; B, Walking Impairment Questionnaire (WIQ) outcomes for clinical trials of supervised treadmill exercise compared with control. Individual participant data meta-analyses were performed using analysis of covariance adjusting for study, age, sex, race, smoking, myocardial infarction, heart failure, and the baseline measure of outcome of interest to estimate the adjusted between-group difference in outcomes among those randomized to supervised treadmill exercise and to nonexercise control.
Figure 2.
Figure 2.. Adjusted Results From Meta-Analysis of Home-Based Walking Exercise Randomized Clinical Trials
A, 6-minute Walk and treadmill outcomes; B, Walking Impairment Questionnaire (WIQ) outcomes for clinical trials of home-based walking exercise compared with control. Individual participant data meta-analyses were performed using analysis of covariance adjusting for study, age, sex, race, smoking, myocardial infarction, heart failure, and the baseline measure of outcome of interest to estimate the adjusted between-group differences in outcomes among those randomized to home-based walking exercise and to nonexercise control.
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References

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