JMIR Publications

ABSTRACT

Background:

Current guidelines recommend supervised exercise training (SET) as a first line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective compared to home-based exercise therapy (HBET) or Go-Home-And-Walk advice. However, the lack of available SET programs hampers the broad SET implementation into clinical practice.

Objective:

Our aim was to explore the feasibility and acceptability of a telemonitored exercise intervention with remote feedback to bridge the gap between ineffective HBET and underused SET programs in patients with IC.

Methods:

Twenty IC patients (Rutherford 1-3) with internet access and who were not engaged in structured exercise training were recruited. Participants were instructed to complete three walking sessions and two resistance-band exercise sessions per week in their home-environment during a 4-week period. Walking sessions were monitored using a GPS sports watch and resistance training was guided through video-material and an instruction manual with logbook. Feedback was offered at least once by e-mail or phone. Feasibility and acceptability were assessed by means of a five Likert-scale questionnaire. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal (MWD) and pain-free walking distance (PFWD), Short Physical Performance Battery, Timed-Up-and-Go test and questionnaires on ambulatory capacity (WIQ), kinesiophobia (TSK), quality of life (VascuQOL) and exercise self-efficacy (ESES). Physical activity behaviour was assessed using a triaxial accelerometer at baseline and after three months. Statistically significant changes were tested by means of paired t-tests or Wilcoxon signed rank-tests.

Results:

All patients [15 men, 64.6 yrs (range 41-81)] completed the 4-week intervention and were (highly) satisfied with the program. Adherence to the program was somewhat higher regarding walking sessions compared to elastic band exercise (75% vs 62.5% of patients completing all sessions) and patients’ questionnaire responses documented willingness to recommend the program to other patients and preference to continue the intervention. These data highlighted the feasibility and acceptability of home-based technology-guided exercise therapy. Further, participants endorsed the use of the sports watches to track walking sessions, felt safe and appreciated the personal feedback and flexibility of training. Despite being pain-free, resistance training was perceived as less enjoyable. In addition, PFWD (+89 m, p<.001), MWD (+52 m, p=.04), WIQ distance score (+0.18, p=.01) and activity related (+0.54, p=.002) and total quality of life (+0.36, p=.009) improved following the intervention. Kinesiophobia-levels, self-efficacy, functional measures and physical activity levels remained statistically unaltered.

Conclusions:

This pragmatic pilot-study supports the feasibility, acceptability and potential of telemonitored HBET in the management of IC patients to improve ambulatory capacity and quality of life. Clinical Trial: Clinicaltrials.gov NCT04043546