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Hospital vs Home-Based Exercise Rehabilitation for Patients with Peripheral Arterial Occlusive Disease

Thomas J. Meyer

William C. Krupski

Linda S. Cranford

William R. Hiatt

Judith G. Regensteiner, PhD

Section of Vascular Medicine University of Colorado School of Medicine (UCHSC) Box B-180, 4200 E. 9th Ave Denver, Colorado 80262

Supervised, hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease. However, it has been suggested that unsupervised, home-based exercise programs, which have been relatively little evaluated, would be equally efficacious as compared with hospital-based programs. The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise perfor mance more than a home-based program. Of 20 consecutively enrolled patients with claudication, 10 were randomly placed into a supervised, hospital-based program and 10 into an unsupervised, home-based program for a three-month period. Exercise perfor mance was evaluated by treadmill testing using a graded protocol. In addition, func tional status was evaluated by the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study SF-20 questionnaire (MOS). Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit. Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with (continued on next page) the program. Patients in the hospital-based group improved peak walking time by 137%, pain-free walking time by 150%, and peak oxygen consumption by 19% (all P<0.05). Patients reported an improved walking distance and speed according to WIQ data (both P<0.05). In addition, the MOS physical functioning score in the hospital-based group improved by 20 percentage points (P<0.05). In contrast, patients in the home-based program did not improve exercise performance measured on the treadmill. Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home- based program (P<0.05). The ability to walk distances was the only questionnaire measure that improved in persons who received the home-based program (P<0.05). Preliminary results suggest that a supervised, hospital-based program is more effective for improving treadmill exercise performance than an unsupervised, home-based program.

Angiology, Vol. 48, No. 4, 291-300 (1997)
DOI: 10.1177/000331979704800402


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