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Home-based exercise with coach and wearable activity monitor (eg, Fitbit) no better than usual care for PAD
Clinical Question
Is a home-based exercise intervention including telephone coaching and a wearable activity monitor more effective than usual care for adults with peripheral arterial disease?
Bottom line
In the care of adults with clinically significant peripheral arterial disease (PAD), a home-based exercise intervention including a wearable activity monitor (Fitbit) and telephone coaching was no better than usual care for improving walking performance or overall quality of life. 1b
Reference
Study design: Randomized controlled trial (single-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
These investigators identified 200 adults (mean age 70.2 years) who met standard diagnostic criteria for PAD (mean arterial brachial index 0.66). The patients randomly received assignment (conceal allocation) to either a home-based exercise intervention or usual care. Patients in the intervention group received a wearable activity monitor and attended 4 weekly meetings in the first month with an exercise coach. Data from the wearable activity monitor were uploaded to a study website and were visible to the patient and coach. After the first month, the intervention continued with at least weekly phone calls from the coach, including a review of activity monitor data and a discussion of exercise goals, challenges to meeting goals, and strategies to overcome challenges. Group telephone meetings led by the coach also occurred twice monthly and included various topics about managing exercise pain and exercising in cold weather. Patients in the usual care group received no study intervention. Individuals masked to treatment group assignment assessed all outcomes. Complete follow-up occurred for 91% of participants at 9 months. Using intention-to-treat analysis, participants in the exercise intervention group reported greater increases in walking exercise frequency compared with the usual care group at 3 months of follow-up. However, at 9 months there was no longer any significant difference in exercise frequency between the intervention and control groups. Most important, at the 9-month follow-up, there was no significant difference for the primary outcome of mean change in 6-minute walk distance for the exercise intervention group compared with the usual care group. Similarly, there were no significant group differences in assessments of function or quality of life. Of note, there was a significantly greater decrease in the amount of daily pain reported by the usual care group compared with the exercise intervention group.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Les nouvelles technologies semblent bonnes pour motiver pour commencer l’exercice mais pas à le maintenir. Ce que je retiens c’est qu’il faut motiver les patients autant qu’on peut à faire l’exercice sans investir dans ces gadgets.
One has to wonder if participation and motivation waned in the exercise group beyond three months. I think adherence would be difficult to sustain and difficult to assess.
As an older physician we were supposed to try and get an autopsy on all deaths. We saw a lot of Atherosclerosis. It is not pretty. Seeing a few will quickly disabuse one of the notion that the rotten pipes can be fixed by exercise.
3 month improvement is significant - I am encouraged. Adults need constant tweaking and encouraging to maintain changes in exercise. After 9 months most programs would be stale.
MY PATIENTS HAVE VERY LIMITED ACCESS TO REHAB SERVICES (OR FITBITS!)
Apply to patient with PVD
Good poem