Home-based exercise for elderly patients with intermittent claudication limited by osteoarticular disorders - feasibility and effectiveness of a low-intensity programme

Vasa. 2018 Apr;47(3):227-234. doi: 10.1024/0301-1526/a000692. Epub 2018 Feb 21.


Background: Peripheral arterial disease (PAD) is a common cardiovascular pathology affecting mobility in elderly. Osteoarticular diseases (ODs), responsible for functional limitations and confounding leg symptoms, may interfere with exercise therapy. This study evaluates the feasibility and effectiveness of a structured home-based exercise programme on rehabilitative outcomes in a cohort of elderly PAD patients with and without coexisting ODs.

Patients and methods: Patients were enrolled from 2002 to 2016 in an exercise programme prescribed and controlled at the hospital and based on two daily 10-minute home walking sessions below the self-selected speed. The presence and localization of ODs at baseline were derived from consultation of medical documents. The ankle-brachial index and functional outcomes, defined as speed at the onset of claudication and attainable maximal speed by an incremental treadmill test, were assessed at baseline and discharge. Feasibility was determined according to dropout rate, number of visits, duration of the programme, and adherence.

Results: A total of 1,251 PAD patients were enrolled (931 men; 71 ± 9 years; 0.63 ± 0.19 ankle-brachial index). Eight hundred sixty-four patients were free of ODs (ODfreePAD, 69 %), whereas 387 were affected by ODs (ODPAD, 31 %), predominantly located in the spine (72 %). In the logistic regression models, the presence of ODs was associated with female sex, overweight, sedentary and/or driving professions. At discharge, ODPAD and ODfreePAD did not differ in dropout rates (12 % each), programme duration (378 ± 241 vs. 390 ± 260 days), number of visits (7 ± 3 each), and adherence (80 % each). Similar improvements for ODPAD and ODfreePAD were observed for the ankle-brachial index (0.06 ± 0.12 each), the speed at onset of claudication (0.7 ± 0.7 vs. 0.7 ± 0.8 kmh-1; p = 0.70), and maximal speed (0.4 ± 0.6 vs. 0.4 ± 0.6 kmh-1; p = 0.77).

Conclusions: Equally satisfactory rehabilitative outcomes were observed in elderly patients with claudication limited by ODs who completed a well-tolerated, low-impact structured exercise programme.

Keywords: Peripheral arterial disease; exercise testing; exercise therapy; mobility; rehabilitation.

MeSH terms

  • Ankle Brachial Index
  • Comorbidity
  • Exercise Test
  • Exercise Therapy / methods*
  • Exercise Tolerance
  • Feasibility Studies
  • Female
  • Health Status
  • Home Care Services, Hospital-Based*
  • Humans
  • Intermittent Claudication / diagnosis
  • Intermittent Claudication / epidemiology
  • Intermittent Claudication / physiopathology
  • Intermittent Claudication / therapy*
  • Italy / epidemiology
  • Joint Diseases / diagnosis
  • Joint Diseases / epidemiology
  • Joint Diseases / physiopathology*
  • Male
  • Patient Compliance
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / epidemiology
  • Peripheral Arterial Disease / physiopathology
  • Peripheral Arterial Disease / therapy*
  • Prevalence
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler, Color
  • Walking Speed