Annals of Behavioral Medicine

, Volume 33, Issue 3, pp 318–324 | Cite as

Unsupervised walking therapy and atherosclerotic risk-factor management for patients with peripheral arterial disease: A pilot trial

  • Tracie C. Collins
  • Shawna L. Johnson
  • Julianne Souchek


Background: Although only a small percentage of patients with peripheral arterial disease (PAD) have claudication, many more suffer from atypical leg symptoms.Purpose: This pilot trial evaluated a risk-factor modification program to improve walking ability in patients with PAD and leg symptoms other than intermittent claudication.Methods: Patients 18 years or older with an ankle-brachial index (ABI) of 0.50 to 0.89 completed a baseline assessment of current walking ability, physical activity level, health-related quality of life, glycosylated hemoglobin values, and fasting lipid profiles. Patients were randomized to usual care (control group) versus usual care plus an educational intervention on risk-factor management (intervention group). We compared functional outcomes between and within groups using the Student’s t test and control and intervention group outcomes at 12 weeks using analysis of covariance with the baseline value as the covariate.Results: We randomized 50 patients into two treatment arms. There was no difference in the mean age of patients in each group. At baseline, mean ABI for the control versus the intervention group was 0.72 (SD=0.10) and 0.75 (SD=0.10), respectively, and mean stair-climbing values did not differ between groups. At 12 weeks, mean stair-climbing values were 40.2 (SD=30.2) for the control and 61.2 (SD=32.8) for the intervention group. The difference in adjusted mean walking distance between groups at 12 weeks was not significant. Analysis of covariance associated assignment to the intervention versus the control arm with a significant increase at 12 weeks in the ABI (p=.008) and stair-climbing ability (p=.02).Conclusions: Patients in the intervention group improved objective measures of blood flow and reported stair-climbing ability.


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  1. (1).
    Savage P, Ricci MA, Lynn M, et al.: Effects of home versus supervised exercise for patients with intermittent claudication.Journal of Cardiopulmonary Rehabilitation. 2001,21:152–157.PubMedCrossRefGoogle Scholar
  2. (2).
    Gardner A, Katzel L, Sorkin J, Goldberg A: Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease: A randomized controlled trial.Journal of Cardiopulmonary Rehabilitation. 2002,22:192–198.PubMedCrossRefGoogle Scholar
  3. (3).
    Hiatt W: Medical treatment of peripheral arterial disease and claudication.New England Journal of Medicine. 2001,344:1608–1621.PubMedCrossRefGoogle Scholar
  4. (4).
    Regensteiner J: Exercise in the treatment of claudication: Assessment and treatment of functional impairment.Vascular Medicine. 1997,2:238–242.PubMedGoogle Scholar
  5. (5).
    Regensteiner J, Meyer T, Krupski W, Cranford L, Hiatt W: Hospital vs home-based exercise rehabilitation for patients with peripheral arterial occlusive disease.Angiology. 1997,48:291–300.PubMedCrossRefGoogle Scholar
  6. (6).
    Collins T, Petersen N, Suarez-Almazor M, Ashton C: The prevalence of peripheral arterial disease in a racially diverse population.Archives of Internal Medicine. 2003,163:1469–1474.PubMedCrossRefGoogle Scholar
  7. (7).
    Hirsch A, Criqui M, Treat-Jacobson D, et al.: Peripheral arterial disease detection, awareness, and treatment in primary care.Journal of the American Medical Association. 2001,286:1317–1324.PubMedCrossRefGoogle Scholar
  8. (8).
    McDermott M, Greenland P, Kiang L, et al.: Leg symptoms in peripheral arterial disease: Associated clinical characteristics and functional impairment.Journal of the American Medical Association. 2001,286:1599–1606.PubMedCrossRefGoogle Scholar
  9. (9).
    Criqui M, Denenberg J, Bird C, et al.: The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing.Vascular Medicine. 1996,1:65–71.PubMedGoogle Scholar
  10. (10).
    Adams R: Revised Physical Activity Readiness Questionnaire.Canadian Family Physician. 1999,45:992, 995, 1004–1005.PubMedGoogle Scholar
  11. (11).
    Calfas K, Sallis J, Oldenberg B, Ffrench M: Mediators of change in physical activity following an intervention in primary care: PACE.Preventive Medicine. 1997,26:297–304.PubMedCrossRefGoogle Scholar
  12. (12).
    McDermott M, Greenland P, Liu K, et al.: The ankle-brachial index is associated with leg function and physical activity: The Walking and Leg Circulation Study.Annals of Internal Medicine. 2002,136:873–883.PubMedGoogle Scholar
  13. (13).
    Regensteiner J, Steiner J, Panzer R, Hiatt W: Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease.Journal of Vascular Medicine and Biology. 1990,2:142–152.Google Scholar
  14. (14).
    McHorney C, Ware J, Raczek A: The MOS 36-item short form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.Medical Care. 1993,31:247–263.PubMedCrossRefGoogle Scholar
  15. (15).
    Ware J, Kosinski M, Keller S:SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston: The Health Assessment Lab, New England Medical Center, 1994.Google Scholar
  16. (16).
    National Heart, Lung, and Blood Institute and Office of Research on Minority Health:Be Heart Smart! 2004. Retrieved from (2005)Google Scholar
  17. (17).
    U.S. Department of Health and Human Services:Your guide to lowering blood pressure. 2004. Retrieved from (2005)Google Scholar
  18. (18).
    American Dietetic Association:Diabetes Care and Education. 2004. Retrieved from (2005)Google Scholar
  19. (19).
    American Diabetes Association:Control the ABCs of Diabetes. 2004. Retrieved from (2005)Google Scholar
  20. (20).
    University of Georgia College of Pharmacy:Pharmacy Adherence. 2004. Retrieved from (2005)Google Scholar
  21. (21).
    Calfas K, Long B, Sallis J, et al.: A controlled trial of physician counseling to promote the adoption of physical activity.Preventive Medicine. 1996,25:225–233.PubMedCrossRefGoogle Scholar
  22. (22).
    Delis KT, Nicolaides AN, Wolfe JH, Stansby G: Improving walking ability and ankle brachial pressure indices in symptomatic peripheral vascular disease with intermittent pneumatic foot compression: A prospective controlled study with one-year follow-up.Journal of Vascular Surgery. 2000,31:650–661.PubMedCrossRefGoogle Scholar
  23. (23).
    Mannarino E, Pasqualini L, Innocente S, et al.: Physical training and antiplatelet treatment in stage II peripheral arterial occlusive disease: Alone or combined?Angiology. 1991,42:513–521.PubMedCrossRefGoogle Scholar
  24. (24).
    Regensteiner J, Steiner J, Hiatt W: Exercise training improves functional status in patients with peripheral arterial disease.Journal of Vascular Surgery. 1996,23:104–115.PubMedCrossRefGoogle Scholar
  25. (25).
    Hiatt W, Wolfel E, Meier R, Regensteiner J: Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response.Circulation. 1994,90:1866–1874.PubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2007

Authors and Affiliations

  • Tracie C. Collins
    • 1
  • Shawna L. Johnson
    • 2
  • Julianne Souchek
    • 3
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of MinnesotaUSA
  2. 2.Michael E. DeBakey VA Medical CenterBaylor College of MedicineUSA
  3. 3.Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical CenterBaylor College of MedicineUSA

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