Home-Based Exercise

Abstract

People with lower extremity peripheral artery disease (PAD) have impaired lower extremity functioning, increased rates of functional decline, and faster rates of mobility loss than people without PAD,1 yet few therapies are available for improving functional performance or preventing mobility loss in people with PAD. Only 2 medications, pentoxifylline and cilostazol, are US Food and Drug Administration–approved for treating PAD-related walking impairment. No medications for PAD-related walking impairment have been US Food and Drug Administration–approved since 1999. Recent evidence shows that pentoxifylline is not much more effective than placebo, and benefits from cilostazol are modest. Most patients with PAD without critical limb ischemia are not candidates for lower extremity revascularization. Among patients with PAD who undergo angioplasty with stenting, up to 25% to 30% of these stents develop restenosis within 1 year.Supervised treadmill exercise has greater benefit than medications and is recommended as first-line therapy to improve walking performance in PAD, yet barriers exist to participation in supervised treadmill exercise for patients with PAD. First, supervised exercise is not reimbursed by health insurance, including Medicare. Many patients with PAD cannot afford this highly effective treatment. Second, traveling to an exercise center 3 times weekly for supervised exercise is burdensome, especially for patients with PAD whose mobility is limited. Even when supervised exercise is offered without costs to patients with PAD in a research program, many decline participation.2 In a recent …