Effect of a standalone rehabilitation programme for patients with peripheral arterial disease on claudication, cardiovascular risk factors and quality of life

Abstract

Background/Aims There have been calls to make rehabilitation programmes more accessible to patients with peripheral arterial disease. This study aimed to evaluate the effectiveness of a standalone peripheral arterial disease rehabilitation programme on walking outcomes, quality of life and cardiovascular risk factors as primary outcomes. Secondary outcomes relating to the characteristics that may have influenced change in walking outcomes and reasons for non-attendance or non-completion were also explored. Methods In this prospective, observational, one-site study, new patients were offered a 10-week programme, consisting of exercise, education and intervention for uncontrolled cardiovascular risk factors, in line with international peripheral arterial disease guidelines. Claudication times were measured using the Gardner-Skinner protocol and quality of life was measured using VascuQol. Pre- and post-intervention data were analysed using the SPSS version 23, with Pearson's Rho, Spearman's Rho and t tests being performed as appropriate. Statistical significance was set at P<0.05. Results Of the 160 referrals received, 114 patients were enrolled in the programme and 89 (78%) completed it. Reasons for non-completion were mainly either logistical (domestic commitments or return to work) or perceptions of insuitability relating to age, infirmity or severity of peripheral arterial disease. Of those who completed the programme, the median age was 66 years, 81% were men, 71% had a history of hypertension, 25% had diabetes and 37% smoked. There were significant pre–post improvements (P<0.05) in initial and maximum claudication time and distance, systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein and quality of life scores. Improvements in maximum claudication times were associated with lower baseline initial claudication times, lower body mass index, some quality of life scores and male gender. Conclusions The peripheral arterial disease rehabilitation programme was effective in improving functional capacity, quality of life and some cardiovascular risk factors. Factors found to influence improvements in claudication times could be discussed with patients before and during the programme to address misperceptions, provide encouragement and improve compliance and recruitment. The safe environment of supervised exercise may have contributed to these results, prompting efforts to make exercise accessible to all patients with peripheral arterial disease.