Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA.
Division of Vascular Surgery, Michigan State University School of Medicine, Ann Arbor, MI.
J Vasc Surg. 2022 Dec;76(6):1651-1656.e1. doi: 10.1016/j.jvs.2022.06.087. Epub 2022 Jul 21.
Clinical practice guidelines recommend supervised exercise therapy (SET) as first-line therapy for patients with peripheral artery disease (PAD) and intermittent claudication (IC). The Society for Vascular Surgery Appropriate Use Criteria for IC deems excercise therapy (ET) as appropriate for all patients with IC. However, compliance with recommendations for the use of ET is often poor owing to the lack of availability, patient travel requirements, and cost. Results of home-based ET programs have been mixed with a trend toward improved results with more frequent patient engagement. The feasibility, use, and effectiveness of a 12-week app-based structured ET program using cognitive-behavioral therapy (CBT) techniques for IC was evaluated.
Patients with PAD confirmed by an abnormal ankle-brachial index or toe-brachial index and IC were recruited prospectively to participate in Society for Vascular Surgery SET, a 12-week app-based ET program. Participants performed home 6-minute walk tests, completed quality-of-life surveys, received education options via micro learning courses (eg, What is PAD?, Exercise, and Nutrition), and ongoing health coaching using CBT techniques. They were instructed to record at least three 30-minute ET walks a week using their personal mobile phones. Programming also included daily doses of health education, coaching, and reminders sent via text message.
One hundred thirty-nine patients (37% women; mean age, 65 years) were enrolled across 20 institutions (44% offered in-person ET programs). One hundred twenty patients (86%) completed the program. Participants recorded 201,163 minutes of walking 8,013,520 steps with the ET program, completing a total of 5049 SET walks. Nineteen enrolled participants (14%) became inactive because they either paused (14 participants: medical reasons, travel, or other) or withdrew (5 participants: security concerns, lack of motivation). Ninety-two percent of patients met their stated CBT specific, measurable, achievable, relevant, and time-bound goals. Freedom from intervention at 6 months was 92% and 69% at 12 months.
Deployment of a 12-week app-based ET program for PAD incorporating CBT was feasible in achieving 86% program completion and effective at meeting guideline recommended activity goals. Ninety-two percent of participants achieved their CBT specific, measurable, achievable, relevant, and time-bound goals. The use of ET was increased by virtue of offering this program at institutions that did not offer ET.
临床实践指南推荐有间歇性跛行（IC）的外周动脉疾病（PAD）患者接受监督下的运动疗法（SET）作为一线治疗。血管外科学会的适当使用标准认为，所有 IC 患者都适合进行运动疗法（ET）。然而，由于缺乏可用性、患者旅行需求和成本等原因，ET 的使用建议往往难以得到遵守。基于家庭的 ET 计划的结果喜忧参半，更频繁的患者参与度显示出改善的趋势。评估了一种使用认知行为疗法（CBT）技术的基于应用程序的 12 周结构化 ET 计划治疗 IC 的可行性、使用情况和效果。
通过异常的踝臂指数或趾臂指数证实患有 PAD 且有 IC 的患者前瞻性地被招募参加血管外科学会的 SET，这是一项为期 12 周的基于应用程序的 ET 计划。参与者在家中进行 6 分钟步行测试，完成生活质量调查，通过微学习课程（例如，什么是 PAD？、运动和营养）获得教育选择，并使用 CBT 技术进行持续的健康辅导。他们被指示每周至少记录三次 30 分钟的 ET 步行，使用个人手机。编程还包括每天通过短信发送健康教育、辅导和提醒。
在 20 个机构（44%提供现场 ET 计划）中，共招募了 139 名患者（37%为女性；平均年龄为 65 岁）。120 名患者（86%）完成了该计划。参与者使用 ET 计划记录了 201,163 分钟的步行时间，完成了 5049 次 SET 步行，共记录了 8,013,520 步。19 名入组的参与者（14%）因暂停（14 名参与者：医疗原因、旅行或其他）或退出（5 名参与者：安全问题、缺乏动力）而变得不活跃。92%的患者达到了他们规定的 CBT 特定、可衡量、可实现、相关和有时限的目标。6 个月时无干预的比例为 92%，12 个月时为 69%。
在实现 86%的计划完成率和有效满足指南推荐的活动目标方面，部署一个包含 CBT 的基于应用程序的 12 周 ET 计划治疗 PAD 是可行的。92%的参与者达到了他们的 CBT 特定、可衡量、可实现、相关和有时限的目标。通过在不提供 ET 的机构提供该计划，增加了 ET 的使用。
