Thangada Neela D, Zhang Dongxue, Zhao Lihui, Tian Lu, McDermott Mary M
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
J Vasc Surg. 2025 Feb;81(2):441-449.e1. doi: 10.1016/j.jvs.2024.10.013. Epub 2024 Oct 17.
Home-based walking exercise is first-line therapy for peripheral artery disease (PAD), but benefits of home-based walking exercise are variable. This study evaluated whether specific clinical characteristics were associated with greater improvement after home-based walking exercise or with higher rates of serious adverse events (SAEs).
Data were combined from two randomized clinical trials comparing home-based walking exercise with control in PAD. The home-based exercise interventions used behavioral interventions to help participants adhere to exercise. The primary outcome was the proportion of PAD participants who improved 6-minute walk (6MW) by at least 20 meters. Serious adverse events consisted of overnight hospitalizations or death that occurred during the randomized clinical trial.
Of 376 participants with PAD (69.6 years; 54.5% Black; 49.5% women), 217 were randomized to exercise and 159 to control. Home-based exercise improved 6MW by at least 20 meters in 100 participants (54.9%), compared with 37 (28.0%) in control (odds ratio, 3.13; 95% confidence interval, 1.94-5.06; P < .001). Age, sex, race, comorbidities, baseline 6MW, and income did not significantly alter the effect of home-based exercise on improved 6MW. SAEs occurred in 28.1% and 23.3% of participants randomized to exercise and control, respectively (P = .29). There were statistically significant interactions, indicating that home-based exercise increased SAE rates, compared with control, in Black compared with non-Black participants (P interaction < .001), in those with vs without coronary artery disease (CAD) (P interaction < .001), and in people with vs without history of heart failure (P interaction = .005).
Among people with PAD, home-based exercise improved 6MW by at least 20 meters in 54.9% of people. Older age, female sex, Black race, and specific comorbidities were not associated with lower rates of attaining meaningful improvement in 6MW following home-based exercise. Further study is needed to establish whether certain patient characteristics, such as history of coronary artery disease, may affect SAE rates in patients with PAD participating in home-based exercise.
居家步行锻炼是外周动脉疾病（PAD）的一线治疗方法，但居家步行锻炼的益处存在差异。本研究评估了特定临床特征是否与居家步行锻炼后更大程度的改善或更高的严重不良事件（SAE）发生率相关。
数据来自两项比较PAD患者居家步行锻炼与对照的随机临床试验。居家锻炼干预采用行为干预措施来帮助参与者坚持锻炼。主要结局是PAD参与者6分钟步行距离（6MW）改善至少20米的比例。严重不良事件包括随机临床试验期间发生的过夜住院或死亡。
在376例PAD患者（年龄69.6岁；54.5%为黑人；49.5%为女性）中，217例被随机分配至锻炼组，159例被分配至对照组。居家锻炼使100例参与者（54.9%）的6MW改善至少20米，而对照组为37例（28.0%）（优势比，3.13；95%置信区间，1.94 - 5.06；P <.001）。年龄、性别、种族、合并症、基线6MW和收入并未显著改变居家锻炼对6MW改善的效果。SAE分别发生在28.1%的锻炼组参与者和23.3%的对照组参与者中（P = 0.29）。存在统计学显著的交互作用，表明与对照组相比，居家锻炼使黑人参与者的SAE发生率高于非黑人参与者（交互作用P <.001），有冠状动脉疾病（CAD）者高于无CAD者（交互作用P <.001），有心力衰竭病史者高于无心力衰竭病史者（交互作用P = 0.005）。
在PAD患者中，居家锻炼使54.9%的患者6MW改善至少20米。年龄较大、女性、黑人种族和特定合并症与居家锻炼后6MW获得有意义改善的较低发生率无关。需要进一步研究以确定某些患者特征（如冠状动脉疾病史）是否会影响参与居家锻炼的PAD患者的SAE发生率。
