Community walking programs for treatment of peripheral artery disease

Background: Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), although effective, are often not used due to barriers, including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option because they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methods and outcomes of community walking programs for PAD. Methods: A literature review using appropriate search terms was conducted within PubMed/MEDLINE and the Cochrane databases to identify studies in the English language that used community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. Results: Ten randomized controlled trials examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes, with no differences in peak walking time compared with supervised walking exercise groups. Conclusions: Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs.