Exercise Therapy for PAD Using Mobile Health
Enhanced Home-Based Exercise Therapy for Peripheral Arterial Disease Through Mobile Health and Remote Monitoring
VA Office of Research and Development
75 participants
Dec 1, 2021
INTERVENTIONAL
Conditions
Summary
Peripheral artery disease (PAD) is a highly prevalent condition affecting up to 10% of Veterans that leads to loss of walking ability and increased risk of amputation. Veterans have limited access to supervised exercise therapy, a facility-based program proven to improve walking ability in PAD, which is poorly attended due to the inconvenience and cost of attending a 12-week program with multiple weekly sessions. This CDA-2 application will investigate the feasibility of home-based exercise therapy (HBET) delivered using mobile health (mHealth) technologies in Veterans with symptomatic PAD. We will partner with the MOVE! program to deliver HBET through group behavioral coaching and a novel wearable activity monitor in a newly proposed program called Smart MOVE!. There is a clear need to provide effective and convenient alternatives to supervised exercise for Veterans with PAD. This study will provide evidence to proceed with Smart MOVE!, a much-needed patient-centered rehabilitation program for Veterans with PAD.
Eligibility
Inclusion Criteria5
- Age >40 years
- Eligible Veteran status
- Clinically stable intermittent claudication ( 2 months of Rutherford Class II symptoms, no evidence of chronic limb-threatening ischemia)
- Established PAD diagnosis (abnormal ankle-brachial index or evidence of PAD on prior certified vascular laboratory or radiology imaging)
- Access to safe location to perform walking exercises
Exclusion Criteria32
- Above or below knee amputation
- critical limb ischemia (rest pain or tissue loss including ulceration or gangrene)
- inability to walk without a walker
- wheelchair confinement
- non-English speaking
- significant visual impairment that interferes with walking activity
- hearing impairment that interferes with full study participation
- unable or unwilling to return to the medical center at the expected visit frequency or unable or unwilling to use the technology required for the intervention
- Individuals whose walking is limited by a condition other than PAD
- Any active cardiac condition including unstable angina
- unstable atrial or ventricular arrhythmias
- high-grade heart block without a pacemaker
- active myopericarditis
- recent venous thromboembolism
- or recent abnormal baseline stress test suggesting ischemia
- other high-risk findings (e.g., drop of systolic blood > 20 mmHg with exercise)
- Presence of Class III NYHA heart failure or CCS III angina.
- Major surgery including lower extremity revascularization or orthopedic surgery during the preceding three months or anticipated in the next nine months
- Major medical illness including lung disease requiring continuous oxygen (patients wearing nighttime oxygen only may still qualify)
- neurodegenerative disorders such as Parkinson's Disease that impair walking ability
- cancer requiring treatment in the past 2 years (with exception for non-melanoma skin cancer or if they received treatment for early-stage cancer with an excellent overall prognosis)
- Heart attack, stroke, or coronary artery bypass surgery in the preceding 3 months
- Mental health illness that may interfere with the ability to consent and/or participate in the study, including mini-mental status examination score <24
- dementia
- active psychiatric disorder such as schizophrenia or bipolar disorder
- history of suicidal or homicidal ideation in the preceding six months
- history of suicidal attempts in the preceding 12 months
- history of active substance use in the preceding six months that would interfere with study participation (as determined by their primary care or mental health provider)
- Subjects endorsing SI or HI may be eligible for continued participation with monitoring if approved by their primary mental health provider
- Currently walking regularly for exercise at a level comparable to the amount of exercise prescribed in the intervention
- Currently enrolled in another clinical trial or structured exercise program (i.e., cardiac rehabilitation)
- Deemed to be poorly suited for the study or the study intervention at the discretion of the PI or study staff
Interested in this trial?
Get notified about updates and connect with the research team.
Interventions
Multi-component behavioral intervention of PAD consisting of: 1. guideline-directed HBET prescription 2. active behavioral coaching (via MOVE! program or other) 3. mobile health monitoring
Basic guidance on performing walking exercises for PAD according to established guidelines. Participants will receive a mobile health device for self-tracking only but not receive any behavioral coaching.
Preliminary performance evaluation determine the optimal components of the Smart MOVE! intervention. Specific procedures will include: 1. Provider and stakeholder interviews 2. PAD patient interviews 2\) N-of-1 trials to refine the intervention
Locations(1)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT04889105