Lower extremity peripheral arterial disease (PAD) affects 10% to 15% of community dwelling men and women age 65 and older. Our work and that of others show that patients with PAD have a higher prevalence of lower extremity functional impairment and increased rates of functional decline compared to persons without PAD. The specific functional impairments documented in persons with PAD are associated with increased risks of disability, nursing home placement, hospitalization, and mortality in community-dwelling populations. Supervised exercise rehabilitation programs improve treadmill walking performance in patients with PAD. However, few PAD patients have access to supervised exercise rehabilitation programs because of costs and barriers to the travel required back and forth to the exercise facility. Consequently, few PAD patients participate in supervised exercise programs. Current clinical guidelines for management of patients with PAD indicate that there are insufficient data to support home-based walking exercise programs in persons with PAD. A definitive clinical trial is needed to determine whether an intervention designed to increase home-based walking exercise improves lower extremity functioning in patients with PAD. The primary aim of this study is to determine whether an intervention designed to increase home-based walking exercise significantly improves six-minute walk performance in men and women with PAD.
Our specific aims will be tested in 200 men and women with PAD. Our intervention employs a Group Mediated Cognitive Behavioral intervention to help patients with PAD overcome identified barriers and develop the skills necessary to engage in regular home walking exercise. A multidisciplinary team with internationally-recognized expertise in exercise, behavioral interventions, PAD, functional outcomes, and exercise rehabilitation has been assembled to carry out the proposed study. If a home-based walking exercise program significantly benefits patients with PAD, this finding will have significant implications for maintaining functioning and preventing functional decline in the large and growing number of men and women with PAD. Previous study shows that patients with lower extremity peripheral arterial disease (PAD) have greater functional impairment, increased rates of functional decline, and increased mobility loss compared to persons without PAD. Yet few therapies have been identified that improve lower extremity functioning or prevent functional decline or mobility loss in persons with PAD. Current clinical guidelines for management of patients with PAD indicate that there are insufficient data to support home-based walking exercise programs in persons with PAD. A definitive clinical trial is needed to determine whether an intervention designed to increase home-based walking exercise improves lower extremity functioning in patients with PAD. If a home-based walking exercise program significantly benefits patients with PAD, this finding will have significant implications for maintaining functioning and preventing functional decline in the large and growing number of men and women with PAD. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL088589-01A1
Application #
7372129
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Ershow, Abby
Project Start
2008-04-01
Project End
2012-03-31
Budget Start
2008-04-01
Budget End
2009-03-31
Support Year
1
Fiscal Year
2008
Total Cost
$754,757
Indirect Cost
Name
Northwestern University at Chicago
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
005436803
City
Chicago
State
IL
Country
United States
Zip Code
60611
McDermott, Mary M; Peterson, Charlotte A; Sufit, Robert et al. (2018) Peripheral artery disease, calf skeletal muscle mitochondrial DNA copy number, and functional performance. Vasc Med 23:340-348
Cason, Cori A; Dolan, Kyle T; Sharma, Gaurav et al. (2018) Plasma microbiome-modulated indole- and phenyl-derived metabolites associate with advanced atherosclerosis and postoperative outcomes. J Vasc Surg 68:1552-1562.e7
Parast, Layla; McDermott, Mary M; Tian, Lu (2016) Robust estimation of the proportion of treatment effect explained by surrogate marker information. Stat Med 35:1637-53
White, Sarah H; McDermott, Mary M; Sufit, Robert L et al. (2016) Walking performance is positively correlated to calf muscle fiber size in peripheral artery disease subjects, but fibers show aberrant mitophagy: an observational study. J Transl Med 14:284
McDermott, Mary M; Guralnik, Jack M; Criqui, Michael H et al. (2015) Unsupervised exercise and mobility loss in peripheral artery disease: a randomized controlled trial. J Am Heart Assoc 4:
Rejeski, W Jack; Spring, Bonnie; Domanchuk, Kathryn et al. (2014) A group-mediated, home-based physical activity intervention for patients with peripheral artery disease: effects on social and psychological function. J Transl Med 12:29
McDermott, Mary M; Guralnik, Jack M; Criqui, Michael H et al. (2014) Home-based walking exercise in peripheral artery disease: 12-month follow-up of the GOALS randomized trial. J Am Heart Assoc 3:e000711
Huang, Chiang-Ching; McDermott, Mary M; Liu, Kiang et al. (2013) Plasma metabolomic profiles predict near-term death among individuals with lower extremity peripheral arterial disease. J Vasc Surg 58:989-96.e1
McDermott, Mary McGrae (2013) Functional impairment in peripheral artery disease and how to improve it in 2013. Curr Cardiol Rep 15:347
McDermott, Mary M; Liu, Kiang; Guralnik, Jack M et al. (2013) Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. JAMA 310:57-65

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