African Americans (AAs) are nearly twice as likely as non-Hispanic whites to suffer from peripheral arterial disease (PAD) - a disease which affects 12 million Americans and is defined as atherosclerosis of the abdominal aorta and arteries of the lower extremities. When compared to non-Hispanic whites with PAD, AAs with PAD have more severe disease and a greater reduction in walking distance, speed, and/or stair climbing. AAs experience more severe PAD as a result of lower levels of physical activity. This is concerning as exercise, in the form of walking, improves muscle strength, reduces walking impairment, and increases walking distance in patients with PAD. The benefits of walking therapy are only realized if the patient adheres to such therapy. Given the lower levels of physical activity in AAs with PAD, progression of disease and worsening lower limb function is of grave concern. Efforts are needed to increase home-based walking in AAs with PAD with a resultant increase in walking distance. Such efforts should target low motivation. Given its effectiveness for individuals who are less ready to change, motivational interviewing is an ideal counseling method to promote home-based walking in AAs with PAD. In a pilot study, we used a counseling protocol, Patient-centered Assessment and Counseling for Exercise (PACE), to improve home-based walking and lower limb outcomes. Using PACE, we demonstrated an improvement in lower limb blood flow and stair climbing ability but the PACE protocol does not specifically address low motivation and is not culturally sensitive. We hypothesize that our PACE protocol combined with motivational interviewing plus culturally sensitive print material will increase home-based walking and reduce walking impairment in AAs with PAD. For this proposed work, we seek to determine the efficacy of our PACE protocol combined with motivational interviewing and culturally sensitive print material (PACE Plus) to increase walking distance in AAs with PAD. We will deliver the PACE Plus protocol for 6 months, using both face-to-face visits and telephone contact. Our primary outcome will be walking distance 6 months (i.e., at the end of active intervention). We will randomize participants (n=180) to one of three study arms: 1) Attention Control (Tx1); 2) PACE alone (Tx2); or 3) PACE Plus (Tx3). Achievement of the above aims will help to identify an innovative approach to increasing home-based walking and reducing walking impairment in AAs with PAD.
Home-based walking programs increase walking distance in patients with peripheral arterial disease (PAD). Home-based walking provides a more feasible and cost-effective method to improve the health of African Americans with PAD. Unfortunately, the motivation of African Americans to adhere to home-based walking is greatly limited without additional reinforcement and no prior studies have focused on this population. We seek to determine the efficacy of a counseling protocol that targets the stage of change and self-efficacy, which is reinforced with motivational interviewing and culturally sensitive print material, to increase walking distance, at 6- and 12-months, in African Americans with PAD.
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