Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyApril 2023
Brief counselling from an allied health professional did not provide meaningful benefit.
Exercise training is an effective intervention for patients with peripheral artery disease (PAD) and intermittent claudication, but the best outcomes are achieved through supervised treadmill exercise, which is costly and not universally accessible. Home-based walking exercise would improve access for many patients, but the optimal approach to delivering this intervention is uncertain.
Investigators from two Australian hospitals performed a randomised trial to evaluate the effect of a brief counselling intervention to increase walking among patients with symptomatic PAD for whom vascular intervention was not planned. Trained allied health professionals counselled participants in two one-hour face-to-face sessions at a central facility and in two 15-minute telephone sessions designed to enhance knowledge and motivation to increase walking. Control patients received four 15-minute open-ended phone calls. The primary endpoint was the increase in number of daily steps at four-month follow up compared with baseline, assessed by accelerometer during a seven-day period.
A total of 200 patients were randomised (mean age, 69 years; 28% women), and 79% completed all four intervention sessions. At four-month follow up, daily steps had increased by 529 (about 10%) in the counselling group and 114 in the control group (about 2%), a difference of 415 steps, which was not statistically significant. There was also no improvement in daily steps at 12 or 24 months or in six-minute walk test distance at any time point. Several disease-specific quality-of-life scales showed small differences favouring the counselling intervention at both four and 12 months.
Comment: As an editorialist notes, the contrast between these neutral results and previous studies showing substantial benefit from supervised treadmill training and more-intensive home-based interventions suggests that more-intensive interventions should be preferred for such individuals. Whether the use of telemedicine-based interventions might span this gap should be actively investigated.
David J. Cohen, MD, MSc
Director of Clinical and Outcomes Research, Cardiovascular Research Foundation, New York City; Director of Academic Affairs, St. Francis Hospital, Roslyn, USA.
Golledge J, et al. Effect of brief counseling by allied health professionals on step count of people with peripheral artery disease: a randomized clinical trial. JAMA Cardiol 2023 Feb 8; e-pub (https://doi.org/10.1001/jamacardio.2022.5437).
McDermott MM. Walking exercise for peripheral artery disease. JAMA Cardiol 2023 Feb 8;
e-pub (https://doi.org/10.1001/jamacardio.2022.5443).
This summary is taken from the following Journal Watch title: Cardiology