Development and evaluation of a home-based exercise programme for people with symptomatic peripheral artery disease

Abstract

Intermittent claudication (IC) is the symptomatic presentation of peripheral arterydisease (PAD), a chronic condition associated with poor health outcomes and qualityof life. While supervised exercise programmes are standard care for IC, travel andtime commitments can lead to poor uptake from patients. Home-based exerciseprogrammes (HBEPs) are a potential alternative to overcome these barriers, yet theoptimal design remains unclear.

The primary aim of this thesis was to design and evaluate a novel HBEP for those withIC. To achieve this, first a systematic review was undertaken to assess the safety ofHBEPs for those with IC. A wearable physical activity monitor was used to facilitatethe HBEP which was investigated for its reliability and validity against a research gradeaccelerometer. Finally, the feasibility of conducting a randomised controlled trial of aHBEP was assessed, with semi-structured interviews performed to understandparticipant acceptability of the programme.

This is the first project to investigate the safety of HBEPs for people with IC; the keyfindings being that they were deemed safe, yet more care may potentially bewarranted in programmes prescribing exercise to ‘high’ pain thresholds. Secondly, theassessment of the Fitbit Charge 4© revealed ‘good’ reliability, yet it overestimated stepcount when compared to the ActiGraph wGT3X-BT accelerometer, indicating aprogressive increase in physical activity rather than specific step goals should be thefocus of the HBEP. Finally, the HBEP was well tolerated, with minimal attrition andparticipants generally found the programme enjoyable. Adherence and compliancewith the intervention varied, with key emphasis placed on participant autonomy, butwould be considered feasible. As part of a fully powered trial, with accompanyingbehavioural change techniques, this HBEP has the potential to be an effectivealternative for those with IC unable to attend traditional supervised exerciseprogrammes.

Date of Award	Sept 2024
Original language	English
Awarding Institution	Coventry University
Supervisor	Amy Harwood (Supervisor), David Broom (Supervisor), Gordon McGregor (Supervisor) & Stefan T. Birkett (Supervisor)