Home-based walking intervention improves walking distance in PAD: MOSAIC study

A new study published in the Journal of American Medical Association suggests that a home-based, walking exercise habit modification intervention, compared to standard care, resulted in enhanced walking distance at 3 months in persons with peripheral artery disease (PAD) with intermittent claudication.

Home-based walking exercise therapies for persons with peripheral artery disease (PAD) are advised, however evidence of their usefulness is equivocal. As a result, Lindsay M. Bearne and colleagues did this research. To compare the impact of a home-based, walking exercise behavior modification intervention administered by physical therapists to conventional treatment in persons with PAD with intermittent claudication.

Between January 2018 and March 2020, 190 persons with PAD with intermittent claudication were enrolled in a multicenter randomized clinical study at six hospitals in the United Kingdom; the final follow-up date was September 8, 2020. Participants were randomly assigned to either a walking exercise habit modification intervention administered by physical therapists trained in a motivational approach (n = 95) or standard care (n = 95). At the 3-month follow-up, the primary outcome was a 6-minute walking distance (minimal clinically important difference, 8-20 m).

The key findings of this study were as follow:

1. 148 (78%) of the 190 randomized individuals completed the 3-month follow-up.

2. The intervention group's 6-minute walking distance increased from 352.9 m at baseline to 380.6 m at 3 months, whereas the usual care group's distance increased from 369.8 m to 372.1 m.

3. Five of the eight secondary outcomes were statistically insignificant.

4. At 6-month follow-up, baseline WELCH scores changed from 20.7 to 20.7 in the usual care group and from 18.0 to 27.8 in the intervention group, Brief Illness Perceptions Questionnaire scores changed from 45.7 to 38.9 in the intervention group and from 44.0 to 45.8 in the usual care group, and Theory of Planned Behavior Questionnaire attitude component scores changed from 14.7 to 15.4 in the intervention group and from 14.6 to 13.9 in the usual care group.

5. In the intervention group, thirteen significant adverse events occurred, compared to three in the usual care group. All were considered to be unconnected to the research or unlikely to be relevant.

In conclusion, when compared to normal care, a home-based walking exercise behavior modification intervention enhanced walking distance after 3 months. More study is needed to assess the long-term viability of these findings.

Reference:

Bearne LM, Volkmer B, Peacock J, et al. Effect of a Home-Based, Walking Exercise Behavior Change Intervention vs Usual Care on Walking in Adults With Peripheral Artery Disease: The MOSAIC Randomized Clinical Trial. JAMA. 2022;327(14):1344–1355. doi:10.1001/jama.2022.3391