Decision Aids for Determining Facility Versus Non-Facility-Based Exercise in Those with Symptomatic Peripheral Artery...

Area of Science:

• Cardiovascular Medicine
• Rehabilitation Science

Background:

• Supervised exercise therapy (SET) is a Class IA recommended treatment for symptomatic peripheral artery disease (PAD).
• Interest is growing in non-facility-based exercise training as an alternative to traditional supervised programs.
• Current literature shows mixed effectiveness for non-facility-based training, influenced by supervision, intensity, and frequency.

Purpose of the Study:

• To provide a rationale for referring patients with symptomatic PAD to home-based versus facility-based exercise therapy.
• To explore the underutilization of facility-based SET and the potential role of alternative exercise settings.

Main Methods:

• Review of randomized controlled trials and current literature on exercise therapy for PAD.
• Analysis of factors influencing the effectiveness of non-facility-based exercise (e.g., supervision, intensity, frequency).
• Consideration of barriers to facility-based exercise and patient-specific factors for home-based recommendations.

Main Results:

• Facility-based SET is considered the gold standard for symptomatic PAD.
• Non-facility-based exercise may improve walking performance but is generally inferior to facility-based SET.
• Utilization of facility-based SET is likely less than 2% among eligible patients, suggesting a need for alternatives.

Conclusions:

• Non-facility-based exercise can help overcome common barriers like motivation, transportation, and proximity.
• Referral for home-based exercise requires careful consideration of disease severity, patient motivation, resources, mobility, balance, cognitive function, and comorbidities.
• Facility-based SET remains underutilized, highlighting the importance of optimizing access and exploring alternative delivery models.