Incentives and individualized coaching improve completion rates of supervised exercise therapy for claudication

Area of Science:

• Vascular Medicine
• Exercise Physiology
• Quality Improvement

Background:

• Supervised exercise therapy (SET) is a recommended first-line treatment for intermittent claudication.
• Published SET program completion rates are historically low, ranging from 5% to 55%.
• Low adherence to SET may limit its clinical benefits for peripheral artery disease (PAD) patients.

Purpose of the Study:

• To determine if targeted patient-supportive interventions can enhance SET program completion rates.
• To assess the impact of improved SET adherence on patient outcomes and subsequent vascular interventions.
• To maintain the efficacy of SET programming while improving patient participation.

Main Methods:

• A prospective quality improvement protocol enrolled 73 patients with intermittent claudication (ABI < 0.9).
• A three-pronged approach was used: financial incentives (up to $180), scheduled coaching, and informational materials.
• Program completion was defined as ≥24 of 36 sessions over 12 weeks; outcomes included symptom improvement, functional measures, and time to vascular intervention.

Main Results:

• SET completion rate increased to 76.7% (56 out of 73 patients) with the intervention, a significant improvement.
• Completed SET patients reported reduced leg pain and improved walking ability (P = .004 and P = .038, respectively).
• Functional measures improved significantly, including walking duration (30 vs 13.5 min), distance (0.7 vs 0.3 miles), and METs (3.1 vs 2.6); time to vascular intervention was delayed (213.5 vs 122.5 days).

Conclusions:

• Targeted incentives and personalized coaching effectively improved patient completion of supervised exercise therapy.
• SET completion led to subjective and objective improvements in walking symptoms and functional capacity.
• Improved SET adherence delays the need for vascular intervention, supporting its role as a critical first-line therapy.