A group-mediated, home-based physical activity intervention for patients with peripheral artery disease: effects on social and psychological function

W Jack Rejeski, Bonnie Spring, Kathryn Domanchuk, Huimin Tao, Lu Tian, Lihui Zhao, Mary M McDermott, W Jack Rejeski, Bonnie Spring, Kathryn Domanchuk, Huimin Tao, Lu Tian, Lihui Zhao, Mary M McDermott

Abstract

Background: PAD is a disabling, chronic condition of the lower extremities that affects approximately 8 million people in the United States. The purpose of this study was to determine whether an innovative home-based walking exercise program for patients with peripheral artery disease (PAD) improves self-efficacy for walking, desire for physical competence, satisfaction for physical functioning, social functioning, and acceptance of PAD related pain and discomfort.

Methods: The design was a 6-month randomized controlled clinical trial of 194 patients with PAD. Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition.

Results: Of the 194 participants randomized, 178 completed the baseline and 6-month follow-up visit. The mean age was 70.66 (±9.44) and was equally represented by men and women. Close to half of the cohort was African American. Following 6-months of treatment, the intervention group experienced greater improvement on self-efficacy (p = .0008), satisfaction with functioning (p = .0003), pain acceptance (p = .0002), and social functioning (p = .0008) than the control group; the effects were consistent across a number of potential moderating variables. Change in these outcomes was essentially independent of change in 6-minute walk performance.

Trial registration: [ClinicalTrials.gov Identifier: NCT00693940].

Figures

Figure 1
Figure 1
Forest plots for treatment differences (±95 CI) on selected characteristics for self- efficacy and satisfaction with physical function. Legend: Mdn = median; BLV = baseline visit; IC = intermittent claudication; the plotted points represent change from baseline for the control and intervention groups and the p values to the right are the probability values for the control versus treatment comparisons.
Figure 2
Figure 2
Forest plots for treatment differences (±95 CI) on selected characteristics for pain acceptance and social provisions. Legend: Mdn = median; BLV = baseline visit; IC = intermittent claudication; the plotted points represent change from baseline for the control and intervention groups and the p values to the right are the probability values for the control versus treatment comparisons.

References

    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB. et al.Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245. doi: 10.1161/CIR.0b013e31828124ad.
    1. McDermott MM, Greenland P, Liu K, Guralnik JM, Criqui MH, Dolan NC. et al.Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. 2001;286:1599–1606. doi: 10.1001/jama.286.13.1599.
    1. McDermott MM, Liu K, Greenland P, Guralnik JM, Criqui MH, Chan C. et al.Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004;292:453–461. doi: 10.1001/jama.292.4.453.
    1. McDermott MM, Ferrucci L, Liu K, Guralnik JM, Tian L, Liao Y. et al.Leg symptom categories and rates of mobility decline in peripheral arterial disease. J Am Geriatr Soc. 2010;58:1256–1262. doi: 10.1111/j.1532-5415.2010.02941.x.
    1. McDermott MM, Liu K, Guralnik JM, Criqui MH, Spring B, Tian L. et al.Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. JAMA. 2013;310:57–65. doi: 10.1001/jama.2013.7231.
    1. Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health. 1998;13:623–650. doi: 10.1080/08870449808407422.
    1. Cutrona CE, Russell DW. In: Advances in Personal Relationships. Jones WHP, editor. Greenwich, CT: JIA Press; 1987. The provisions of social relationships and adaptation to stress; pp. 37–67.
    1. Rejeski WJ, Brawley LR, Jung ME. In: Hazzard’s Principles of Geriatric Medicine and Gerontology. 6. Halter J, editor. New York: McGraw-Hill; 2008. Self-management in geriatric medicine; pp. 325–341.
    1. McAuley E, Rudolph D. Physical activity, aging, and psychological well-being. JAPA. 1995;3:67–96.
    1. Rejeski WJ, King AC, Katula JA, Kritchevsky S, Miller ME, Walkup MP. et al.Physical activity in prefrail older adults: confidence and satisfaction related to physical function. J Gerontol: Psychol Sci Soc Sci. 2008;63:19–26. doi: 10.1093/geronb/63.1.P19.
    1. McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 2004;107:159–166. doi: 10.1016/j.pain.2003.10.012.
    1. Rejeski WJ, Tian L, Liao Y, McDermott MM. Social cognitive constructs and the promotion of physical activity in patients with peripheral artery disease. J Cardiopulmon Rehab Prev. 2008;28:65–72. doi: 10.1097/01.HCR.0000311512.61967.6e.
    1. McDermott MM, Domanchuk K, Liu K, Guralnik JM, Tian L, Criqui MH. et al.The Group Oriented Arterial Leg Study (GOALS) to improve walking performance in patients with peripheral arterial disease. Contemp Clin Trials. 2012;33:1311–1320. doi: 10.1016/j.cct.2012.08.001.
    1. McDermott MM, Dyer A. Treadmill exercise or resistance training in patients with peripheral arterial disease reply. JAMA. 2009;301:1986–1987.
    1. Ray KM, Hector LL, Lynes LK, Stewart AL, Painter PL, Dibble SL. Assessment of satisfaction with physical fitness in kidney transplant recipients. MMSE. 1996;28(Supplement):S7–S8.
    1. Reboussin BA, Rejeski WJ, Martin KA, Callahan K, Dunn AL, King AC. et al.Correlates of satisfaction with body function and body appearance in middle- and older aged adults: the Activity Counseling Trial (ACT) Psychol Health. 2000;15:239–254. doi: 10.1080/08870440008400304.
    1. Rejeski WJ, Mihalko SL. Physical activity and quality of life in older adults. J Gerontol: Bio Sci Med Sci. 2001;56:23–35. doi: 10.1093/gerona/56.suppl_2.23.
    1. Rejeski WJ, Foy CG, Brawley LR, Brubaker PH, Focht BC, Norris JL. et al.Older adults in cardiac rehabilitation: a new strategy for enhancing physical function. MMSE. 2002;34:1705–1713.
    1. Borg G. Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics; 1998.
    1. Brawley L, Rejeski WJ, Gaukstern JE, Ambrosius WT. Social cognitive changes following weight loss and physical activity interventions in obese, older adults in poor cardiovascular health. Ann Behav Med. 2012;44:353–364. doi: 10.1007/s12160-012-9390-5.
    1. Rejeski WJ, Ettinger WH, Martin K, Morgan T. Treating disability in knee osteoarthritis with exercise therapy: A central role for self-efficacy and pain. Arthritis Care Res. 1998;11:94–101. doi: 10.1002/art.1790110205.
    1. Rejeski WJ, Brawley LR, Ambrosius W, Brubaker PH, Focht BC, Foy CG. et al.Older adults with chronic disease: the benefits of group mediated counseling in the promotion of physically active lifestyles. Health Psychol. 2003;22:414–423.
    1. Ettinger WH, Davis MA, Neuhaus JM, Mallon KP. Long-term physical functioning in persons with knee osteoarthritis from NHANES. I: effects of comorbid medical conditions. J Clin Epidemiol. 1994;47:809–815. doi: 10.1016/0895-4356(94)90178-3.
    1. McDermott MM, Guralnik JM, Albay M, Bandinelli S, Miniati B, Ferrucci L. Impairments of muscles and nerves associated with peripheral arterial disease and their relationship with lower extremity functioning: the InCHIANTI study. JAGS. 2004;52:405–410. doi: 10.1111/j.1532-5415.2004.52113.x.
    1. Ferrell B, Casarett D, Epplin J, Fine P, Gloth FM, Herr K. et al.The management of persistent pain in older persons. JAGS. 2002;50:S205–S224.
    1. Somers TJ, Keefe FJ, Godiwala N, Hoyler GH. Psychosocial factors and the pain experience of osteoarthritis patients: new findings and new directions. Curr Opin Rheumatol. 2009;21:501–506. doi: 10.1097/BOR.0b013e32832ed704.
    1. Shega JW, Andrew M, Hemmerich J, Cagney KA, Ersek M, Weiner DK. et al.The relationship of pain and cognitive impairment with social vulnerability: an analysis of the Canadian study of health and aging. Pain Med. 2012;13:190–197. doi: 10.1111/j.1526-4637.2011.01309.x.
    1. Rejeski WJAR, Fielding R. et al.Promoting physical activity for elders with compromised function: The Lifestyle Interventions and Independence for Elders (LIFE) Study physical activity intervention. Clin Interven Aging. 2013;8:1–13.
    1. McAuley E, Blissmer B, Katula J, Duncan T, Mihalko SL. Physical activity, self-esteem, and self-efficacy relationships in older adults: a randomized controlled trial. Ann Behav Med. 2000;22:131–139. doi: 10.1007/BF02895777.
    1. McAuley E, Blissmer B. Self-efficacy determinants and consequences of physical activity. ESSR. 2000;28:85–88.
    1. Rejeski WJ, Shelton B, Miller ME, Dunn AL, Sallis JF. Mediators of increased physical activity and change in subjective well-being: results from the Activity Counseling Trial (ACT) J Health Psychol. 2001;6:159–168. doi: 10.1177/135910530100600206.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться