Availability of Supervised Exercise Programs and the Role of Structured Home-based Exercise in Peripheral Arterial Disease

Objectives: The effectiveness of supervised exercise programs (SEPs) for the management of peripheral arterial disease (PAD) can be hampered by low accessibility and poor compliance. The current international availability and use of SEPs was evaluated and the evidence on alternative approaches such as structured, home-based exercise programs (HEPs) was reviewed. Methods-materials: International survey on SEP availability among vascular surgeons using an online questionnaire. A systematic review on structured-HEPs effectiveness was also performed. Results: A total of 378 responses were collected from 43 countries, with the majority (95%) from Europe. Only 30.4% of the participants had access to SEPs and within this group there was significant heterogeneity on the way SEPs were implemented. This systematic review identified 12 studies on the effectiveness of HEPs. In 3 studies SEPs were superior to HEPs in improving functional capacity or equivalent in improving quality of life (QoL). HEPs significantly improved most of the functional capacity and QoL markers when compared to the "go home and walk" advice and baseline measurements. Conclusions: SEPs remain an underutilized tool despite recommendations. Structured HEPs may be effective and can be useful alternatives when SEPs are not available. Further research is warranted to establish cost-effectiveness. (C) 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.