In the Journals

HONOR: Home-based exercise intervention fails to improve walking performance in PAD

Mary M. McDermott

Walking performance did not improve in patients with peripheral artery disease who underwent a home-based exercise intervention with a wearable activity monitor and coaching compared with usual care, according to the HONOR study published in JAMA.

“In the current study, the exercise intervention did not increase the frequency or amount of exercise at 9-month follow-up,” Mary M. McDermott, MD, professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine, and colleagues wrote. “These results are important given the increasing number of individuals using wearable devices to improve health.”

Exercise in PAD

Researchers analyzed data from 200 patients (mean age, 70 years; 53% women) with PAD. Data that were reviewed included systolic pressure measurements, ankle-brachial index, medical history, race/ethnicity, height, weight, BMI and leg symptoms.

Patients were assigned the home-based exercise intervention or usual care.

The home-based exercise intervention consisted of four weekly sessions with a coach during the first month, in which patients walked for exercise and were aided in setting exercise goals. Coaches then contacted the patients periodically for the remaining 9 months to discuss progress, review wearable activity monitor data, set new exercise goals and discuss challenges.

Patients in the usual care group did not receive the intervention and were contacted every 3 months to collect information on walking exercise frequency and physical activity.

The primary outcome was change in 6-minute walk distance from baseline to 9-month follow-up. Secondary outcomes of interest included changes in the following:

  • Walking Impairment Questionnaire (WIQ) speed, distance and stair climbing scores;
  • Patient-Reported Outcomes Measurement Information System (PROMIS) measures of pain interference, mobility and satisfaction with activities and social roles;
  • Medical Outcomes Study SF-36 physical functioning score; and
  • objectively measured physical activity.

Nine-month follow-up was completed by 91% of patients. At 9 months, the mean change in 6-minute walk distance did not significantly differ between the intervention group (mean change, 5.5 m) and the usual care group (mean change, 14.4 m; difference = –8.9 m; 95% CI, –26 to 8.2).

No improvements in function, pain

The PROMIS pain interference score worsened in patients assigned the intervention (mean change, 0.7) compared with those assigned the usual care (mean change, –2.8; difference = 3.5; 95% CI, 1.3-5.8).

There were no significant differences between both groups in Medical Outcomes Study SF-36 physical functioning sore, WIQ score or the PROMIS mobility or satisfaction scores.

“These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD,” McDermott and colleagues wrote. – by Darlene Dobkowski

Disclosures: McDermott reports she received grant funding from Novartis and Regeneron and nonfinancial support from Hershey’s, ReserveAge and ViroMed. Please see the study for all other authors’ relevant financial disclosures.

Mary M. McDermott

Walking performance did not improve in patients with peripheral artery disease who underwent a home-based exercise intervention with a wearable activity monitor and coaching compared with usual care, according to the HONOR study published in JAMA.

“In the current study, the exercise intervention did not increase the frequency or amount of exercise at 9-month follow-up,” Mary M. McDermott, MD, professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine, and colleagues wrote. “These results are important given the increasing number of individuals using wearable devices to improve health.”

Exercise in PAD

Researchers analyzed data from 200 patients (mean age, 70 years; 53% women) with PAD. Data that were reviewed included systolic pressure measurements, ankle-brachial index, medical history, race/ethnicity, height, weight, BMI and leg symptoms.

Patients were assigned the home-based exercise intervention or usual care.

The home-based exercise intervention consisted of four weekly sessions with a coach during the first month, in which patients walked for exercise and were aided in setting exercise goals. Coaches then contacted the patients periodically for the remaining 9 months to discuss progress, review wearable activity monitor data, set new exercise goals and discuss challenges.

Patients in the usual care group did not receive the intervention and were contacted every 3 months to collect information on walking exercise frequency and physical activity.

The primary outcome was change in 6-minute walk distance from baseline to 9-month follow-up. Secondary outcomes of interest included changes in the following:

  • Walking Impairment Questionnaire (WIQ) speed, distance and stair climbing scores;
  • Patient-Reported Outcomes Measurement Information System (PROMIS) measures of pain interference, mobility and satisfaction with activities and social roles;
  • Medical Outcomes Study SF-36 physical functioning score; and
  • objectively measured physical activity.

Nine-month follow-up was completed by 91% of patients. At 9 months, the mean change in 6-minute walk distance did not significantly differ between the intervention group (mean change, 5.5 m) and the usual care group (mean change, 14.4 m; difference = –8.9 m; 95% CI, –26 to 8.2).

No improvements in function, pain

The PROMIS pain interference score worsened in patients assigned the intervention (mean change, 0.7) compared with those assigned the usual care (mean change, –2.8; difference = 3.5; 95% CI, 1.3-5.8).

There were no significant differences between both groups in Medical Outcomes Study SF-36 physical functioning sore, WIQ score or the PROMIS mobility or satisfaction scores.

“These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD,” McDermott and colleagues wrote. – by Darlene Dobkowski

Disclosures: McDermott reports she received grant funding from Novartis and Regeneron and nonfinancial support from Hershey’s, ReserveAge and ViroMed. Please see the study for all other authors’ relevant financial disclosures.