SS03 - A National Feasibility, Effectiveness and Utilization Pilot of a Home-Based, Mobile Phone Administered, Exercise Therapy Program Using Cognitive Behavioral Therapy for Intermittent Claudication

Objectives: Clinical practice guidelines recommend exercise therapy (ET) as first-line therapy for patients with intermittent claudication and peripheral artery disease. The SVS Appropriate Use Criteria (AUC) for intermittent claudication deems exercise therapy as appropriate for all patients with intermittent claudication. However, utilization of ET is poor due to lack of availability/access, travel requirements and cost. Results of home-based exercise therapy programs have been mixed with a trend towards improved results with more frequent patient engagement. We evaluate the feasibility, effectiveness and utilization of a home-based ET program which includes cognitive behavior therapy (CBT) administered by health coaches.

Methods: Patients with PAD (confirmed by abnormal ABI or TBI) and intermittent claudication were recruited prospectively to participate in a 12 week home-based, mobile phone delivered, exercise therapy program. Participants performed phone-based 6-minute walk tests, completed mini-WIQ QOL surveys and received health coaching utilizing CBT. They were asked to complete three health education courses (What is PAD?, Exercise, Nutrition) and were asked to record at least three 30-minute exercise therapy walks a week using their personal mobile phones. Programming also included “daily doses” of health education sent via text messages.

Results: One hundred and forty-five (145) patients (40% women, mean age 65) were onboarded across 18 institutions (44% did not offer in-person exercise therapy programs). Seventy-eight percent (78%) of patients completed the program. Patients recorded 149,135 minutes of walking 5,205,943 steps with the exercise therapy program. Nineteen percent (19%) of patients paused, withdrew or were non-responsive due to medical issues, technical difficulties or concerns about privacy. Ninety-two percent (92%) of patients met their stated CBT S.M.A.R.T goals.

Conclusions: Deployment of a mobile phone administered home-based exercise therapy program incorporating CBT was feasible achieving program completion of 78% and effective with 92% of patients achieving their CBT S.M.A.R.T goals. Utilization of exercise therapy was increased by virtue of offering this program at institutions which did not offer exercise therapy. Long-term follow-up is required to assess such a program’s ability to extend freedom from intervention.