A community-based exercise program following endovascular therapy for patients wi

描述(申请人提供)：尽管有监督的运动计划对外周动脉疾病(PAD)非常有效，但很少有人能够成功地使用这些计划。阻碍患者采用和坚持受监督的锻炼计划的障碍包括步行锻炼缺乏保险补偿，以及距离医院和诊所较近作为外部障碍。缺乏锻炼知识和习惯久坐行为是潜在的内部障碍。到目前为止，PAD的社区锻炼计划遇到了不一致的结果，可能是由于缺乏培训和后续行动。因此，需要为以社区为基础的运动训练计划建立更一致和有针对性的计划，同时消除与受监督的运动训练计划相关的外部和内部障碍。需要在以社区为基础的研究中实施过程评估，因为这在血管医学中几乎没有受到关注。这项拟议研究的主要目的是确定以社区为基础的锻炼计划的效果，包括训练(T)、监测(M)和指导(C)(TMC)部分，以改善PAD患者的高峰步行时间(PWT)，这是该研究的主要结果。我们将检验这样一种假设，即与只接受常规护理建议的患者相比，随机参加TMC社区锻炼计划的PAD患者将改善PWT。运动治疗将采用一种新的方法，包括运动训练(T)、特定监测计划(M)和个人反馈/指导(C)的组合。训练将侧重于步行锻炼，使用既定的指导方针，包括频率(社区中12周，每周3次)、持续时间(35-50分钟)和强度(在3-5分钟内因跛行疼痛而开始休息时间或使用感觉到的劳累程度的生产策略)。研究人员将使用压电式和弹簧杠杆式活动监测器客观监测PAD患者的运动，以评估对该计划的遵守情况。此外，患者将负责自我监测他们的活动，以促进他们的个人责任感，以保持终身改变的习惯锻炼。最后，将进行一种操作指导模式，该模式将提供培训指导，并直接针对社区中步行锻炼的局部障碍(通过使用环境审计工具对患者步行区域的初步社区评估进行评估)。解决如何将培训指导付诸实施的问题将是利用当地环境作为锻炼平台的重要一步。总之，社区环境下的TMC可能是一个突破性的计划，可以改善PAD患者的健康，同时绕过运动训练的许多上述障碍。 公共卫生相关性：尽管有监督的锻炼通常是外周动脉疾病(PAD)患者的一线治疗方法，但由于保险覆盖范围不足和患者靠近医疗设施等障碍，它的使用率很低。几乎所有以社区为基础的运动训练计划都被证明是不成功的，因为依赖于患者对运动常规的自我监控。因此，重要的是建立一个基于社区的运动治疗模式的有效性，其中包括详细的组成部分(例如，培训、监测和指导)，如果成功，可以作为血管内治疗后PAD患者在医院接受监督运动治疗的替代方案。

DESCRIPTION (provided by applicant): Although supervised exercise programs for peripheral arterial disease (PAD) are highly effective, few people are able to successfully utilize these programs. Barriers that prevent patients from adopting and adhering to supervised exercise programs include lack of insurance reimbursement for walking exercise and poor proximity to hospitals and clinics as external barriers. Lack of knowledge about how to exercise and habitual sedentary behavior represent potential internal barriers. Community-based exercise programs for PAD have to date met with inconsistent results possibly due to lack of training and follow-up. Thus, more consistent and directed programs need to be established for community-based exercise training programs that also remove the external and internal barriers associated with supervised exercise training programs. Process evaluation needs to be implemented in community-based research, as this has not received virtually no attention in vascular medicine. The primary aim of the proposed study is to determine the effect of a community-based exercise program with training (T), monitoring (M) and coaching (C) (TMC) components to improve peak walking time (PWT) in PAD patients, which is the primary outcome of the study. We will test the hypothesis that PAD patients randomized to a community-based exercise program with TMC will improve PWT compared to patients who only receive usual care advice. A novel approach will be employed for the exercise treatment which includes a combination of exercise training (T), specific monitoring plans (M) and individual feedback/coaching (C). Training will focus on walking exercise using established guidelines for frequency (3 X per week for 12 weeks in the community), duration (35-50 minutes per session) and intensity (to initiate rest periods due to claudication pain in 3-5 min or production strategy using ratings of perceived exertion). Researchers will objectively monitor exercise of PAD patients using piezoelectric and spring-levered activity monitors to assess adherence to the program. Additionally, patients will be responsible for self-monitoring their activity in order to promote their sense of personal responsibility to maintain lifelong changes in habitual exercise. Finally, an operational coaching model that will provide training guidance and directly target local barriers to walking exercise in the community will be conducted (assessed by an initial community-based assessment of the patient's walking area using an environmental audit tool). Problem-solving on how to operationalize the training instructions will be an important step in order to use the local environment as a platform for exercise. In conclusion, TMC in community-based settings may be a ground-breaking program for improving health of PAD patients while circumventing many of the above barriers to exercise training. PUBLIC HEALTH RELEVANCE: While supervised exercise is generally a first line therapy for patients with peripheral artery disease (PAD), it is considerably underutilized due to barriers such as inadequate insurance coverage and patient proximity to health care facilities. Virtually all community-based exercise training programs have proven unsuccessful due to the reliance on patient self-monitoring of the exercise routine. Thus, it is important to establish the effectiveness of a community-based exercise therapy model incorporating detailed components (e.g. training, monitoring and coaching) that, if successful, may serve as an alternative to supervised exercise therapy in hospitals for patients with PAD following endovascular therapy.