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

描述（由申请人提供）：尽管外周动脉疾病（PAD）的监督锻炼计划非常有效，但很少有人能够成功地利用这些计划。阻碍患者接受和坚持有监督的锻炼计划的障碍包括缺乏步行锻炼的保险报销，以及作为外部障碍的离医院和诊所很近。缺乏关于如何锻炼的知识和习惯性的久坐行为是潜在的内在障碍。迄今为止，由于缺乏训练和随访，以社区为基础的PAD运动项目的结果不一致。因此，需要为基于社区的运动训练计划建立更加一致和有针对性的计划，同时消除与监督运动训练计划相关的外部和内部障碍。过程评价需要在基于社区的研究中实施，因为这在血管医学中几乎没有得到任何关注。本研究的主要目的是确定以社区为基础的运动计划，包括训练(T)、监测(M)和指导(C) (TMC)，以改善PAD患者的峰值步行时间（PWT），这是本研究的主要结果。与只接受常规护理建议的患者相比，随机分配到社区运动计划的PAD患者将改善PWT，我们将验证这一假设。运动治疗将采用一种新颖的方法，包括运动训练(T)，具体监测计划(M)和个人反馈/指导(C)的结合。训练将侧重于步行运动，使用既定的指导方针进行频率（在社区中每周3次，持续12周），持续时间（每次35-50分钟）和强度（由于跛行疼痛在3-5分钟内开始休息或使用感知强度评级的生产策略）。研究人员将使用压电式和弹簧式活动监测器客观地监测PAD患者的运动情况，以评估其对该计划的依从性。此外，患者将负责自我监控他们的活动，以提高他们的个人责任感，以保持终身习惯运动的变化。最后，将实施一种可操作的指导模式，该模式将提供培训指导，并直接针对社区中步行锻炼的当地障碍（通过使用环境审计工具对患者步行区域进行初步社区评估来评估）。为了利用当地环境作为锻炼平台，解决如何实施培训指导的问题将是重要的一步。总之，以社区为基础的TMC可能是一个突破性的项目，可以改善PAD患者的健康状况，同时规避上述运动训练的许多障碍。

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.