Gender Differences in Outcomes Following a Pain-Free, Home-Based Exercise Program for Claudication

Background: Peripheral artery disease (PAD) is a common cardiovascular pathology that affects mobility. In previous research, supervised exercise, a recommended treatment for claudication, was less effective in women. This study retrospectively investigated whether functional outcomes exhibit sex differences following a pain-free, home-based exercise program for PAD patients. Materials and Methods: Patients with PAD and claudication enrolled to a structured home-based program from 2003 to 2016 were studied. The program was prescribed at the hospital and based on two daily 10-minute pain-free walking sessions at progressively increasing speed. Outcome measures, which were assessed at baseline and discharge, were pain threshold speed (PTS) and maximal (Smax) during a treadmill test and pain-free walking distance (PFWD) and total distance walked in 6 minutes (6MWD). The ankle-brachial index (ABI), program duration, and patient adherence were determined. Results: A total of 1007 patients (women; n=264; 26%) were enrolled. At baseline, compared to men, women exhibited similar ABI values but lower PTS and PFWD values (p<0.001). At discharge, with similar adherence (score 3/41 each) in both groups, superimposable improvements were observed for PTS (0.8 +/- 0.8km/h each), Smax (0.4 +/- 0.5km/h each), PFWD (women 95 +/- 100; men 86 +/- 104), 6MWD (women 32 +/- 65; men 35 +/- 58), and ABI (women 0.07 +/- 0.12; men 0.06 +/- 0.11) without between-group differences (confirmed after propensity analysis). Conclusion: A personalized, structured pain-free exercise program for PAD patients performed inside the home for a few minutes a day was equally effective in both sexes. Programs favoring adherence and functional outcomes in women should be tested in prospective studies.