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Vessel Plus 2021;5:[Accepted].10.20517/2574-1209.2021.79@The Author(s) 2021
Accepted Manuscript
Open AccessOriginal Article

Survival and clinical outcomes of diabetic peripheral artery disease patients following a pain-free home-based walking program

Correspondence Address: Nicola Lamberti, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy. E-mail:nicola.lamberti@unife.it


© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


Aim: We retrospectively examined the impact on the rate of survival of pain-free home-based exercise in diabetic peripheral artery disease patients compared to patients receiving usual care.


Methods: A total of 202 patients at Fontaine’s stage II with diabetes were studied. Half were enrolled in a structured home-based exercise program (E), whereas the other received walking advice as active control group (C). Long-term clinical outcomes at five-year were gathered from the Emilia-Romagna Health Service Registry, with survival probability selected as primary outcome.


Results: At baseline, the two groups did not differ for any demographic or clinical characteristics. High adherence to the program was recorded in the E group (88% of home-walking sessions executed, average distance walked during the program: 174 km). After five years, a survival rate of 90% for the E group and 60% for the C group was observed, with a significantly (P < 0.001) higher mortality risk for C group (Hazard ratio, HR: 3.92) Additionally, among secondary outcomes, the E group showed a significantly (P = 0.048) lower rate of peripheral revascularizations than C group (15% vs. 24% respectively; HR:1.91), all-cause hospitalizations (P = 0.007; 61% vs. 80%, HR:1.58) and of amputations (P = 0.049; 6% vs. 13%, HR:2.47). In a Cox multivariate-proportional regression model of entire population, the predictors of survival probability were age (HR: 1.05), Charlson index (HR: 1.24), lower ankle-brachial index (HR: 6.66) and Control group (HR: 4.99).  


Conclusion: A simple sustainable program aimed at improving mobility of diabetic patients with claudication at high cardiovascular risk was associated with better survival and long-term clinical outcomes.

Cite This Article

Lamberti N, Tsolaki E, Guerzoni F, Napoli N, Traina L, Piva G, Gasbarro V, Zamboni P, Straudi S, Manfredini R, Manfredini F. A pain-free home-based walking program. Vessel Plus 2021;5:[Accept]. DOI: http://dx.doi.org/10.20517/2574-1209.2021.79

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