Telehealth Exercise Training in Peripheral Arterial Disease - TEXT-PAD

A Multimodal Tele-health Behavioural Intervention in Patients With Peripheral Arterial Disease From Low Socio-economic Areas: a Feasibility and Pilot Randomized Controlled Trial With Embedded Process Evaluation

Peripheral arterial disease is a common, under-treated and under-researched issue. The vast majority of these patients often have multiple issues which can be improved with targeted behavioural change interventions. NICE has recommended that supervised exercise is the mainstay of treatment for intermittent claudication (ischaemic muscle pain on walking due to blocked and narrowed arteries). However, in the vast majority of UK hospitals, this isn't undertaken, and with the issues around group-based sessions and repeated visits to hospitals, this treatment option is not available with the coronavirus pandemic.

This is a single-centre randomised control trial in 60 patients with peripheral arterial disease attending the Freeman Hospital. Patients will be randomised to either an enhanced behavioural change intervention targeting multiple health behaviours vs a simple walking intervention. Also, some patients will be involved in focus groups to understand their experience of the intervention and whether it is feasible and acceptable, allowing changes to be made to the program.

The primary outcome will be to assess the feasibility and acceptability of the program. We will also be assessing multiple secondary outcomes including functional capacity, quality of life, sleep quality and smoking and alcohol reduction.

Inclusion Criteria:

• Diagnosis of PAD confirmed by ankle-brachial index <0.90 in one or both limbs
• Age >= 40 years
• Able to walk distance >50m
• Live in an area deemed in lowest 30% of super output area from Office of National Statistics

Exclusion Criteria:

• chronic limb threatening ischemia
• short claudication distance <50m
• severe heart disease (Grade III or IV, New York Heart Association)
• severe ischemic or haemorrhagic stroke or neurodegenerative diseases
• severe hypertension (systolic blood pressure of more than 180 mm Hg, and a diastolic
• blood pressure of more than 100 mm Hg)
• uncontrolled cardiac arrhythmias (unstable angina during the previous month and
• myocardial infarction during the previous month)
• a resting heart rate of more than 120 beats per minute
• has already undergone angioplasty, bypass or other surgical intervention for PAD
• other severe comorbid conditions preventing the ability to engage in physical activity,
• inability or unwillingness to undertake the commitments of the study