Real-life adaptations in walking patterns in patients with established peripheral arterial disease assessed using a global positioning system in the community: a cohort study.

OBJECTIVE: Lower extremity peripheral arterial disease (PAD) is a chronic condition most commonly presenting with intermittent claudication (IC). Intermittent claudication limits walking ability and may negatively affect health-related quality of life. Treadmill assessment of maximal walking distance (MWD) is the gold standard to assess PAD symptom severity. Despite being a well-established and reproducible tool, it may be inappropriate (due to frailty or fear) for some patients and only describes maximal abilities for a single walk test. Global positioning systems (GPS) have been proposed as reliable and reproducible tool to measure total, mean and maximal walking distances in patients with PAD, in the community setting. Using GPS, our study attempted to explore what happens to the walking ability of patients with IC following no intervention under 'real-life' conditions.

DESIGN AND METHODS: Using the GlobalSat DG100 GPS, forty-three patients (69 ± 9 years; nine female; no invasive interventions or rehabilitation) undertook two 60-min walking assessments, 6 months apart. Assessments took place in community spaces that had even terrain, no tall trees or buildings and were free from motorized vehicles. Global positioning systems-measured maximum walking distance was the main study outcome measure.

RESULTS: Over the 6-month period, patients demonstrated significantly shorter GPS-measured, mean (552 m versus 334 m; P = 0·02) and maximum (714 m versus 545 m; P = 0·04) walking distances, stopping also more frequently (nine versus five times; P = 0·03).

CONCLUSIONS: Given the reported symptom progression, we advocate early intervention (e.g. exercise interventions) combined with frequent patient monitoring in attempts to maintain or improve walking ability.