Published May 2022
Supervised walking exercise is used to treat leg pain in older people caused by restricted blood flow. But it’s expensive for the NHS to provide and often difficult for patients to complete. Professor Lindsay Bearne and her team trained physiotherapists to provide patients with the knowledge, motivation and skills they needed to engage with walking exercise in their own time outside of a medical facility.
It’s challenging to provide supervised exercise therapy in a way that’s suitable for everyone who needs it, so we have to look at different ways of delivering this important treatment.Professor Lindsay Bearne
When walking becomes painful
Many older people experience a cramp-like pain in their legs when they walk due to a condition called peripheral arterial disease. Blood vessels in the legs get blocked, restricting the flow of oxygenated blood to the muscles, causing debilitating pain. Some people with this condition can only walk for a few minutes before the pain is so intense that they have to stop to let it subside. Even a short trip to the shops can be a difficult, slow and painful experience.
One recommended treatment for this kind of leg pain is supervised exercise therapy. Patients walk on a treadmill at a healthcare facility for at least 30 minutes, three times a week, supervised by a healthcare professional. But attending these sessions is time consuming and travelling to a facility isn’t always easy, especially if there aren’t any facilities nearby. Plus these services aren’t available on the NHS in all parts of the country. These barriers mean many people don’t attend regularly enough to get the benefits.
Testing a new treatment plan
Sometimes people are advised to complete walking exercise at home but doing this, without guidance and support, can be challenging, and most people don’t keep it up. We wondered if we could create a new way of delivering this treatment. We called it the MOSAIC programme, as it combines support from a physiotherapist and home-based walking exercise.
First, participants had two in-person sessions with a physiotherapist to help them understand their condition, motivate them to walk and to establish their own walking plan. Then they would walk on their own between sessions, with a further two telephone sessions with the physiotherapist to help them to keep up with their walking exercise.
We included 190 participants of different ages, ethnic groups and severity of disease as part of this randomised clinical trial. After three months, participants following our MOSAIC programme could walk for a further 17 metres in a six-minute period than those receiving the normal NHS care and could walk half a minute longer before getting leg pain.
This is a meaningful change for people with this condition. Participants told us they were walking more at home and could carry out their daily activities more easily.
Small improvements make a difference
Those figures might not sound like a lot, but this is a meaningful change for people with this condition. Participants told us they were walking more at home and could carry out their daily activities more easily. Those who completed our MOSAIC programme also told us that it was a positive experience. Many of the physiotherapists we trained enjoyed learning new skills to help motivate the participants and it increased their confidence in treating people with this type of leg pain.
We’ve shared our results with the participants and physiotherapists who took part, and we’ve also presented our work to vascular surgeons and physiotherapists at conferences who have shown a lot of interest. This research is important because it’s challenging to provide supervised exercise therapy in a way that’s suitable for everyone who needs it, so we have to look at different ways of delivering this important treatment.
Taking the next steps
The Dunhill Medical Trust not only provided the funding for this research but were also very supportive throughout the process. We had to close our trial early because of the COVID-19 pandemic but they were really helpful and regularly discussed our plans with us. By being flexible, the Trust also enabled us to repurpose some of the funds to ensure it could be completed.
Now we’ve shown that our MOSAIC programme is effective after three months, our next steps are to study the long term effects, investigate whether it’s cost effective, and explore how the treatment could be rolled out to more hospitals.
Find out more
You can read more about the trial in our paper here.