PMID- 29710165
OWN - NLM
STAT- MEDLINE
DCOM- 20180507
LR  - 20181114
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Print)
IS  - 0098-7484 (Linking)
VI  - 319
IP  - 16
DP  - 2018 Apr 24
TI  - Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone 
      Coaching on Walking Performance in Peripheral Artery Disease: The HONOR 
      Randomized Clinical Trial.
PG  - 1665-1676
LID - 10.1001/jama.2018.3275 [doi]
AB  - IMPORTANCE: Clinical practice guidelines support home-based exercise for patients 
      with peripheral artery disease (PAD), but no randomized trials have tested 
      whether an exercise intervention without periodic medical center visits improves 
      walking performance. OBJECTIVE: To determine whether a home-based exercise 
      intervention consisting of a wearable activity monitor and telephone coaching 
      improves walking ability over 9 months in patients with PAD. DESIGN, SETTING, AND 
      PARTICIPANTS: Randomized clinical trial conducted at 3 US medical centers. 
      Patients with PAD were randomized between June 18, 2015, and April 4, 2017, to 
      home-based exercise vs usual care for 9 months. Final follow-up was on December 
      5, 2017. INTERVENTIONS: The exercise intervention group (n = 99) received 4 
      weekly medical center visits during the first month followed by 8 months of a 
      wearable activity monitor and telephone coaching. The usual care group (n = 101) 
      received no onsite sessions, active exercise, or coaching intervention. MAIN 
      OUTCOMES AND MEASURES: The primary outcome was change in 6-minute walk distance 
      at 9-month follow-up (minimal clinically important difference [MCID], 20 m). 
      Secondary outcomes included 9-month change in subcomponents of the Walking 
      Impairment Questionnaire (WIQ) (0-100 score; 100, best), SF-36 physical 
      functioning score, Patient-Reported Outcomes Measurement Information System 
      (PROMIS) mobility questionnaire (higher = better; MCID, 2 points), PROMIS 
      satisfaction with social roles questionnaire, PROMIS pain interference 
      questionnaire (lower = better; MCID range, 3.5-4.5 points), and objectively 
      measured physical activity. RESULTS: Among 200 randomized participants (mean [SD] 
      age, 70.2 [10.4] years; 105 [52.5%] women), 182 (91%) completed 9-month 
      follow-up. The mean change from baseline to 9-month follow-up in the 6-minute 
      walk distance was 5.5 m in the intervention group vs 14.4 m in the usual care 
      group (difference, -8.9 m; 95% CI, -26.0 to 8.2 m; P = .31). The exercise 
      intervention worsened the PROMIS pain interference score, mean change from 
      baseline to 9 months was 0.7 in the intervention group vs -2.8 in the usual care 
      group (difference, 3.5; 95% CI, 1.3 to 5.8; P = .002). There were no significant 
      between-group differences in the WIQ score, the SF-36 physical functioning score, 
      or the PROMIS mobility or satisfaction with social roles scores. CONCLUSIONS AND 
      RELEVANCE: Among patients with PAD, a home-based exercise intervention consisting 
      of a wearable activity monitor and telephone coaching, compared with usual care, 
      did not improve walking performance at 9-month follow-up. These results do not 
      support home-based exercise interventions of wearable devices and telephone 
      counseling without periodic onsite visits to improve walking performance in 
      patients with PAD. TRIAL REGISTRATION: clinicaltrials.gov Identifier: 
      NCT02462824.
FAU - McDermott, Mary M
AU  - McDermott MM
AD  - Department of Medicine, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois.
AD  - Department of Preventive Medicine, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois.
FAU - Spring, Bonnie
AU  - Spring B
AD  - Department of Preventive Medicine, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois.
AD  - Department of Psychiatry and Behavioral Sciences, Northwestern University 
      Feinberg School of Medicine, Chicago, Illinois.
AD  - Weinberg College of Arts and Sciences, Northwestern University, Evanston, 
      Illinois.
FAU - Berger, Jeffrey S
AU  - Berger JS
AD  - Department of Preventative Cardiology, New York University School of Medicine, 
      New York, New York.
FAU - Treat-Jacobson, Diane
AU  - Treat-Jacobson D
AD  - Center for Aging Science and Care Innovation, University of Minnesota School of 
      Nursing, Minneapolis.
FAU - Conte, Michael S
AU  - Conte MS
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of California, San Francisco.
FAU - Creager, Mark A
AU  - Creager MA
AD  - Department of Vascular Medicine, Dartmouth-Hitchcock Medical Center, Dartmouth 
      Geisel School of Medicine, Hanover, New Hampshire.
FAU - Criqui, Michael H
AU  - Criqui MH
AD  - Division of Preventive Medicine, Department of Family Medicine and Public Health, 
      University of California, San Diego.
FAU - Ferrucci, Luigi
AU  - Ferrucci L
AD  - Division of Intramural Research, National Institute on Aging, Baltimore, 
      Maryland.
FAU - Gornik, Heather L
AU  - Gornik HL
AD  - Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of 
      Medicine, Case Western Reserve University, Cleveland, Ohio.
FAU - Guralnik, Jack M
AU  - Guralnik JM
AD  - Department of Epidemiology, University of Maryland, Baltimore.
FAU - Hahn, Elizabeth A
AU  - Hahn EA
AD  - Department of Medicine, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois.
FAU - Henke, Peter
AU  - Henke P
AD  - Department of Surgery, University of Michigan, Ann Arbor.
FAU - Kibbe, Melina R
AU  - Kibbe MR
AD  - Department of Surgery, University of North Carolina School of Medicine, Chapel 
      Hill.
FAU - Kohlman-Trighoff, Debra
AU  - Kohlman-Trighoff D
AD  - Department of Cardiology and Cardiovascular Medicine, Duke University, Durham, 
      North Carolina.
FAU - Li, Lingyu
AU  - Li L
AD  - Department of Medicine, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois.
FAU - Lloyd-Jones, Donald
AU  - Lloyd-Jones D
AD  - Department of Medicine, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois.
AD  - Department of Preventive Medicine, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois.
FAU - McCarthy, Walter
AU  - McCarthy W
AD  - Department of Cardiovascular and Thoracic Surgery, Rush University Medical 
      Center, Chicago, Illinois.
FAU - Polonsky, Tamar S
AU  - Polonsky TS
AD  - Department of Medicine, University of Chicago Medical School, Chicago, Illinois.
FAU - Skelly, Christopher
AU  - Skelly C
AD  - Department of Surgery, University of Chicago Medical School, Chicago, Illinois.
FAU - Tian, Lu
AU  - Tian L
AD  - Department of Health Research and Policy, Stanford University, Stanford, 
      California.
FAU - Zhao, Lihui
AU  - Zhao L
AD  - Department of Preventive Medicine, Northwestern University Feinberg School of 
      Medicine, Chicago, Illinois.
FAU - Zhang, Dongxue
AU  - Zhang D
AD  - Department of Medicine, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois.
FAU - Rejeski, W Jack
AU  - Rejeski WJ
AD  - Department of Health and Exercise Science, Wake Forest University School of 
      Medicine, Winston-Salem, North Carolina.
LA  - eng
SI  - ClinicalTrials.gov/NCT02462824
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Intramural
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - IM
EIN - JAMA. 2018 Jul 3;320(1):96. PMID: 29971378
CIN - JAMA. 2018 Sep 25;320(12):1285-1286. PMID: 30264109
MH  - Aged
MH  - Exercise Therapy/*methods
MH  - Female
MH  - *Home Nursing
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Compliance
MH  - Peripheral Arterial Disease/physiopathology/*rehabilitation
MH  - Surveys and Questionnaires
MH  - Telemedicine
MH  - Telephone
MH  - *Walking
MH  - *Wearable Electronic Devices
PMC - PMC5933394
COIS- Conflict of Interest Disclosures: The authors have completed and submitted the 
      ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr McDermott 
      reported receiving grant funding from the National Heart, Lung, and Blood 
      Institute, the National Institute on Aging, Novartis, and Regeneron; nonfinancial 
      support from ViroMed; and the study drug for another peripheral artery disease 
      study from ReserveAge and Hershey's. Dr Spring reported serving on an ActiGraph 
      scientific advisory board. Dr Berger reported receiving grant funding from 
      AstraZeneca, Janssen, and the National Institutes of Health. Dr Conte reported 
      serving on the clinical advisory board for Abbott Vascular; serving on the 
      scientific advisory board for Symic; and receiving funding from the National 
      Heart, Lung, and Blood Institute. Dr Gornik reported receiving research support 
      from AstraZeneca; and having a patent pending regarding a method to measure ankle 
      brachial index. Dr Guralnik reported receiving personal fees from Pluristem 
      Pharma, Boeringer-Ingleheim, and Viking Therapeutics. Dr Skelly reported having 
      editor royalty agreements with Springer and Inside Ultrasound; and being the 
      co-founder of Maji Therapeutics. No other disclosures were reported.
EDAT- 2018/05/02 06:00
MHDA- 2018/05/08 06:00
PMCR- 2018/10/24
CRDT- 2018/05/01 06:00
PHST- 2018/05/01 06:00 [entrez]
PHST- 2018/05/02 06:00 [pubmed]
PHST- 2018/05/08 06:00 [medline]
PHST- 2018/10/24 00:00 [pmc-release]
AID - 2679277 [pii]
AID - joi180033 [pii]
AID - 10.1001/jama.2018.3275 [doi]
PST - ppublish
SO  - JAMA. 2018 Apr 24;319(16):1665-1676. doi: 10.1001/jama.2018.3275.