‘New physio trials a step in the right direction for adults struggling to walk’

Dr Miriam Stoppard looks at a new initiative that could help sufferers from peripheral artery disease

We all know the mental and physical benefits of ­walking, and it’s a simple ­exercise many of us take for granted. But for some, walking can cause excruciating pain in the calves, which makes putting one foot in front of the other an ordeal.

This can be due to a condition called intermittent claudication, caused by furred up arteries cutting down the blood supply to your leg muscles – but a new study has given some sufferers a spring in their step.

Adults with this poor leg circulation had one-to-one physiotherapy sessions aimed at improving motivation and commitment to ­exercise – and they were able to walk further.

The MOSAIC trial (Motivating Structured walking Activity in people with Intermittent Claudication) saw King’s College London working with six UK hospitals. It ran between January 2018 and March 2020, and involved 190 adults with peripheral artery disease (PAD).

PAD is a quite common condition where fatty deposits in the arteries obstruct the blood supply to leg muscles. It means sufferers can have reduced walking capacity. ­Supervised exercise therapy is ­recommended to improve it in people with PAD, but participation rates are low.

This could be because of lack of time, limited transport to the exercise sessions, motivation and resources.

Researchers believe a ­physio-led programme could improve motivation and commitment to home-based walking exercise and improve walking capacity. The MOSAIC trial split patients into two, with one group receiving the usual NHS care and the other having the one-to-one physio.

Sessions focused on motivating people to walk used behaviour change techniques to help them persevere. They also got a manual, a step counter and exercise diary.

At three months, that group walked further in a timed test of six minutes compared to their NHS counterparts. MOSAIC participants were also able to walk 17 metres further in the test and walked 31 seconds longer before getting leg pain.

They were also able to do everyday activities better, had more positive beliefs about walking as a treatment and were able to continue exercising after sessions finished.

A follow-up six months later also found they reported greater improvements in their walking ability.

Professor Lindsay Bearne, the trial’s chief investigator, says: “Regular exercise is recommended for people with PAD but ­supervised exercise sessions are not always available or convenient for people to attend.

“The MOSAIC programme provides an innovative, effective and acceptable treatment that improves outcomes and helps people with this debilitating condition learn how to exercise ­appropriately and manage their condition themselves.”

What a great initiative.