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12 April 2022

Physiotherapy programme improves walking in people with poor leg circulation

Adults with poor leg circulation who took part in one-to-one physiotherapy sessions that aimed to improve motivation and commitment to exercise were able to walk further than those who received usual NHS care alone, new research has found.

Pedometer walking main

Results from the Motivating Structured walking Activity in people with Intermittent Claudication (MOSAIC) trial is published today in JAMA, by researchers from King’s. The trial was a multi-centre, randomised clinical trial in six hospitals in the United Kingdom between January 2018 and March 2020 involving 190 adults with peripheral artery disease (PAD).

PAD is a common condition where fatty deposits in the arteries restricts blood supply to leg muscles. People with PAD can have reduced walking capacity and an increased risk of cardiovascular morbidity and mortality. Supervised exercise therapy is recommended to improve walking capacity in people with PAD, but participation rates are low. This could be because of lack of time, limited transportation to the exercise sessions, motivation, and resources. The research team believed that a physiotherapist led, behaviour change intervention could improve people’s motivation and commitment to regular home-based walking exercise and that this may improve outcomes, but so far evidence of their effect has been mixed.

The MOSAIC trial split their cohort into two; one group received usual NHS care and the second cohort received four one to one sessions with a physiotherapist. The sessions focussed on motivating people to walk and used behaviour change techniques to help them continue their walking exercise. As part of MOSAIC, people were also provided with a manual, a step counter and exercise diary.

At three months, the researchers found people who received MOSAIC walked further in a timed test of six minutes than their NHS counterparts. MOSAIC participants were able to walk 17 metres further during the test and walked 31 seconds longer before getting leg pain.

Participants were also able to do everyday activities better, had more positive beliefs about walking as a treatment and were able to continue exercising after the sessions ceased. A follow-up after six months found people who received MOSAIC reported greater improvements in walking that people who had usual NHS care alone.

Regular exercise is recommended for people with peripheral arterial disease 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.

Professor Lindsay Bearne, the MOSAIC Trial Chief Investigator, previously from the School of Life Course & Population Sciences

Future studies by this multidisciplinary research group will investigate the long-term effects, cost effectiveness and the best ways to implement the MOSAIC programme into practice.

Co-authors include Prof Janet Peacock, Dr Abdel Douiri and Prof Cath Sackley from the School of Life Course & Population Sciences; Prof John Weinman from the Institute of Pharmaceutical science and Prof Bijan Modarai from the School of Cardiovascular Medicine and Sciences. The study was funded by the Dunhill Medical Trust (R477/0516).

In this story

Abdel Douiri

Chair in Medical Statistics and Clinical Trials

Professor Janet Peacock

Emeritus Professor of Medical Statistics

Professor Catherine Sackley

Professor of Rehabilitation