Patient-Reported Barriers for Participation in Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease

Objectives Supervised exercise therapy (SET) provides clinical benefit for patients suffering from intermittent claudication due to peripheral artery disease (PAD). However, enrollment in programs when offered remains low. We sought to identify patient-reported barriers to enrollment in SET as part of a prospective quality improvement program. Methods Patients who presented to clinic and were diagnosed with claudication were offered enrollment in a prospective quality improvement protocol, offered at nine regional offices throughout our health system. Both patients who enrolled and declined enrollment were offered a 12-question questionnaire to identify potential barriers to enrollment. Additional data including gender, smoking status, ankle-brachial index (ABI), proximity to the nearest regional office, and disadvantage levels of neighborhoods (low: 1-3, medium: 4-7, and high: 8-10 area deprivation index [ADI]) was collected and compared by program participation using univariate analysis. Results Patients enrolled in the SET program (n=66 patients) versus those who declined (n=84 patients) were of similar age (medium age: 71.4 vs. 69.7 years, p=0.694), baseline ABI (0.6 vs. 0.6, p=0.944), smoking status (former 56.1% vs. 53.6%, p=0.668), distance away from outpatient center (8.2 mi vs. 8.4 mi, p=0.249), and had similar Connecticut state ADIs (2021 high-disadvantage: 35.4% vs 33.3%, p=0.549). Patients participating in the SET program were more likely to be male (78.8% vs. 56.0%, p=0.003). Top self-reported barriers for patients who declined participation included transportation/distance (39.3%), preference for independent walking (56.0%), inability to commit to three sessions per week (52.4%), and lack of interest (20.2%). In addition, a higher proportion of patients who declined participation identified severe barriers of preference for independent walking (39.3% vs. 1.5%, p<0.001), inability to commit to three sessions per week (26.2% vs. 3.0% p<0.001), transportation/distance issues (23.8% vs. 7.6% p=0.008), and cost (27.4% vs. 9.1%, p=0.005) as significant barriers for participation in SET. Conclusions Patients who declined participation in SET for PAD had similar disease status and access to care than participating counterparts. Top reported barriers to enrollment include a preference for independent walking, transportation/distance, commitment to 3x/week program, and cost, which highlight areas of focus for equitable access to these limb-saving services.