Music Enhanced Walking for Relief of Intermittent Claudication
Dates: 5/19/2016 - 11/19/2017
Co-Investigators: Eileen Collins, Ulf Bronas, Alana Steffen
Abstract: Peripheral arterial disease (PAD) is a debilitating disease causing decreased circulation to the lower limbs and intermittent claudication pain. Walking exercise is the most effective treatment of intermittent claudication pain for PAD. Self-selected music therapy has been used successfully as a distractive tool to reduce symptoms of pain, anxiety and dyspnea in COPD, cancer, and patients with chronic diseases. Moreover, recent advances enabling us to enhance rhythm and tempo of music to alter walking cadence make it possible to utilize music as a rehabilitative tool to prescribe proper intensity based on cadence while taking advantage of the motivational and distractive properties of music.
Aims: The purpose of this study is therefore to test the hypothesis that a music-enhanced independent home-based program will significantly improve walking ability and reduce intermittent claudication pain in patients with PAD over 12-weeks compared to a home-based exercise program without music-enhancement. Additionally, we will complete a descriptive study comparing walking cadence in three 6-minute walks conducted in a random order (walk without music, walk with music, walk with RAS [rhythmic auditory stimulation] music).
Sample: Fifteen patients with PAD (Ankle-Brachial Index<0.9) will be randomized to a 12-week, home-based walking program. Ten patients will receive the walking program with music enhancement and 5 patients will receive the same program without the music enhancement.
Approach: For the 12-week home-based walking program with music enhancement, patients will choose the genre(s) of music that they prefer to listen to. Songs will be chosen based on genre and age. The beats/minute of the music will be accentuated and adjusted to the number of steps/minute in the exercise prescription. The primary outcome is walking distance covered during a six-minute walk at baseline compared to 12-weeks. Secondary outcomes include onset of claudication pain, quality of life and weekly volume of walking accumulated. The control group will receive the same walking program without music enhancement. In addition to the feasibility RCT, we will conduct 3 six-minute walks in a random order at baseline. Results of these tests will inform whether walking cadence increases with RAS. Since walking distance may improve with practice, the order of the walks will be conducted randomly. Data will be collected at 6 and 12 weeks. Although our primary outcome is to measured following 12 weeks of the walking program, we will test patients at 6 weeks to ascertain if we can move forward more quickly and if the exercise prescription needs to be adjusted.
Analysis: GLMM modeling will be used to determine the effect of the intervention (RCT) or condition (descriptive study) on distance walked and intermittent claudication pain.