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A digital health program enhances walking capacity and health status in symptomatic peripheral artery disease

Amlani, Vishal ; Dobies, Bartosz ; Wahlgren, Carl Magnus ; Andersson, Manne ; Sigvant, Birgitta ; Gottsäter, Anders LU orcid ; Zarrouk, Moncef LU ; Nilsson, Olga ; Hallsson, Hallur and Karlsdottir, Linda , et al. (2026) In European Heart Journal - Digital Health 7(5).
Abstract

Aims: Intermittent claudication (IC) is the most common manifestation of peripheral artery disease (PAD), an atherosclerotic condition associated with high cardiovascular morbidity and mortality. Management targets cardiovascular risk reduction and limb function, but effective non-invasive treatments for limb symptoms remain limited. The aim of this prospective, multicentre randomized controlled trial was to evaluate whether a 12-week multimodal smartphone-based digital health programme improves walking capacity and symptoms in patients with IC. Methods and results: The IPAD trial compared standard care alone with standard care plus a 12-week digital health intervention focused on lifestyle modification and physical activity,... (More)

Aims: Intermittent claudication (IC) is the most common manifestation of peripheral artery disease (PAD), an atherosclerotic condition associated with high cardiovascular morbidity and mortality. Management targets cardiovascular risk reduction and limb function, but effective non-invasive treatments for limb symptoms remain limited. The aim of this prospective, multicentre randomized controlled trial was to evaluate whether a 12-week multimodal smartphone-based digital health programme improves walking capacity and symptoms in patients with IC. Methods and results: The IPAD trial compared standard care alone with standard care plus a 12-week digital health intervention focused on lifestyle modification and physical activity, incorporating behavioural change techniques and gamification. The primary observer-blinded endpoint was maximum walking distance (MWD) during a 6-min walk test (6MWT), contextualized against minimal clinically important difference thresholds. Secondary endpoints included pain-free 6MWT distance and health-related quality of life (HRQoL). Over 21 months, 155 patients were randomized 1:1. Mean (SD) age was 71.8 (7.6) years. Compared with controls, the intervention group showed greater improvement in MWD (+21.44 m; 95% confidence interval [CI] 6.00–36.87; P = 0.007), exceeding the predefined 12-m MCID at the group level, and in pain-free walking distance (+32.95 m; 95% CI 0.68–65.23; P = 0.045). The relative risk of achieving an individual 12-m MCID did not differ between groups (risk ratio [RR] 1.27; 95% CI 0.91–1.76; P = 0.162). Exploratory analysis using a 20.1-m MCID showed a higher proportion of patients achieving the MCID in the intervention group (RR 1.97; 95% CI 1.16–3.34; P = 0.012). HRQoL improved nominally, with a between-group benefit on the EuroQol-5 Dimensions visual analogue scale (+6.29 points; 95% CI 1.33–11.20; P = 0.013). Conclusion: The digital health programme resulted in a clinically meaningful improvement in walking capacity in PAD patients with IC.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Digital health, Intermittent claudication, Peripheral artery disease
in
European Heart Journal - Digital Health
volume
7
issue
5
article number
ztag072
publisher
Oxford University Press
external identifiers
  • scopus:105041851043
  • pmid:42211775
ISSN
2634-3916
DOI
10.1093/ehjdh/ztag072
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
id
4102c546-431f-45bb-84fd-f127bffd2829
date added to LUP
2026-07-18 10:43:20
date last changed
2026-09-12 14:31:06
@article{4102c546-431f-45bb-84fd-f127bffd2829,
  abstract     = {{<p>Aims: Intermittent claudication (IC) is the most common manifestation of peripheral artery disease (PAD), an atherosclerotic condition associated with high cardiovascular morbidity and mortality. Management targets cardiovascular risk reduction and limb function, but effective non-invasive treatments for limb symptoms remain limited. The aim of this prospective, multicentre randomized controlled trial was to evaluate whether a 12-week multimodal smartphone-based digital health programme improves walking capacity and symptoms in patients with IC. Methods and results: The IPAD trial compared standard care alone with standard care plus a 12-week digital health intervention focused on lifestyle modification and physical activity, incorporating behavioural change techniques and gamification. The primary observer-blinded endpoint was maximum walking distance (MWD) during a 6-min walk test (6MWT), contextualized against minimal clinically important difference thresholds. Secondary endpoints included pain-free 6MWT distance and health-related quality of life (HRQoL). Over 21 months, 155 patients were randomized 1:1. Mean (SD) age was 71.8 (7.6) years. Compared with controls, the intervention group showed greater improvement in MWD (+21.44 m; 95% confidence interval [CI] 6.00–36.87; P = 0.007), exceeding the predefined 12-m MCID at the group level, and in pain-free walking distance (+32.95 m; 95% CI 0.68–65.23; P = 0.045). The relative risk of achieving an individual 12-m MCID did not differ between groups (risk ratio [RR] 1.27; 95% CI 0.91–1.76; P = 0.162). Exploratory analysis using a 20.1-m MCID showed a higher proportion of patients achieving the MCID in the intervention group (RR 1.97; 95% CI 1.16–3.34; P = 0.012). HRQoL improved nominally, with a between-group benefit on the EuroQol-5 Dimensions visual analogue scale (+6.29 points; 95% CI 1.33–11.20; P = 0.013). Conclusion: The digital health programme resulted in a clinically meaningful improvement in walking capacity in PAD patients with IC.</p>}},
  author       = {{Amlani, Vishal and Dobies, Bartosz and Wahlgren, Carl Magnus and Andersson, Manne and Sigvant, Birgitta and Gottsäter, Anders and Zarrouk, Moncef and Nilsson, Olga and Hallsson, Hallur and Karlsdottir, Linda and Oddsson, Sæmundur and Thorgeirsson, Tryggvi and Nordanstig, Joakim}},
  issn         = {{2634-3916}},
  keywords     = {{Digital health; Intermittent claudication; Peripheral artery disease}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal - Digital Health}},
  title        = {{A digital health program enhances walking capacity and health status in symptomatic peripheral artery disease}},
  url          = {{http://dx.doi.org/10.1093/ehjdh/ztag072}},
  doi          = {{10.1093/ehjdh/ztag072}},
  volume       = {{7}},
  year         = {{2026}},
}