Barriers to participation in supervised exercise therapy reported by people with peripheral artery disease

Madeline D. Cetlin, Tamar Polonsky, Karen Ho, Dongxue Zhang, Lu Tian, Lihui Zhao, Philip Greenland, Diane Treat-Jacobson, Melina R. Kibbe, Michael H. Criqui, Jack M. Guralnik, Mary M. McDermott

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: This study identified barriers to participation in supervised exercise therapy covered by the Centers for Medicare and Medicaid Services (CMS), reported by people with lower extremity peripheral artery disease (PAD). Methods: People with PAD participating in research studies of walking impairment due to PAD in the Chicagoland area were asked to complete a questionnaire between March 15, 2019, and July 12, 2022, assessing their experience and attitudes about supervised exercise therapy. Participants were identified using mailed postcards to people aged 50 and older in Chicagoland, from medical centers in Chicago, and using bus and train advertisements. The questionnaire was developed based on focus group feedback from people with PAD. Results: Of 516 participants with PAD approached, 489 (94.8%) completed the questionnaire (mean age: 71.0 years [standard deviation: 8.7], mean ankle-brachial index: 0.71 [standard deviation: 0.25]; 204 [41.7%] women and 261 [53.4%] Black). Of the 489 participants, 416 (85.1%) reported that their physician had never prescribed or recommended supervised exercise therapy. Overall, 357 (73.2%) reported willingness to travel three times weekly to the medical center for supervised exercise participation. However, of these, 214 (59.9%) reported that they were unwilling or unable to pay the $11 per exercise session copay required for supervised exercise covered by CMS. Of 51 people with PAD who reported prior participation in supervised exercise, only 5 (9.8%) completed the 12 weeks of supervised exercise therapy covered by CMS and 29 (56.9%) completed 6 or fewer weeks. Of 131 (26.8%) unwilling to travel three times weekly to a center for supervised exercise, the most common reasons for unwillingness to participate were “too time-consuming” (55.0%), “too inconvenient” (45.8%), and “lack of interest in treadmill exercise” (28.2%). Conclusions: Approximately 2 to 4 years after CMS began covering supervised exercise for PAD, most people with PAD in this study from a large urban area had not participated in supervised exercise therapy. Of those who participated, most completed fewer than half of the sessions covered by CMS. The required CMS copayment was a common barrier to supervised exercise participation by people with PAD.

Original languageEnglish (US)
Pages (from-to)506-514
Number of pages9
JournalJournal of vascular surgery
Issue number2
StatePublished - Feb 2023

Bibliographical note

Funding Information:
The work was funded by the National Heart, Lung, and Blood Institute ( R01-HL126117 , R01-HL131771 , R01-HL122846 ), the National Institute on Aging ( R01-AG068458 , R01-AG072335 , R21-AG063076 , R21-AG056903 , R01-AG-050897 ), and the American Heart Association ( 18SFRN33900097 , 18SFRN33970010 ).

Publisher Copyright:
© 2022 Society for Vascular Surgery


  • Costs
  • Exercise
  • Guidelines
  • Intermittent claudication
  • Peripheral artery disease

PubMed: MeSH publication types

  • Journal Article


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