Challenges in recruitment of persons with peripheral artery disease for exercise studies

This article describes feasibility of direct and indirect recruitment methods for exercise studies designed for older adults with peripheral artery disease (PAD). Recruitment of older adults with PAD for participation in exercise studies has been particularly challenging. Age, risk factors, and comorbid conditions affect physical activity in older adults with PAD. Barriers to exercise, such as safety, health, and age-related changes, contribute to lack of participation in exercise studies. Various direct and indirect recruitment approaches and participant responses, along with reasons for nonparticipation, are categorized into participant demographic, community, and research-related barriers. At a cost of $1,330.00, indirect recruitment strategies of social marketing and community outreach resulted in two referrals and no enrollments. Recruitment-site champions and education resulted in no referrals and no enrollments. Direct recruitment approaches such as health system recruitment and referrals paired with flyers resulted in 44 referrals and one enrollment. Only one referral was obtained from a physician practice. Reasons for nonparticipation included lack of follow-up, presence of one or more exclusion criteria, lack of transportation, and comorbid disease burden that limited activity. Community- and research-related barriers included recruitment competition for other studies, budget limitations, lack of recruitment staff, and strict inclusion/exclusion criteria. Successful recruitment of older adults with PAD for participation in exercise clinical trials may require substantial time and budget. Interventions to address identified barriers such as personal attitudes and socioeconomic factors, lack of social support, and lack of transportation, combined with community factors such as rural location, and research study design considerations may facilitate recruitment efforts.