PAD is a progressive cardiovascular disease resulting from narrowing or obstruction of the arteries in the lower limbs, a consequence of atherosclerosis — a chronic process characterized by the formation of fatty plaques and fibrous tissue in the arterial wall, leading to reduced blood flow. Its development is favoured by risk factors such as smoking, high blood pressure, diabetes, and high cholesterol. Although often asymptomatic in the early stages, it typically manifests as intermittent claudication, defined by pain or cramps that occur on walking and improve with rest. However, the more one walks, the less pain tends to occur over time, since regular exercise improves muscle oxygenation and helps to stop the disease progression. In contrast, the absence of consistent physical activity leads to progressive reduction of mobility and autonomy, leading to a sedentary lifestyle, functional dependence, social isolation, and a high prevalence of symptoms of anxiety and depression.
Home / Publications / Publication
Home / Publications / Publication
MORE DISTANCE, LESS PAIN: IMPACT OF A DIGITAL PROGRAM ON PERIPHERAL ARTERIAL DISEASE
Publication type: Article Summary
Original title: Effect of a monitored home-based exercise program combined with a behavior change intervention and a smartphone app on walking distances and quality of life in adults with peripheral arterial disease: the WalkingPad randomized clinical trial
Article publication date: November 2023
Source: Frontiers in Cardiovascular Medicine
Authors: Ivone Silva, Célia Sofia Moreira, Susana Pedras, Rafaela Oliveira, Carlos Veiga, Luís Moreira, Daniel Santarém, Daniel Guedes & Hugo Paredes
What is the goal, target audience, and areas of digital health it addresses?
The WalkingPad study aimed to evaluate the effectiveness of a home-based exercise therapy program combined with a behavioural change intervention, supported by a mobile application developed for remote monitoring and follow-up of people with peripheral arterial disease (PAD) and intermittent claudication. The study is intended for healthcare professionals, researchers in cardiovascular rehabilitation and health technologies, as well as decision-makers and managers interested in digital rehabilitation solutions, falling within the areas of e-Health, m-Health, digital therapeutics, telemonitoring, and digital vascular rehabilitation.
What is the context?
PAD is a progressive cardiovascular disease resulting from narrowing or obstruction of the arteries in the lower limbs, a consequence of atherosclerosis — a chronic process characterized by the formation of fatty plaques and fibrous tissue in the arterial wall, leading to reduced blood flow. Its development is favoured by risk factors such as smoking, high blood pressure, diabetes, and high cholesterol. Although often asymptomatic in the early stages, it typically manifests as intermittent claudication, defined by pain or cramps that occur on walking and improve with rest. However, the more one walks, the less pain tends to occur over time, since regular exercise improves muscle oxygenation and helps to stop the disease progression. In contrast, the absence of consistent physical activity leads to progressive reduction of mobility and autonomy, leading to a sedentary lifestyle, functional dependence, social isolation, and a high prevalence of symptoms of anxiety and depression.
In addition to its local impact on the lower limbs, PAD is a systemic marker of atherosclerosis and is associated with an increased risk of acute myocardial infarction, stroke, and early mortality. It should therefore be understood as a public health problem with a strong impact on quality of life and overall cardiovascular prognosis.
What are the current approaches?
International recommendations point to supervised exercise programs in a clinical setting as the first-line treatment for PAD, with widely proven benefits in improving walking distance and quality of life. However, the scarcity of specialized centres, the associated costs, and logistical barriers hinder their widespread implementation and reduce accessibility for patients. As an alternative, home-based exercise therapy is a viable option, allowing structured walking to be carried out in a residential setting. Although effective in the short term, the lack of direct supervision compromises patient motivation and limits the sustainability of results over time.
In this scenario, behavioural change interventions aimed at reinforcing motivation and promoting adherence to exercise, often associated with healthy lifestyle counselling strategies, have gained relevance. At the same time, the development of digital tools such as mobile applications, pedometers, accelerometers, and other portable devices, has facilitated the monitoring of physical activity, delivery of personalized reminders, and sharing data with health professionals. Despite their potential, these digital solutions continue to face significant limitations, including limited clinical validation, poor integration into healthcare systems, and usability difficulties in older populations, factors that limit their effectiveness and hinder large-scale adoption.
What does innovation consist of? How is the impact of this study assessed?
The innovation of WalkingPad lay in the development of a mobile application and web platform designed specifically to support home-based exercise programs for people with PAD and intermittent claudication. WalkingPad aims to improve pain-free walking distance, quality of life, and prevent severe complications such as amputations.
This technological solution enabled the remote prescription and monitoring of individualized walking plans — with routes close to the patient’s home and intensity tailored to their clinical condition — as well as the automatic recording of distance travelled, real-time self-recording of pain, delivery of motivational messages and personalized progression recommendations (such as taking breaks when claudication pain increases and recording that moment). In addition, it integrated geolocation systems and biometric parameters that validated the patient’s identity and clinical condition, analyzing gait patterns and detecting changes that could signal disease progression or indicate that the walk had been performed by another person. The data was securely transmitted to the web platform, allowing professionals to track clinical progress and provide personalized feedback.
The program also incorporated a behavioural intervention based on Self-Determination Theory, including two 120-minute face-to-face sessions and regular telephone calls over 24 weeks, conducted by a psychologist, with the aim of supporting self-management, identifying individual barriers, and reinforcing progress. Additional telephone calls were made in cases of program interruption to encourage continuation.
The clinical trial took place at the Centro Hospitalar Universitário de Santo António, involving 73 participants with PAD and intermittent claudication, of whom 60 completed the three assessments (baseline, 3 and 6 months). Patients were randomly assigned to two groups: the experimental group (n=38), which used the WalkingPad, and the control group (n=35), which manually recorded sessions in a paper diary. Both groups received standard treatment and a structured exercise prescription (30 minutes, three times a week, to near-maximum pain).
The impact of the intervention was assessed using primary outcomes — Pain-Free Walking Distance, Functional Walking Distance, Maximal Walking Distance, and 6-Minute Walk Distance — and secondary outcomes, including quality of life (Vascular Disease-Specific Quality of Life Questionnaire and 12-Item Short Form Health Survey), functional performance (Walking Impairment Questionnaire), and emotional state (Geriatric Anxiety Inventory-Short Form and Geriatric Depression Scale-5).
What are the main results? What is the future of this approach?
The results of this study demonstrated significant clinical improvements in the group that used the mobile application in addition to structured exercise prescription and behavioural intervention. At 3 months, there was an average increase of 93 metres in Pain-Free Walking Distance and 136 metres in Functional Walking Distance, reflecting significant gains in exercise tolerance. At 6 months, progress was even more consistent, with average increases of 210 metres in Maximal Walking Distance and 48 metres in 6-Minute Walk Distance. In addition to these functional parameters, significant improvements were noted in quality of life, in the perception of walking ability and in emotional state, with a reduction in symptoms of anxiety and depression.
The control group, which followed the same exercise program but only used manual recording in a paper diary, also showed positive progress, albeit to a lesser extent. At 3 months, the average increase was 42 metres in Pain-Free Walking Distance and 61 metres in Functional Walking Distance, while at 6 months, 108 metres were observed in Maximal Walking Distance and 19 metres in 6-Minute Walk Distance. These results, although encouraging, showed a substantially lower impact compared to the digitally monitored group, confirming that the integration of the application reinforced adherence, consistency, and effectiveness of rehabilitation.
The future of this approach lies in its large-scale integration into healthcare systems and its adaptation to other chronic cardiovascular conditions, paving the way for more personalized, accessible, and sustainable rehabilitation models capable of amplifying the clinical and social impact of vascular rehabilitation.
Would you like to know all the details?
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Home / Publications / Publication
MORE DISTANCE, LESS PAIN: IMPACT OF A DIGITAL PROGRAM ON PERIPHERAL ARTERIAL DISEASE
Publication type: Article Summary
Original title: Effect of a monitored home-based exercise program combined with a behavior change intervention and a smartphone app on walking distances and quality of life in adults with peripheral arterial disease: the WalkingPad randomized clinical trial
Article publication date: November 2023
Source: Frontiers in Cardiovascular Medicine
Authors: Ivone Silva, Célia Sofia Moreira, Susana Pedras, Rafaela Oliveira, Carlos Veiga, Luís Moreira, Daniel Santarém, Daniel Guedes & Hugo Paredes
What is the goal, target audience, and areas of digital health it addresses?
The WalkingPad study aimed to evaluate the effectiveness of a home-based exercise therapy program combined with a behavioural change intervention, supported by a mobile application developed for remote monitoring and follow-up of people with peripheral arterial disease (PAD) and intermittent claudication. The study is intended for healthcare professionals, researchers in cardiovascular rehabilitation and health technologies, as well as decision-makers and managers interested in digital rehabilitation solutions, falling within the areas of e-Health, m-Health, digital therapeutics, telemonitoring, and digital vascular rehabilitation.
What is the context?
PAD is a progressive cardiovascular disease resulting from narrowing or obstruction of the arteries in the lower limbs, a consequence of atherosclerosis — a chronic process characterized by the formation of fatty plaques and fibrous tissue in the arterial wall, leading to reduced blood flow. Its development is favoured by risk factors such as smoking, high blood pressure, diabetes, and high cholesterol. Although often asymptomatic in the early stages, it typically manifests as intermittent claudication, defined by pain or cramps that occur on walking and improve with rest. However, the more one walks, the less pain tends to occur over time, since regular exercise improves muscle oxygenation and helps to stop the disease progression. In contrast, the absence of consistent physical activity leads to progressive reduction of mobility and autonomy, leading to a sedentary lifestyle, functional dependence, social isolation, and a high prevalence of symptoms of anxiety and depression.
In addition to its local impact on the lower limbs, PAD is a systemic marker of atherosclerosis and is associated with an increased risk of acute myocardial infarction, stroke, and early mortality. It should therefore be understood as a public health problem with a strong impact on quality of life and overall cardiovascular prognosis.
What are the current approaches?
International recommendations point to supervised exercise programs in a clinical setting as the first-line treatment for PAD, with widely proven benefits in improving walking distance and quality of life. However, the scarcity of specialized centres, the associated costs, and logistical barriers hinder their widespread implementation and reduce accessibility for patients. As an alternative, home-based exercise therapy is a viable option, allowing structured walking to be carried out in a residential setting. Although effective in the short term, the lack of direct supervision compromises patient motivation and limits the sustainability of results over time.
In this scenario, behavioural change interventions aimed at reinforcing motivation and promoting adherence to exercise, often associated with healthy lifestyle counselling strategies, have gained relevance. At the same time, the development of digital tools such as mobile applications, pedometers, accelerometers, and other portable devices, has facilitated the monitoring of physical activity, delivery of personalized reminders, and sharing data with health professionals. Despite their potential, these digital solutions continue to face significant limitations, including limited clinical validation, poor integration into healthcare systems, and usability difficulties in older populations, factors that limit their effectiveness and hinder large-scale adoption.
What does innovation consist of? How is the impact of this study assessed?
The innovation of WalkingPad lay in the development of a mobile application and web platform designed specifically to support home-based exercise programs for people with PAD and intermittent claudication. WalkingPad aims to improve pain-free walking distance, quality of life, and prevent severe complications such as amputations.
This technological solution enabled the remote prescription and monitoring of individualized walking plans — with routes close to the patient’s home and intensity tailored to their clinical condition — as well as the automatic recording of distance travelled, real-time self-recording of pain, delivery of motivational messages and personalized progression recommendations (such as taking breaks when claudication pain increases and recording that moment). In addition, it integrated geolocation systems and biometric parameters that validated the patient’s identity and clinical condition, analyzing gait patterns and detecting changes that could signal disease progression or indicate that the walk had been performed by another person. The data was securely transmitted to the web platform, allowing professionals to track clinical progress and provide personalized feedback.
The program also incorporated a behavioural intervention based on Self-Determination Theory, including two 120-minute face-to-face sessions and regular telephone calls over 24 weeks, conducted by a psychologist, with the aim of supporting self-management, identifying individual barriers, and reinforcing progress. Additional telephone calls were made in cases of program interruption to encourage continuation.
The clinical trial took place at the Centro Hospitalar Universitário de Santo António, involving 73 participants with PAD and intermittent claudication, of whom 60 completed the three assessments (baseline, 3 and 6 months). Patients were randomly assigned to two groups: the experimental group (n=38), which used the WalkingPad, and the control group (n=35), which manually recorded sessions in a paper diary. Both groups received standard treatment and a structured exercise prescription (30 minutes, three times a week, to near-maximum pain).
The impact of the intervention was assessed using primary outcomes — Pain-Free Walking Distance, Functional Walking Distance, Maximal Walking Distance, and 6-Minute Walk Distance — and secondary outcomes, including quality of life (Vascular Disease-Specific Quality of Life Questionnaire and 12-Item Short Form Health Survey), functional performance (Walking Impairment Questionnaire), and emotional state (Geriatric Anxiety Inventory-Short Form and Geriatric Depression Scale-5).
What are the main results? What is the future of this approach?
The results of this study demonstrated significant clinical improvements in the group that used the mobile application in addition to structured exercise prescription and behavioural intervention. At 3 months, there was an average increase of 93 metres in Pain-Free Walking Distance and 136 metres in Functional Walking Distance, reflecting significant gains in exercise tolerance. At 6 months, progress was even more consistent, with average increases of 210 metres in Maximal Walking Distance and 48 metres in 6-Minute Walk Distance. In addition to these functional parameters, significant improvements were noted in quality of life, in the perception of walking ability and in emotional state, with a reduction in symptoms of anxiety and depression.
The control group, which followed the same exercise program but only used manual recording in a paper diary, also showed positive progress, albeit to a lesser extent. At 3 months, the average increase was 42 metres in Pain-Free Walking Distance and 61 metres in Functional Walking Distance, while at 6 months, 108 metres were observed in Maximal Walking Distance and 19 metres in 6-Minute Walk Distance. These results, although encouraging, showed a substantially lower impact compared to the digitally monitored group, confirming that the integration of the application reinforced adherence, consistency, and effectiveness of rehabilitation.
The future of this approach lies in its large-scale integration into healthcare systems and its adaptation to other chronic cardiovascular conditions, paving the way for more personalized, accessible, and sustainable rehabilitation models capable of amplifying the clinical and social impact of vascular rehabilitation.
Would you like to know all the details?
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Facial paralysis, defined by the inability to move one or both sides of the face, has an incidence of 20 to 30 cases per 100,000 people annually. This condition often causes facial weakness, difficulties in…
Detection of Anxiety and Panic Attacks in Real Time
The growing number of people with anxiety disorders, along with increased awareness of mental health, drives the need for new technological tools that provide remote and continuous monitoring of anxiety and panic disorders. Thus, the…
A Novel Approach for Robotic-assisted Tele-echography
Currently, robotic systems for ultrasound diagnostic procedures fall into two main categories: portable robots that require manual positioning and fully autonomous robotic systems that independently control the ultrasound probe’s orientation and positioning. Portable robots rely…
From Big Data to Big Decisions: How AI Stratifies Cancer Cases by Risk Factors
The CLARIFY Decision Support Platform (DSP) is a responsive web application designed to support decision-making in cancer care through real-time data integration and predictive analytics. Built on Big Data Europe, the platform integrates a variety…
From “Free Text” to Structured Clinical Data: the Foundation for Clinical Decision Support Systems
Currently, the practice of recording clinical information in “free text” offers flexibility, but hinders automatic data extraction, limiting the application of analytical models. Most records are unstructured, and the use of non-standard abbreviations increases ambiguity,…
Artificial Intelligence used in Depression Detection in Cancer Survivors
The goal of the FAITH project (Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment) is to remotely identify and predict depressive symptoms in cancer survivors using a federated machine learning approach…
Integration of SONHO v2 and SClínico Systems at ULS of Coimbra to Improve Healthcare Services
With more than half a million hospital medical consultations carried out in the first half of 2024, the ULS of Coimbra stands out as an institution dedicated to integrated, high-quality and patient-centered healthcare, with 8…
Elderly Care Ecosystem: an Innovative Platform for Personalized and Efficient Services
The Elderly Care Ecosystem (ECE) is an integration of various digital health technologies, exploring the areas of telehealth and predictive analytics. The goal of this ecosystem is to improve the quality of life for elderly…
Innovative technology that subconsciously relieves anxiety through a scarf
The SCAARF technology aims to offer an alternative method to alleviate anxiety symptoms in a non-intrusive and subconscious way. This technology is an innovative idea in the field of digital health and wearable technology, designed…
Digital Health Interventions: Equity in Hypertension Care for Everyone
Nearly half of all adults in the United States have hypertension, one of the leading risk factors for cardiovascular disease, and only about a quarter (24%) of those people have their hypertension under control. Studies…
Personalization and Technology in Diabetes Management
IPDM has significant potential to improve diabetes management and drive health system reforms to become high-performing, effective, equitable, accessible, and sustainable. Evidence and good practices inspire health system transformation. Adopting person-centred approaches like co-creation and…
Negotiations on the European Health Data Space Advance With the Participation of the SPMS
The European Health Data Space will be a common health data sharing system across the European Union. It foresees the use of data for purposes that benefit people and society. It will ensure citizens have…
Secretary of State Margarida Tavares Emphasizes Digital Innovation in Health Promotion
Margarida Tavares spoke at the opening of the conference ” O Digital na promoção contínua da saúde e do bem-estar”, organized by the Associação para a Promoção e Desenvolvimento da Sociedade da Informação (APDSI) and…
ARS Algarve Modernizes Radiology With AI and New Data Center
The radiology service of ARS Algarve has already performed nearly 29,000 exams using Artificial Intelligence (AI) technology. In recent years, there has been a significant investment in image digitization and data storage, as well as…
European Health Data Space: Unified Access To Health Data In The EU
The COVID-19 pandemic highlighted the importance of digital services in health, but complex rules and increasing cyberattacks make it difficult to share data across Member States; the EHDS, based on several regulations, provides tailor-made rules…
European Commission Amends Digital Europe Programme With an Investment of €762.7 Million
The European Commission has amended the Digital Europe Programme work programmes 2023-2024, investing an additional €762.7 million in Europe’s digital transition and cybersecurity. The digital transition is the main work programme with a budget of…
SPMS Integrates the TEF-Health Initiative
SPMS participates in the TEF-Health initiative as a partner in a consortium composed of 51 entities from 9 European Union countries. This action is co-financed by the European Commission and has a duration of five…
FMUP Creates Inhealth Junior Academy for High School Students
The InHealth Junior Academy — Academia Júnior de Inovação em Saúde is an initiative of the Departamento de Medicina da Comunidade, Informação e Decisão em Saúde da Faculdade de Medicina da Universidade do Porto (FMUP)….
SPMS Represents Portugal as Vice-president of GDHP
The GDHP is an intergovernmental organization in the digital health sector that facilitates cooperation and collaboration between government representatives and the World Health Organization (WHO). Its purpose is to foster policymaking that promote the digitalization…
Digital Transformation of Health at INCoDe.2030 in Tomar
The “National Digital Skills Initiative e.2030, Portugal” (INCoDe.2030) is an initiative that aims to improve the Portuguese population’s level of digital skills, placing Portugal at the level of the most advanced European countries in this…
Braga Hospital Evaluates Memory With Interactive Game in Patients With Multiple Sclerosis
Multiple Sclerosis is known as a chronic disease of the central nervous system, with a wide variety of motor and sensory symptoms that can lead to work disability, socioeconomic burden, and reduced quality of life…
Neurosurgery Teleconsultation Wins Innovation Award
The aim of the BI Award for Innovation in Healthcare is to recognize innovative projects in the healthcare sector that improve the quality of life for the Portuguese people. In 2021, the specific theme was…
HealthData@PT: New SPMS Initiative for Health Data
Action HealthData@PT is launched in the context of the implementation of the European Health Data Space, and is an initiative approved by the European Commission under the EU4Health 2021-2027 programme. This initiative contributes to the…
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