Despite comparatively less structure than SET, home-based exercise has demonstrated efficacy in 3 randomized trials. Gardner et al randomized 119 patients to either standardized exercise therapy, home exercise therapy, or non-exercise control group. Both SET and home-based exercise demonstrated similar increases in pain-free and maximal treadmill walking at 12-week follow-up compared to non-exercise controls. However, the home-based group had a 28% dropout rate–clearly demonstrating the participation and adherence challenges associated with home-based exercise (25).
Some evidence suggests that home-based exercise may offer increased benefits in ‘real world’ exercise performance compared to SET. In a separate trial by Gardner et al, 180 participants were randomized to SET, home-based walking exercise or a light resistance exercise control arm (26). At 12 weeks, the SET participants demonstrated a superior increase in maximal treadmill walking time compared to home-based exercise participants (192 sec vs 110 sec, respectively). However, the home-based exercise group demonstrated significantly improved 6-minute walk distance compared to SET (45 meters vs 15 meters, respectively).
As adherence is the most salient challenge with home-based exercise, cognitive behavioral therapy has proven to be beneficial. Group-Mediated Cognitive Behavioral (GMCB) intervention increased 6-minute walk distance, pain-free treadmill walking time and maximal walking time compared to controls (27).