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Harwood, Amy E., Sean Pymer, Lee Ingle, Patrick Doherty, Ian C. Chetter, Belinda Parmenter, Christopher D. Askew y Gary A. Tew. "Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners". BMJ Open Sport & Exercise Medicine 6, n.º 1 (noviembre de 2020): e000897. http://dx.doi.org/10.1136/bmjsem-2020-000897.
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Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.
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Blears, Elizabeth E., Jessica K. Elias, Christian Tapking, Craig Porter y Victoria G. Rontoyanni. "Supervised Resistance Training on Functional Capacity, Muscle Strength and Vascular Function in Peripheral Artery Disease: An Updated Systematic Review and Meta-Analysis". Journal of Clinical Medicine 10, n.º 10 (19 de mayo de 2021): 2193. http://dx.doi.org/10.3390/jcm10102193.
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Supervised resistance training appears to be a promising alternative exercise modality to supervised walking in patients with peripheral artery disease (PAD). This meta-analysis examined the efficacy of supervised RT for improving walking capacity, and whether adaptations occur at the vascular and/or skeletal muscle level in PAD patients. We searched Medline, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) in PAD patients testing the effects of supervised RT for ≥4 wk. on walking capacity, vascular function, and muscle strength. Pooled effect estimates were calculated and evaluated using conventional meta-analytic procedures. Six RCTs compared supervised RT to standard care. Overall, supervised RT prolonged claudication onset distance during a 6-min walk test (6-MWT) (101.7 m (59.6, 143.8), p < 0.001) and improved total walking distance during graded treadmill walking (SMD: 0.67 (0.33, 1.01), p < 0.001) and the 6-MWT (49.4 m (3.1, 95.6), p = 0.04). Five RCTS compared supervised RT and supervised intermittent walking, where the differences in functional capacity between the two exercise modalities appear to depend on the intensity of the exercise program. The insufficient evidence on the effects of RT on vascular function and muscle strength permitted only limited exploration. We conclude that RT is effective in prolonging walking performance in PAD patients. Whether RT exerts its influence on functional capacity by promoting blood flow and/or enhancing skeletal muscle strength remains unclear.
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Spannbauer, Anna, Maciej Chwała, Tomasz Ridan, Arkadiusz Berwecki, Piotr Mika, Anita Kulik, Małgorzata Berwecka y Maria T. Szewczyk. "Intermittent Claudication in Physiotherapists’ Practice". BioMed Research International 2019 (18 de septiembre de 2019): 1–10. http://dx.doi.org/10.1155/2019/2470801.
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Intermittent claudication is a symptom of atherosclerosis of the lower limbs (peripheral arterial disease (PAD)) and is characterized by pain and cramps of lower limb muscles during exercise. Claudication leads to a reduction in physical activity of patients. PAD is a systemic disease. Atherosclerotic lesions located in the arteries of the lower limbs not only pose the risk of the ischemic limb loss, but above all, they are an important prognostic factor. Patients with claudication are at significant risk of cardiovascular complications such as infarcts or strokes. Comprehensive rehabilitation of patients with intermittent claudication based on the current TASC II (Inter-Society Consensus for the Management of Peripheral Arterial Disease) guidelines, ESC (European Society of Cardiology) guidelines, and AHA (American Heart Association) guidelines includes supervised treadmill training, training on a bicycle ergometer, Nordic Walking, resistance exercises of lower limb muscles, and exercises of upper limbs. A trained, educated, and motivated patient has a chance to improve life quality as well as life expectancy.
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Lima, Aluísio, Raphael Ritti-Dias, Cláudia L. M. Forjaz, Marilia Correia, Alessandra Miranda, Maria Brasileiro-Santos, Amilton Santos, Dario Sobral Filho y Alexandre Silva. "A session of resistance exercise increases vasodilation in intermittent claudication patients". Applied Physiology, Nutrition, and Metabolism 40, n.º 1 (enero de 2015): 59–64. http://dx.doi.org/10.1139/apnm-2014-0342.
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No study has shown the effects of acute resistance exercise on vasodilatory capacity of patients with peripheral artery disease. The aim of this study was to analyse the effects of a single session of resistance exercise on blood flow, reactive hyperemia, plasma nitrite, and plasma malondialdehyde in patients with peripheral artery disease. Fourteen peripheral artery disease patients underwent, in a random order, 2 experimental sessions: control (rest for 30 min) and resistance exercise (8 exercises, 2 sets of 10 repetitions at an intensity of 5–7 in the OMNI Resistance Exercise Scale). Blood flow, reactive hyperemia, plasma nitrite, and malondialdehyde were measured before and 40 min after the interventions in both sessions. Data were compared between sessions by analysis of covariance, using pre-intervention values as covariates. The increases in blood flow, reactive hyperemia, and log plasma nitrite were greater (p ≤ 0.05) after resistance exercise than the control session (3.2 ± 0.1 vs. 2.7 ± 0.1 mL·100 mL−1tissue·min−1, 8.0 ± 0.1 vs. 5.7 ± 0.1 AU, and 1.36 ± 0.01 vs. 1.26 ± 0.01 μmol∙L−1, respectively). On the other hand, malondialdehyde was similar between sessions (p > 0.05). In peripheral arterial disease patients, a single session of resistance exercise increases blood flow and reactive hyperemia, which seems to be mediated, in part, by increases in nitric oxide release.
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Wolska, Marta, Pamela Czajka y Marek Postuła. "Intermittent claudication - the meaning of pharmacological and non-pharmacological therapy in chronic treatment". Medycyna Faktów 14, n.º 3 (30 de septiembre de 2021): 240–43. http://dx.doi.org/10.24292/01.mf.0321.4.
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Intermittent claudication is a typical sign of peripheral vascular disease, which results from limited arterial blood flow due to atherosclerosis, appears during exercises and is relieved after a short break. Intermittent claudication often presents as a pain in the calf muscle after walking a particular distance. Physical examination, detailed interview and ankle–brachial index are key elements of the diagnostic process, which allows for diagnosis of peripheral artery disease. The treatment is dependent on multiple factors, including the dynamics of the disease and coexisting diseases. The aim of the treatment of patients with intermittent claudication is reducing the risk of cardiovascular complications and improving the quality of life. The treatment is based on a conservative therapy, especially march training. The pharmacological treatment is limited to a few medications, which are rarely used. In the advanced stage of the disease the most appropriate option seems surgery.
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Bronas, Ulf G. y Judith G. Regensteiner. "Connecting the past to the present: A historical review of exercise training for peripheral artery disease". Vascular Medicine 27, n.º 2 (28 de febrero de 2022): 174–85. http://dx.doi.org/10.1177/1358863x211073620.
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Peripheral artery disease (PAD), a prevalent manifestation of atherosclerosis, is associated with increased cardiovascular morbidity and mortality as well as decreased functional ability. Exercise training for PAD is acknowledged to be a highly effective treatment, which improves walking ability and cardiovascular risk. The historical development of this treatment has not been the focus of a report. Therefore, we present a historical review of research on exercise training for PAD. Overall, this body of knowledge has provided strong evidence of the efficacy of supervised exercise training (SET) to improve walking ability for patients with claudication due to PAD. SET, using intermittent bouts of walking exercise to moderate claudication pain on a treadmill, is considered the most efficacious mode of exercise to improve walking ability in patients with claudication. This compelling evidence published over the past 60 years was evaluated by the Centers for Medicare & Medicaid Services in 2017, which culminated in a national coverage determination for SET to improve symptomatic PAD. Future directions include determining optimal delivery strategies for SET and further elucidation of the mechanisms of improvement in walking ability resulting from SET. In addition, alternative forms of exercise should be evaluated and effective home- and community-based exercise interventions should be assessed. There is an enormous need to increase the inclusion of women and racial and ethnic minority groups in studies. It is to be hoped that researchers will continue with new innovative research and persistence in the treatment of claudication due to PAD.
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Gardner, Andrew W., Petar Alaupovic, Donald E. Parker, Polly S. Montgomery, Omar L. Esponda y Ana I. Casanegra. "Influence of Peripheral Artery Disease and Statin Therapy on Apolipoprotein Profiles". International Journal of Vascular Medicine 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/548764.
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Apolipoprotein B is a stronger predictor of myocardial infarction than LDL cholesterol, and it is inversely related to physical activity and modifiable with exercise training. As such, apolipoprotein measures may be of particular relevance for subjects with PAD and claudication. We compared plasma apolipoprotein profiles in 29 subjects with peripheral artery disease (PAD) and intermittent claudication and in 39 control subjects. Furthermore, we compared the plasma apolipoprotein profiles of subjects with PAD either treated (n=17) or untreated (n=12) with statin medications. For the apolipoprotein subparticle analyses, subjects with PAD had higher age-adjusted Lp-B:C (P<0.05) and lower values of Lp-A-I:A-II (P<0.05) than controls. The PAD group taking statins had lower age-adjusted values for apoB (P<0.05), Lp-A-II:B:C:D:E (P<0.05), Lp-B:E + Lp-B:C:E (P<0.05), Lp-B:C (P<0.05), and Lp-A-I (P<0.05) than the untreated PAD group. Subjects with PAD have impaired apolipoprotein profiles than controls, characterized by Lp-B:C and Lp-A-I:A-II. Furthermore, subjects with PAD on statin medications have a more favorable risk profile, particularly noted in multiple apolipoprotein subparticles. The efficacy of statin therapy to improve cardiovascular risk appears more evident in the apolipoprotein sub-particle profile than in the more traditional lipid profile of subjects with PAD and claudication. This trial is registered with ClinicalTrials.govNCT00618670.
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Nicholson, CD. "Experimental Models of Chronic Lower Extremity Arterial Occlusive Disease: Lessons for Drug Development". Vascular Medicine 1, n.º 1 (febrero de 1996): 43–49. http://dx.doi.org/10.1177/1358863x9600100108.
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Peripheral vascular disease is the result of chronic vascular insufficiency. As the vascular insufficiency of the lower limbs progressively deteriorates, the condition progresses from intermittent claudication (pain upon exercise) to pain at rest and gangrene. In very severe cases amputation of the leg may be necessary. Whilst dieting, cessation of smoking and physical exercise all beneficially affect the progression of the disorder, the available drug therapy is of limited benefit. Very effective pharmacological agents capable of alleviating the symptoms of chronic peripheral vascular disease have not been developed. In order to mimic the vascular insufficiency of intermittent claudication, an animal model was developed in rats. This involves short-term and long-term 6–10 weeks ligation of the femoral artery of the rat. As demonstrated using measurements of hindlimb skeletal muscle, blood flow, pO2, metabolism and function, a model of intermittent claudication was produced. Using this model, the beneficial effects of physical training was demonstrated. Physical training induced an increase in blood flow and a greater capacity for aerobic metabolism in the partially ischaemic skeletal muscle. The effect of vasodilators has also been examined in this model; in contrast to agents such as Ca2+ antagonists, K+ channel openers appear to improve nutritional blood flow and metabolism in the afflicted skeletal muscle. This model can also be utilized to demonstrate the effects of haemorrheological interventions and of agents modulating muscle metabolism. However, additional effort is required to develop models for the evaluation of efficacy of antiatherothrombotic drugs.
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Kropielnicka, Katarzyna, Wioletta Dziubek, Katarzyna Bulińska, Małgorzata Stefańska, Joanna Wojcieszczyk-Latos, Ryszard Jasiński, Urszula Pilch et al. "Influence of the Physical Training on Muscle Function and Walking Distance in Symptomatic Peripheral Arterial Disease in Elderly". BioMed Research International 2018 (23 de septiembre de 2018): 1–16. http://dx.doi.org/10.1155/2018/1937527.
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Introduction. A typical symptom of chronic lower-limb ischaemia is lower-limb pain, which occurs during walking forcing the patient to stop, intermittent claudication (IC). Exercise rehabilitation is the basic form of treatment for these patients. Aim. The aim of this study was to compare the effectiveness of three types of physical training programmes conducted over a 12-week period in patients with chronic lower-limb arterial insufficiency. Materials and Methods. Ninety-five people qualified for the 3-month supervised motor rehabilitation programme, conducted three times a week. The respondents were assigned to three types of rehabilitation programmes using a pseudo-randomization method: Group I (TW), subjects undertaking treadmill walking training; Group II (NW), subjects undertaking Nordic walking training; Group III (RES+NW), subjects undertaking resistance and Nordic walking training. Treadmill test, 6 Minute Walk Test (6MWT), and isokinetic test were repeated after 3 months of rehabilitation, which 80 people completed. Results. Combined training (RES+NW) is more effective than Nordic walking alone and supervised treadmill training alone for improving ankle force-velocity parameters (p<0.05) in patients with intermittent claudication. Each of the proposed exercise rehabilitation programmes increased walking distance of patients with intermittent claudication (p<0.05), especially in 6MWT (p=0.001). Significant relationships of force-velocity parameters are observed in the maximum distance obtained in 6MWT, both in Group III (RES + NW) and in Group II (NW) at the level of moderate and strong correlation strength, which indicates that if the lower limbs are stronger the walking distance achieved in 6MWT is longer. Conclusions. Given both the force-velocity parameters and the covered distance, the training RES + NW gives the most beneficial changes compared to training TW alone and NW alone. All types of training increased walking distance, which is an important aspect of the everyday functioning of people with IC.
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McDermott, Mary M., Philip Ades, Jack M. Guralnik, Alan Dyer, Luigi Ferrucci, Kiang Liu, Miriam Nelson et al. "Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication". JAMA 301, n.º 2 (14 de enero de 2009): 165. http://dx.doi.org/10.1001/jama.2008.962.
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Bridgwood, Bernadeta M., Andrew TO Nickinson, John SM Houghton, Coral J. Pepper y Rob D. Sayers. "Knowledge of peripheral artery disease: What do the public, healthcare practitioners, and trainees know?" Vascular Medicine 25, n.º 3 (30 de enero de 2020): 263–73. http://dx.doi.org/10.1177/1358863x19893003.
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This systematic review evaluated the knowledge and awareness of peripheral artery disease (PAD) within the general public (including patients with peripheral vascular disease), nonspecialist healthcare professionals (nsHCP), and trainees (medical students and trainee doctors). Relevant articles were identified from electronic databases using key search terms: ‘peripheral artery disease’; ‘limb ischaemia’; ‘intermittent claudication’; ‘knowledge’; ‘understanding’; ‘public’; ‘medical professional’. The heterogeneous results were described narratively. A lack of knowledge and understanding of PAD (disease awareness) were identified in all groups. Among nsHCPs, factors which affect knowledge include the level of training, early clinical exposure and the presence of family members with cardiovascular/vascular disease. Within the general public, knowledge and awareness was improved if a family member/friend had a diagnosis, or following a patient-centred consultation with any HCP. Public campaigns are proven effective in improving disease knowledge/awareness in conditions such as stroke alongside sustained patient education. These may provide future avenues to improve PAD knowledge and awareness, in order to effectively manage risk factors and minimise delayed or missed diagnosis of PAD. (PROSPERO registration number: CRD42018117304)
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Brenner, Ingrid K. M., C. Ann Brown, Sylvia J. M. Hains, Joan Tranmer, David T. Zelt y Peter M. Brown. "Low-Intensity Exercise Training Increases Heart Rate Variability in Patients With Peripheral Artery Disease". Biological Research For Nursing 22, n.º 1 (4 de noviembre de 2019): 24–33. http://dx.doi.org/10.1177/1099800419884642.
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Patients with peripheral artery disease (PAD), consistent with others with atherosclerotic occlusive disorders, have autonomic dysfunction (as measured by low heart rate variability [HRV]) that predisposes them to sympathetically mediated cardiac arrhythmias and sudden death. Exercise therapy has been shown to increase HRV in patients with coronary artery disease by increasing parasympathetic modulation of heart rate. This study quantified the circulatory and autonomic effects of a progressive, 12-week home-based, low-intensity (pain-free walking) exercise program in PAD and intermittent claudication. Participants ( N = 33, mean age 67.8 8.1 years) were randomly assigned to either a walking group ( n = 18), whose members performed a structured, 12-week, progressive walking program 5 days/week for 12 weeks, or a comparison group ( n = 15), whose members performed usual activities. Circulatory measures (heart rate, blood pressure, and rate pressure product) and autonomic measures (HRV) were obtained at the beginning (Week 1) and end (Week 12) of the study. Minimal change in circulatory measures occurred. However, spectral analysis of HRV revealed that autonomic function improved significantly in members of the walking group; specifically, there was an increase in parasympathetic and a decrease in sympathetic modulation. Members of the walking group also significantly increased maximal walking distance. These findings suggest that a structured, low-intensity, high-frequency walking program improves autonomic function by increasing HRV in patients with PAD.
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Balin, Mehmet y Tarık Kıvrak. "Effect of Repeated Remote Ischemic Preconditioning on Peripheral Arterial Disease in Patients Suffering from Intermittent Claudication". Cardiovascular Therapeutics 2019 (10 de diciembre de 2019): 1–6. http://dx.doi.org/10.1155/2019/9592378.
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Background/Objective. Intermittent claudication (IC) is the symptom of peripheral artery disease (PAD) and causes functional disability. Remote ischemic preconditioning (RIPC), is a phenomenon in which a short period of sub-critical ischemia, protects tissues against ischemia/reperfusion/injury. We considered to test the hypothesis that RIPC in PAD patients suffering from IC would increase muscle resistance to ischemia and thus improve walking-capacity. Materials/Methods. A total of 63 patients with proven-IC underwent two treadmill tests (graded treadmill protocol) with a 28-day interval in between. Patients were consecutively assigned for the non/RIPC-group and RIPC-group procedure one by one. Patients received 5-cycles of alternating 5-minute inflation and 5-minute deflation of blood-pressure cuffs on nondominant upper-limb every day for four weeks. Initial claudication distance (ICD), total walking distance (TWD) and time to relief of claudication (TRC) were recorded during procedure. Results. Patients receiving-RIPC exhibited a marked increase in ICD and TWD between basal and last tests: 209.1 ± 15.4 m vs. 226 ± 15.0 m and 368.8 ± 21.0 m vs. 394 ± 19.9 m, respectively (p<0.001). In addition, patients receiving-RIPC represented a significant decrease in TRC between basal and last tests: 7.8 ± 1.3 min vs. 6.4 ± 1.1 min, respectively (p<0.001). Patients not receiving-RIPC did not exhibit improvement in ICD, TWD, and TRC between basal and last tests: 205.2 ± 12.1 min vs. 207.4 ± 9.9 min, 366.5 ± 24.2 min vs. 369.4 ± 23.2 min and 7.9 ± 1.4 min vs. 7.7 ± 1.3 min, respectively (p>0.05). Conclusion. A significant increase in ICD and TWD were observed in last/treadmill test in RIPC-group. In addition, a significant decrease in TRC was observed in last/treadmill test in RIPC-group. In non/RIPC-group, no improvement was observed in ICD, TWD and TRC.
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Kostewicz, Maciej Waldemar y Waldemar Kostewicz. "Impact of twelve weeks march field training on intermittent claudication in patients with peripheral artery disease after endovascular procedures". Advances in Rehabilitation 2019, n.º 1 (2019): 15–21. http://dx.doi.org/10.5114/areh.2019.84184.
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Mauer, Karin, J. Emilio Exaire, Julie A. Stoner, Jorge F. Saucedo, Polly S. Montgomery y Andrew W. Gardner. "Effect of exercise training on clot strength in patients with peripheral artery disease and intermittent claudication: An ancillary study". SAGE Open Medicine 3 (19 de marzo de 2015): 205031211557593. http://dx.doi.org/10.1177/2050312115575938.
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Gardner, Andrew W., Donald E. Parker y Polly S. Montgomery. "Predictors of Improved Walking after a Supervised Walking Exercise Program in Men and Women with Peripheral Artery Disease". International Journal of Vascular Medicine 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/2191350.
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We compared the changes in ambulatory outcomes between men and women with symptomatic peripheral arterial disease (PAD) following completion of a supervised, on-site, treadmill exercise program, and we determined whether exercise training variables and baseline clinical characteristics were predictive of changes in ambulatory outcomes in men and women. Twenty-three men and 25 women completed the supervised exercise program, consisting of intermittent walking to mild-to-moderate claudication pain for three months. Men and women significantly increased claudication onset time (COT) (p<0.001andp<0.01, resp.) and peak walking time (PWT) (p<0.001for each group). However, change in PWT was less in women (54%) than in men (77%) (p<0.05). Neither group significantly changed 6-minute walk distance (6MWD). In women, baseline COT was the only predictor for the change in COT (p=0.007) and the change in PWT (p=0.094). In men, baseline COT (p<0.01) and obesity (p<0.10) were predictors for the change in COT, and obesity was the only predictor for the change in PWT (p=0.002). Following a supervised, on-site, treadmill exercise program, women had less improvement in PWT than men, and neither men nor women improved submaximal, overground 6MWD. Furthermore, obese men and patients with lower baseline COT were least responsive to supervised exercise. This trial is registered with ClinicalTrial.gov, unique identifier:NCT00618670.
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Rezvani, Farhad, Mara Pelt, Martin Härter y Jörg Dirmaier. "Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis". PLOS ONE 17, n.º 9 (1 de septiembre de 2022): e0273747. http://dx.doi.org/10.1371/journal.pone.0273747.
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Introduction Intermittent claudication is the leading symptom of peripheral artery disease (leg pain when walking). The present study investigates the extent to which walking impairment is associated with health-related quality of life, mental health and health risk behavior. Methods A theory-based, cross-sectional path model was empirically examined using pre-intervention baseline data from a multicenter, randomized-controlled trial of patients with intermittent claudication (PAD-TeGeCoach). Data were available from 1 696 patients who completed a battery of questionnaires between April 14, 2018 and March 12, 2019, including measures of walking impairment (Walking Impairment Questionnaire), health-related quality of life (SF-12), mental burden (GAD-7, PHQ-9), nicotine- and alcohol-related risk behavior (Fagerström-Test, AUDIT-C). Sociodemographic characteristics and comorbid conditions were included in the postulated model a priori to minimize confounding effects. Results Walking impairment was associated with an increase in depressive (β = -.36, p < .001) and anxiety symptoms (β = -.24, p < .001). The prevalence of depressive and anxiety symptoms was 48.3% and 35.5%, respectively, with female patients and those of younger age being at greater risk. Depressive symptoms were predictive of an increased tobacco use (β = .21; p < .001). Walking impairment had adverse effects on physical quality of life, both directly (β = .60, p < .001) and indirectly mediated through depressive symptoms (β = -.16, p < .001); and indirectly on mental quality of life mediated through depressive (β = -.43, p < .001) and anxiety symptoms (β = -.35, p < .001). Discussion The findings underscore the need for a comprehensive treatment strategy in patients with intermittent claudication. Measures to improve walking impairment (e.g. exercise training) are key to enhance quality of life and should be the primary treatment. As a key mediator of mental quality of life, depressive and anxiety symptoms should be addressed by rigorously including mental health treatment. Risky health behaviors should be approached by promoting behavior change (e.g. smoking cessation) as a secondary prevention of peripheral artery disease.
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McDermott, M. M., P. Ades y J. M. Guralnik. "Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication: A Randomized Controlled Trial". Journal of Vascular Surgery 50, n.º 1 (julio de 2009): 234–35. http://dx.doi.org/10.1016/j.jvs.2009.05.046.
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Moneta, G. L. "Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication: A Randomized Controlled Trial". Yearbook of Vascular Surgery 2009 (enero de 2009): 160–62. http://dx.doi.org/10.1016/s0749-4041(09)79181-x.
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Woessner, Mary, Mitch D. VanBruggen, Carl F. Pieper, Richard Sloane, William E. Kraus, Andrew J. Gow y Jason D. Allen. "Beet the Best?" Circulation Research 123, n.º 6 (31 de agosto de 2018): 654–59. http://dx.doi.org/10.1161/circresaha.118.313131.
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Rationale: A primary goal of therapy for patients with peripheral artery disease (PAD) and intermittent claudication is increased ambulatory function. Supervised exercise rehabilitation was recently shown to confer superior walking benefits to pharmacological or surgical interventions. Increases in plasma inorganic nitrite, via oral nitrate, have been shown to increase exercise performance in both human and animal models, especially in hypoxic conditions. Objective: To determine whether a 36-session exercise rehabilitation program while consuming oral inorganic nitrate (4.2 mmol concentrated beetroot juice) would produce superior benefits over exercise plus placebo in pain-free walking and markers of increased skeletal muscle perfusion in patients with PAD and intermittent claudication. Methods and Results: This was a randomized, double-blind, per-protocol study design. After the 12-week protocol, claudication onset time on a maximal treadmill test increased by 59.2±57.3 s for the exercise plus placebo group (n=13) and by 180.3±46.6 s for the exercise plus beetroot juice group (n=11; P ≤0.05). This produced a between treatment medium to large standardized effect size (Cohen d) of 0.62 (95% CI, −0.23 to +1.44). The data for 6-minute walk distance showed a similar pattern with increases of 24.6±12.1 and 53.3±19.6 m ( P ≤0.05) in the exercise plus placebo and exercise plus beetroot juice groups, respectively. Measures of gastrocnemius perfusion, including ankle-brachial index, peak reactive hyperemic blood flow, and tissue deoxygenation characteristics, during exercise (assessed my near-infrared spectroscopy) all changed significantly for the exercise plus beetroot juice group with moderate-to-large effect sizes over exercise plus placebo changes. Conclusions: Although it is premature to speculate on overall clinical utility of a nitrate-based therapy for PAD, this early pilot study evidence is encouraging. Specifically, our data suggests that increasing plasma nitrite before exercise may allow PAD subjects to train with less pain, at higher workloads for longer durations at each training session, thereby maximizing the beneficial peripheral vascular and skeletal muscle adaptations. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01684930 and NCT01785524.
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Kanegusuku, Hélcio, Marília Almeida Correia, Paulo Longano, Raphael Mendes Ritti-Dias, Nelson Wolosker y Gabriel Grizzo Cucato. "Effects of arm-crank exercise on cardiovascular function, functional capacity, cognition and quality of life in patients with peripheral artery disease: Study protocol for a randomized controlled trial". PLOS ONE 17, n.º 5 (5 de mayo de 2022): e0267849. http://dx.doi.org/10.1371/journal.pone.0267849.
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Background Arm-crank exercise training (ACT) is an alternative exercise strategy for patients with symptomatic peripheral artery disease (PAD) due to the attenuation of pain symptoms during the exercise, as well as the benefits to functional capacity. Purpose The aim of this study is to describe the study protocol to analyze the effects of ACT exercise on cardiovascular function, functional capacity, cognition and quality of life in patients with symptomatic PAD. Methods This is a three-armed randomized, prospective, single-blind data collection, single-center, controlled study enrolling 45 patients with symptomatic PAD who will be randomized into 3 intervention groups: walking training (WT), ACT and control group. The WT and ACT will perform 2 sessions/week, 15 to 10 sets of 2 to 5 minutes at values of 13 to 15 on the Borg scale. Before and after 12 weeks of intervention, cardiovascular function (ambulatory blood pressure, office blood pressure, central blood pressure, heart rate variability, arterial stiffness and vascular function), functional capacity (six-minute walk test, 2 minute step test, handgrip test, Walking impairment questionnaire, Walking estimated limitation calculated by history, Baltimore activity scale for intermittent claudication, and short physical performance battery), cognition (executive function and memory), and quality of life (vascular quality of life questionnaire and World Health Organization Quality of Life) will be assessed. Results This is the first trial to evaluate the effects of ACT on regulatory mechanisms of the cardiovascular system in PAD patients. If the results are as expected, they will provide evidence the ability of ACT to promote cardiovascular benefits in the symptomatic PAD population.
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Brix, Michèle, Eva-Elina Buschmann, Andreas Zietzer, Jonnel Anthony Jaurigue, Lulu Li, Constantin Jungk, Ivo Buschmann, Doreen Janke y Philipp Hillmeister. "Long-term individual shear rate therapy counterpulsation enhances plasma nitrite release in patients with PAD". Vasa 46, n.º 1 (1 de enero de 2017): 37–45. http://dx.doi.org/10.1024/0301-1526/a000600.
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Abstract. Background: Individual shear rate therapy (ISRT) has been designed as a novel non-invasive treatment option for peripheral artery disease (PAD) patients and has been shown to improve endothelial function and walking distance. The aim of this study was to elucidate the impact of ISRT on the level of nitric oxide in patient blood plasma and the expression of related molecular markers in peripheral blood mononuclear cells (PBMCs). Molecular diagnostic tests were performed for two ISRT trials. Patients and methods: In ISRT-1 26 healthy subjects underwent one session of treadmill training and one session of ISRT respectively in a cross-over design. In ISRT-2 14 PAD patients with a stable intermittent claudication underwent a 30 hours long-term treatment. Plasma nitrite release as well as the mRNA expression of NOS2 and key regulators of the kallikrein-kinin system were measured in PBMCs at different time points. Results: Short-term ISRT revealed significantly decreased NOS2 expression in PBMCs of healthy volunteers and PAD patients. Long-term ISRT, in turn, demonstrated a significant plasma nitrite increase in PAD patients. Conclusions: We verified that long-term ISRT stimulates the vascular system and exerts a comparable effect to physical exercise in regards to NO release, which coincide with recent findings regarding an improvement of endothelial function. However, further studies are necessary to investigate the role for circulating leukocytes.
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Kapusta, Joanna y Robert Irzmański. "The Impact of Controlled Physical Training with Hydrotherapy on Changes in Swelling and Claudication Distance in Patients with Atherosclerotic Ischemia of the Lower Limbs". International Journal of Environmental Research and Public Health 19, n.º 23 (25 de noviembre de 2022): 15715. http://dx.doi.org/10.3390/ijerph192315715.
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Background: Patients with peripheral artery disease (PAD) often experience intermittent claudication. It is manifested by pain typically seen in the distal part of the legs during walking, which impairs the ability to walk, limits physical activity and results in lower health-related quality of life. It often leads to chronic ischemic pain, ulceration and even amputation. The aim of the study was to evaluate the effect of controlled physical training and whirlpool massage on changes in circuits, range of motion and distance of claudication in people with atherosclerotic ischemia of the lower limbs. Material and methods: The study included 100 patients, males and females aged 39 to 79 years, with peripheral circulation disorders of the lower limbs. The subjects were randomly divided into two groups. Group I (G) was treated with a series of 10 lower-limb whirling massages and took part in individually planned training, including breathing, relaxation and active free lower-limb exercises. Group II-control group (GC) took part only in individually planned training. Prior to the treatment procedures and after their completion, the ranges of movement of the ankle joint and the circumference of the lower limbs were measured and the corridor test (6MWT, six-minute walk test) was performed. Results: Statistically significant reduction in the circumference of the foot, ankle, calf and thigh in the G group was noticed. Both, in G and in GC group, a statistically significant increase in the range of dorsiflexion of the foot was found in comparison to the period before the procedures (p = 0.010; p = 0.006, respectively). There was also a statistically significant increase in the range of motion of the plantar flexion of the foot after the procedures in G (p = 0.007) and in GC (p = 0.048). Differences in the circumference of the lower limbs and the range of ankle joint movements between the study group and the control group before and after the therapy were not statistically significant. However, there was a statistically significant difference between these groups after the procedures in the 6-min walk test—significantly higher values of 6MWT were recorded in group G (p = 0.003). Conclusions: Individually planned training, supplemented with hydrotherapy as thermal therapy, has a beneficial effect on reducing swelling of the lower limbs, increasing the range of foot movements and extending the distance in the 6-min walk test.
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Ambrosetti, Marco. "Advances in exercise rehabilitation for patients with Lower Extremity Peripheral Artery Disease". Monaldi Archives for Chest Disease 86, n.º 1-2 (14 de octubre de 2016). http://dx.doi.org/10.4081/monaldi.2016.752.
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Patients with Lower Extremity Peripheral Artery Disease (LEPAD) have been recently identified as target groups for structured Cardiac Prevention and Rehabilitation (CPR) programs, whose core components and intervention goals are now well recognized. Historically, exercise training (ET) programs have been employed for the treatment of LEPAD with typical intermittent claudication, and several meta-analysis documented improvements in walking distances of enrolled patients. Both in American and European guidelines, a frequency of at least 3 sessions per week and program duration of 12 weeks were judged as optimal, while recommended sessions lengths were 30-45 minutes and 30-60 minutes respectively. Among emerging aspects in the field of LEPAD rehabilitation, 1) the extended role of CPR programs in stages other than that of intermittent claudication, 2) an updated identification of predictors of poor outcome after ET, 3) the attributable effect of exercise on global cardio-respiratory fitness in LEPAD, 4) the combination of ET and invasive measures for advanced stages of LEPAD, and 5) the role of community walking programs have been discussed.
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Carlon, Roberto, Armando Olivieri, Luca Benacchio y Mario Zanchetta. "Short and medium term functional capacity after single cycle of controlled physical training in subjects with claudication". Monaldi Archives for Chest Disease 70, n.º 2 (26 de enero de 2016). http://dx.doi.org/10.4081/monaldi.2008.426.
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BACKGROUND. Previous studies have shown the positive effect of exercise rehabilitation in patients with claudication, but uncertainties remain surrounding the optimal exercise program strategy and the persistence of the benefits over time. The purpose of the present study has been to prospectively assess the feasibility of short-course intensive supervised exercise training beyond pain threshold and to verify the maintenance of walking capacity during a medium term follow-up. METHODS. Ninety patients with intermittent claudication due to peripheral artery disease were enrolled in a supervised intensive exercise training. Seventy six of them (67 ± 7 years, 64 male and 12 female, 48 with bilateral claudication) performed a graded treadmill testing at baseline and after 3 months. Sixty patients completed also a specific questionnaire (Walking Impairement Questionnarie). After a mean follow-up of 2.6 years, fifty six patients repeated treadmill testing and 24 patients repeated the questionnaire. RESULTS. After training, the patients showed a 91% and 53% increase in the initial and absolute claudication distance time, respectively (p=0.0000). At follow-up there was no change in the initial claudication distance time, whereas absolute claudication distance time was reduced by only 13% (p=0.0001). All items of the questionnaire showed a statistically significant improvement after training (from 30 to 71%) and remained unchanged at follow-up. Sixty seven percent of the patients were considered responder, 15% partial responder and 18% no-responder to exercise training, whereas at follow- up these percentages were 55%, 13% and 32%, respectively. These results after training and at follow-up were independent from age, sex, smoke, hypertension, coronary artery disease and diabetes. CONCLUSIONS. Our findings confirm that a short supervised exercise therapy in the form of walking out over pain threshold is effective in maximizing the walking time of the majority of patients with intermittent claudication, independently of demographic data and their associated cardiac risk factors or comorbidities. After a mean follow-up of 2.6 years there was only a minor reduction of absolute claudication distance time and no modification of initial claudication distance time and questionnaire’s score, despite the fact that none of these patients were contacted by the rehabilitation centre after their physical training period.
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Waddell, A., F. Denton, R. Powell, S. Birkett, D. Broom, C. Imray, G. McGregor y AE Harwood. "Community WALKing and home-baSed circuiT tRaining in peOple liviNG with intermittent claudication (WALK-STRONG): protocol for a randomised controlled feasibility trial". journal of Vascular Societies Great Britain and Ireland 1 (2022). http://dx.doi.org/10.54522/jvsgbi.2022.24.
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Plain English Summary Why we are undertaking the research: Peripheral artery disease is a common problem where the blood vessels in the legs are narrowed by fatty deposits. Supervised exercise programmes are recommended to help treat this condition, as they can reduce leg pain and improve fitness. However, not many people are able to access these programmes typically because of barriers including travel burdens, time constraints or other commitments. As an alternative, researchers are developing home-based programmes which do not require people to travel to centres for their sessions. In the UK and to the author’s knowledge, there are not many well researched home-based programmes available for people living with peripheral artery disease. What we aim to do: We plan to undertake a study to see how feasible our home-based programme is. People with peripheral artery disease will either be asked to continue with their normal routine or will be prescribed an exercise programme, with an activity watch to monitor physical activity. This programme will include increasing the number of steps walked each day, an exercise circuit (twice a week) and a telephone support call with a member of the research team to discuss their progress or lack of progress. Questionnaire responses, blood samples, walking ability, muscle strength and the amount of daily exercise will be compared between the two groups at the start of the 12-week programme, at the end, and 12 weeks after the programme has finished. By doing this study, we will be able to refine our home-based exercise programme so that it can be tested on a larger scale to see if it is a good option for people with peripheral artery disease who may not be able to attend a supervised exercise programme.
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Laurenzano, Eugenio, Lucrezia Spadera, Mario De Laurentis y Gregorio Brevetti. "Impairment of microcirculation and energy metabolism in intermittent claudication: beneficial effects of exercise training". Monaldi Archives for Chest Disease 72, n.º 3 (19 de enero de 2016). http://dx.doi.org/10.4081/monaldi.2009.321.
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Although in peripheral arterial disease (PAD) the primary determinant of inadequate blood supply to the affected limb during exercise is a flow-limiting lesion of a conduit artery, there is a large body of evidence that impairment of microcirculation and skeletal muscle energy metabolism play a relevant role in the reduced working ability of affected individuals. This review was conceived to cast some light on this topic, paying special attention to the functional benefits of exercise training (ET) in the treatment of claudicant patients. In PAD, the ischemia induced by maximal exercise increases oxidative stress, inflammation and endothelial dysfunction. Perturbation of the endothelial homeostasis results in increased adhesiveness of leukocytes and platelets, and in reduced vasodilator capability. These events, expression of the interplay between inflammation and endothelium, provoke an obstacle in the microcirculation with a reduction in the nutritive blood flow, leading to acidosis and impaired energy metabolism in skeletal muscle, with consequent reduced exercise tolerance. ET counteracts these effects by improving walking ability and quality of life in patients with intermittent claudication, thus representing the gold standard in the treatment of PAD.
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Murrow, J., J. Brizendine, B. Djire, H. Young, S. Rathbun, K. Nilsson y K. McCully. "P4700Work during treadmill rehabilitation predicts clinical benefit and muscle mitochondrial improvements in intermittent claudication". European Heart Journal 40, Supplement_1 (1 de octubre de 2019). http://dx.doi.org/10.1093/eurheartj/ehz745.1081.
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Abstract Background Supervised exercise training is recommended for intermittent claudication in peripheral artery disease (PAD), but the relationship between work achieved during exercise and clinical outcomes is not well described. As in other training modalities, increased effort measured by cumulative work production is expected to be translate into to positive performance adaptations. In settings of constrained limb blood flow, this relationship is unknown. In addition, the impact of exercise on skeletal muscle oxygen use capacity changes is unknown. Near infrared spectroscopy (NIRS) offers a method of characterizing skeletal muscle mitochondrial adaptations before and after training programs. Methods We enrolled subjects (n=17, age 71±8.8 years, 20% female) with PAD and intermittent claudication (ankle brachial index [ABI]=0.76±0.21) in a 12-week supervised training program, randomized to traditional pain-based training strategy versus hypoxia-based training (using NIRS to direct training). Muscle work was calculated based on training performance. NIRS-based determination of mitochondrial capacity and microvascular flow were measured at baseline and after 12 weeks. Results Subjects trained for an average of 32.9±5.9 sessions walking at 54.4±13.4 m/min per session. Subjects achieved a mean of average workload of 4767±5112 kilogram force meter (kpm) per session and an aggregate of 148536±148020 kpm for the training program. Baseline pain-free walking time of 2.95±2.10 minutes increased by a mean of 3.74±2.47 minutes. Increase in walking time was proportional to the average work level achieved per session, with a correlating trend to the overall work level performed over 12 weeks (r=0.543, p=0.024). There was no increase in blood flow measured by ABI or limb microcirculation perfusion index over the training period. Skeletal muscle mitochondrial capacity increased over the training period and correlated with the overall work performed (r=0.573, p=0.016). Figure 1 Conclusions Treadmill exercise rehabilitation for intermittent claudication may be guided by total dose of exercise and NIRS-based indices of mitochondrial capacity rather than pain-levels achieved or changes in perfusion measures. Acknowledgement/Funding American Heart Association
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"Errors in Table in: Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication: A Randomized Trial". JAMA 307, n.º 16 (25 de abril de 2012): 1694. http://dx.doi.org/10.1001/jama.2012.535.
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McDermott, Mary M., Alan Dyer, Kiang Liu, Jack M. Guralnik, Philip Ades, Luigi Ferrucci, Miriam Nelson et al. "Abstract 4532: Benefits of Strength Training and Supervised Treadmill Exercise on Walking Performance for Persons with Peripheral Arterial Disease with and without Intermittent Claudication Symptoms". Circulation 118, suppl_18 (28 de octubre de 2008). http://dx.doi.org/10.1161/circ.118.suppl_18.s_905-c.
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Most men and women with lower extremity peripheral arterial disease (PAD) do not have classic symptoms of intermittent claudication (IC). We assessed the ability of supervised treadmill walking exercise and lower extremity resistance training to improve walking performance, quality of life, and brachial arterial flow-mediated dilation (FMD) in PAD persons with and without symptoms of IC. The study design was a randomized controlled clinical trial. One-hundred fifty participants with ankle brachial index (ABI) < 0.95 were randomized to one of three arms for 6 months: a) supervised treadmill exercise; b) supervised lower extremity resistance training; c) control condition. Outcomes were six-month change in the six-minute walk test, maximal treadmill walking performance, brachial arterial FMD, and the quality-of-life outcome measures of the Walking Impairment Questionnaire (WIQ) scores and the Short-Form 36 Physical Functioning score. The average age of study participants was 70.6 + 10.3, the average ABI was 0.60 + 0.20, and 52% were women. One hundred thirty-six (91%) participants completed follow-up. Results are shown in the Table . Findings were similar when analyses were restricted to participants without IC. This study demonstrates, for the first time, that both aerobic and resistance exercise interventions improve treadmill walking performance and WIQ scores in PAD persons with and without classic symptoms of IC. Supervised treadmill exercise additionally improves six-minute walk performance and brachial arterial FMD in PAD participants with and without IC. TABLE. Change in outcomes at six month follow-up by group assignment.