scholarly journals Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study

2021 ◽  
Author(s):  
Fabio Manfredini ◽  
Luca Traina ◽  
Vincenzo Gasbarro ◽  
Sofia Straudi ◽  
Lorenzo Caruso ◽  
...  
Keyword(s):  
Observational Study ◽  
Ankle Brachial Index ◽  
Exercise Program ◽  
Training Load ◽  
Walking Distance ◽  
Walking Ability ◽  
Moderate Pain ◽  
Cost Index ◽  
Free Exercise ◽  
Supervised Exercise

AbstractIn patients with peripheral artery disease (PAD), supervised exercise at near-moderate pain improves walking ability but not ankle-brachial index (ABI) values. In a retrospective observational study, we determined vascular and functional effects of a 6-month structured pain-free exercise program in patients with claudication and compressible vessels. Four-hundred and fifty-nine consecutive patients were studied. Segmental limb pressures were measured and ABI calculated during circa-monthly hospital visits. The 6-min (6MWD) and the pain-free walking distance (PFWD) during the 6-min walking test were determined. Two daily 8-min sessions of slow–moderate in-home walking at increasing metronome-paced speed were prescribed. After excluding patients with unmeasurable ABI or incompletion of the program, 239 patients were studied. Safe and satisfactory (88%) execution of the prescribed training sessions was reported. During the visits, bilateral ABI improved (+ 0.07; p < 0.001) as well as the segmental pressures in the more impaired limb, with changes already significant after 5 weeks of slow walking. Both systolic and diastolic blood pressure decreased overtime (F = 46.52; p < 0.001; F = 5.52; p < 0.001, respectively). 6MWD and PFWD improved (41[0‒73]m p < 0.001 and 107[42‒190]m p < 0.001, respectively) with associated decrease of walking heart rate (F = 15.91; p < 0.001) and Physiological Cost Index (F = 235.93; p < 0.001). The variations of most parameters at different visits correlated to the training load calculated. In a regression model, the PFWD variations directly correlated with rate sessions completed, training load and ABI change and inversely with the baseline value (R2 = 0.27; p < 0.001). In the PAD population studied, moderate pain-free exercise improved ABI with associated progressive functional and cardiovascular changes occurring regardless of subjects characteristics.

scholarly journals Effectiveness of Home-Based Pain-Free Exercise versus Walking Advice in Patients with Peripheral Artery Disease: A Randomized Controlled Trial

2021 ◽  
Vol 4 (2) ◽  
pp. 29
Author(s):  
Fabio Manfredini ◽  
Nicola Lamberti ◽  
Luca Traina ◽  
Gladiol Zenunaj ◽  
Chiara Medini ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Controlled Trial ◽  
Ankle Brachial Index ◽  
Exercise Program ◽  
Walking Distance ◽  
Control Group ◽  
Peripheral Artery ◽  
Free Exercise ◽  
Home Based ◽  
Artery Disease

Exercise therapy in the intermediate stages of peripheral artery disease (PAD) represents an effective solution to improve mobility and quality of life (QoL). Home-based programs, although less effective than supervised programs, have been found to be successful when conducted at high intensity by walking near maximal pain. In this randomized trial, we aim to compare a low-intensity, pain-free structured home-based exercise (SHB) program to an active control group that will be advised to walk according to guidelines. Sixty PAD patients aged > 60 years with claudication will be randomized with a 1:1 ratio to SHB or Control. Patients in the training group will be prescribed an interval walking program at controlled speed to be performed at home; the speed will be increased weekly. At baseline and after 6 months, the following outcomes will be collected: pain-free walking distance and 6-min walking distance (primary outcome), ankle-brachial index, QoL by the VascuQoL-6 questionnaire, foot temperature by thermal camera, 5-time sit-to-stand test, and long-term clinical outcomes including revascularization rate and mortality. The home-based pain-free exercise program may represent a sustainable and cost effective option for patients and health services. The trial has been approved by the CE-AVEC Ethics Committee (898/20). Registration details: Clinicaltrials.gov NCT04751890 [Registered: 12 February 2021].

scholarly journals Don’t stop walking: an in-home rehabilitation program for peripheral artery disease patients during the COVID-19 pandemic.

2020 ◽  
Author(s):  
Nicola Lamberti ◽  
Sofia Straudi ◽  
Roberto Manfredini ◽  
Alfredo De Giorgi ◽  
Vincenzo Gasbarro ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Exercise Program ◽  
Rehabilitation Program ◽  
Walking Distance ◽  
Walking Ability ◽  
Peripheral Artery ◽  
Walking Program ◽  
External Conditions ◽  
Artery Disease

Abstract Aims: We studied the outcomes of peripheral artery disease (PAD) patients enrolled in a structured in-home walking program before the lockdown due to the SARS-CoV-2 epidemic emergency, to determine whether this intervention ensured the maintenance of mobility in the case of strict movement restrictions.Methods: We considered 83 patients (age 72±11, males n=65) enrolled in a rehabilitation program based on two daily 8-minute sessions of slow intermittent in-home walking at a prescribed cadence with circa-monthly hospital visits. During the lockdown period, the program was updated by phone. The 6-minute (6MWD) and pain-free walking distance (PFWD) were measured pre- and postlockdown. Body weight (BW), blood pressure (BP), and the ankle-brachial index (ABI) were also determined.Results: Sixty-six patients were measured 117±23 days after their previous visit. A safe, pain-free execution the prescribed sessions, with a median distance covered of 74 km, was reported. Overall, the 6MWD was stable, while PFWD improved (p<0.001). Decreased BW with stable BP and ABI values were also recorded. When considering the outcome values according to the time of enrollment before the lockdown, new-entry subjects (≤3 months; n=35) obtained significant improvements, while those previously enrolled (>3 months; n= 31) were stable.Conclusion: In PAD patients, a structured exercise program easily performed in a home corridor and guided with phone assistance was adhered to by patients and showed effectiveness in maintaining mobility and risk factor control during the COVID-19 pandemic. Safe structured exercise may involve frail subjects regardless of walking ability, type of home and external conditions.

scholarly journals Heat therapy vs. supervised exercise therapy for peripheral arterial disease: a 12-wk randomized, controlled trial

2019 ◽  
Vol 316 (6) ◽  
pp. H1495-H1506 ◽  
Author(s):  
Ashley P. Akerman ◽  
Kate N. Thomas ◽  
Andre M. van Rij ◽  
E. Dianne Body ◽  
Mesfer Alfadhel ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peripheral Arterial Disease ◽  
Water Immersion ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Hot Water ◽  
Walking Distance ◽  
Supervised Exercise ◽  
Heat Therapy ◽  
Peripheral Arterial

Peripheral arterial disease (PAD) is characterized by lower limb atherosclerosis impairing blood supply and causing walking-induced leg pain or claudication. Adherence to traditional exercise training programs is poor due to these symptoms despite exercise being a mainstay of conservative treatment. Heat therapy improves many cardiovascular health outcomes, so this study tested if this was a viable alternative cardiovascular therapy for PAD patients. Volunteers with PAD were randomized to 12 wk of heat ( n = 11; mean age 76 ± 8 yr, BMI 28.7 ± 3.5 kg/m2, 4 females) or exercise ( n = 11; 74 ± 10 yr, 28.5 ± 6.8 kg/m2, 3 females). Heat involved spa bathing at ∼39°C, 3–5 days/wk for ≤30 min, followed by ≤30 min of callisthenics. Exercise involved ≤90 min of supervised walking and gym-based exercise, 1–2 days/wk. Following the interventions, total walking distance during a 6-min walk test increased (from ∼350 m) by 41 m (95% CI: [13, 69], P = 0.006) regardless of group, and pain-free walking distance increased (from ∼170 m) by 43 m ([22, 63], P < 0.001). Systolic blood pressure was reduced more following heat (−7 mmHg, [−4, −10], P < 0.001) than following exercise (−3 mmHg, [0, −6], P = 0.078), and diastolic and mean arterial pressure decreased by 4 mmHg in both groups ( P = 0.002). There were no significant changes in blood volume, ankle-brachial index, or measures of vascular health. There were no differences in the improvement in functional or blood pressure outcomes between heat and exercise in individuals with PAD. NEW & NOTEWORTHY Heat therapy via hot-water immersion and supervised exercise both improved walking distance and resting blood pressure in peripheral arterial disease (PAD) patients over 12 wk. Adherence to heat therapy was excellent, and the heat intervention was well tolerated. The results of the current study indicate that heat therapy can improve functional ability and has potential as an effective cardiovascular conditioning tool for individuals with PAD. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/heat-therapy-vs-exercise-in-peripheral-arterial-disease/ .

scholarly journals Supervised Cycling Training Improves Erythrocyte Rheology in Individuals With Peripheral Arterial Disease

2022 ◽  
Vol 12 ◽  
Author(s):  
Chih-Chin Hsu ◽  
Yu-Ting Lin ◽  
Tieh-Cheng Fu ◽  
Shu-Chun Huang ◽  
Cheng-Hsien Lin ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Aerobic Capacity ◽  
Short Form ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Walking Distance ◽  
Supervised Exercise ◽  
Sf 36 ◽  
Peripheral Arterial ◽  
Cycling Training

Peripheral arterial disease (PAD) results in insufficient flow to lower extremities. Aerobic exercise provides health benefits for individuals with PAD, but basic science behind it is still debated. Twenty-one PAD patients aged about 70 years with female/male as 7/14 were recruited. Among them, 11 were randomized to have supervised cycling training (SCT) and 10 to receive general healthcare (GHC) as controls. SCT participants completed 36 sessions of SCT at the first ventilation threshold within 12 weeks and the controls received GHC for 12 weeks. Ankle-brachial index (ABI), 6-min walk test (6MWT), peak oxygen consumption (V˙O2peak), minute ventilation (V˙E), minute carbon dioxide production (V˙CO2), erythrocyte rheology, including the maximal elongation index (EImax) and shear stress at 50% of maximal elongation (SS1/2), and the Short Form-36 (SF-36) questionnaire for quality of life (QoL) were assessed before and 12 weeks after initial visit. SCT significantly decreased the SS1/2 as well as SS1/2 to EImax ratio (SS1/2/EImax) and increased the erythrocyte osmolality in the hypertonic region as well as the area under EI-osmolality curve. The supervised exercise-induced improvement of erythrocyte deformability could contribute to the increased peripheral tissue O2 delivery and was possibly related with increased V˙O2peak. The physiological benefit was associated with significantly increased ABI, 6-min walking distance, cardiorespiratory fitness, and SF-36 score. However, no significant changes in aerobic capacity and erythrocyte rheological properties were observed after 12-week of GHC. In conclusion, SCT improves aerobic capacity by enhancing erythrocyte membrane deformability and consequently promotes QoL in PAD patients.

scholarly journals A Music-Guided Home-Based Claudication Rehabilitation Program

2019 ◽  
Vol 8 (3) ◽  
pp. 102-107
Author(s):  
Ulf G. Bronas ◽  
Steve Everett ◽  
Alana Steffen ◽  
Joan Briller ◽  
Mary Hannan ◽  
...  
Keyword(s):  
Group Treatment ◽  
Repeated Measures ◽  
Ankle Brachial Index ◽  
Exercise Program ◽  
Exercise Adherence ◽  
Rehabilitation Program ◽  
Walking Distance ◽  
Home Based ◽  
Test Distance ◽  
High Level

ABSTRACT Background: We previously demonstrated that using rhythmic auditory stimulation (RAS) to accentuate the beat and increase the tempo of music immediately increased walking distance and distracted from pain in patients with claudication. We hypothesized that it would be feasible to tailor a home-based walking exercise program using rhythm-controlled RAS-enhanced music, and that this would improve total distance walked during a 6-minute walk test distance (6MWD). Methods: This study was designed as a feasibility study in patients with lifestyle limiting claudication. We enrolled 12 participants (8 men, 8 black, age = 65.4 ± 7.8 y, ankle brachial index = 0.59 ± 0.17) in an RAS-enhanced, music-guided, home-based walking program, 3 times per week for 60 min per session. Repeated-measures mixed modeling with unstructured covariance matrix and robust standard errors were used to assess within-group treatment differences over time. Results: At 6 weeks, 6MWD increased by 48 m (P ≤ 0.001). At 12 weeks, similar patterns were noted, with an increase of 41 m in total walking distance (P = 0.001). Subjective measures of physical function were significantly improved. Exercise adherence was 89%. Conclusion: It is feasible to design a home-based exercise program for claudication by using the rhythmic and distractive properties of music to guide, facilitate, and progress exercise while maintaining a high level of adherence.

scholarly journals Rehabilitation program in patients with moderate-to-severe intermittent claudication: immediate results and one year follow-up

2016 ◽  
Vol 68 (2) ◽  
Author(s):  
Duccio Rossini ◽  
Massimo Bulckaen ◽  
Stefano Di Marco ◽  
Roberto Giovannetti ◽  
Franco Giuntoli ◽  
...  
Keyword(s):  
Exercise Program ◽  
Rehabilitation Program ◽  
Exercise Session ◽  
Home Exercise ◽  
Walking Ability ◽  
Intensive Training ◽  
Supervised Exercise ◽  
Short Course ◽  
One Year

Background: Physical training is believed the primary treatment of claudication symptoms. Although exercise therapy is self-effective, some drugs improving functional capacity have additive effects. TASC (Trans Atlantic Society Consensus) considers Propionil-L-Carnitine (PLC) and prostaglandin-E1 (PGE1) as poorly studied drugs with potential benefits in improving claudication. This retrospective, observational study was performed to compare the efficacy of PGE1 and PLC, and to evaluate both the immediate results of an intensive, short-course rehabilitation program and the outcome at one year follow-up. Methods: Twenty-five patients with severe-moderate claudication were selected. All patients were subjected to an intensive, supervised exercise program for 4 weeks in combination with either PGE1 (10 patients) or PLC (15 patients). Drugs were infused i.v. before every exercise session: 60 μg PGE1 within 2 hours and 600 mg PLC within 10 minutes. Patients were trained with the same supervised treadmill walking-exercise program. At the end of the rehabilitation period, patients were instructed to keep walking (advised home exercise). Initial claudication distance (ICD) and absolute claudication distance (ACD) were evaluated during a constant treadmill test (3 km/hour speed, 10% grade) at entry, after 4 weeks and at one year follow-up. A patient was considered as no-responder if his/her improvement in ACD was &lt;33%. Results: A significant increase of both ICD and ACD was detected after both 4 weeks (+269% and +135%, respectively, in PGE1 group; +245% and +125%, respectively, in PLC group) and one year (+364% and +202%, respectively, in PGE1 group; +279% and +176%, respectively, in PLC group). No-responder patients after the intensive training period (2 in PGE1 group and 4 in PLC group) remained noresponders also at one year follow-up. Both PGE1 and PLC treatments were well tolerated. No serious drug-related side effect requiring interruption of the treatment was observed. Conclusions: A short-course of intensive exercise treatment plus PLC or PGE1 may enhance walking ability. The result was confirmed at one year follow-up.

All Patients Benefit Equally From a Supervised Exercise Program for Claudication

2007 ◽  
Vol 41 (3) ◽  
pp. 212-216 ◽  
Author(s):  
Ferdinand Serracino-Inglott ◽  
Gareth Owen ◽  
Andrew Carter ◽  
Francis Dix ◽  
John Vince Smyth ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Exercise Program ◽  
Walking Distance ◽  
Supervised Exercise ◽  
Diabetic Status ◽  
Heterogenous Group ◽  
Cardiac Status ◽  
Supervised Exercise Program

This study assessed the effect of gender, diabetic status, statin use, smoking, hypertension, cardiac status, and use of cilostazol on the outcome of a supervised exercise program for patients with claudication. Patient risk factors were prospectively recorded in a group of patients who had completed 1 year on a supervised exercise program. In 165 claudicant patients, maximum walking distance increased ( P < .0001) from 67 meters (range, 17-196) to 122 meters (range, 43-409). Quality of life as measured by the Medical Outcome Study Short Form 36 increased ( P < .0001) from a median of 78 (range, 55-110) to 99 (range, 71-154). The improvements in claudication distance, maximal walking distance, and quality of life after the exercise program were not dependent on any of the measured patient factors. Patients referred to exercise programs for claudication are a heterogenous group. Despite this, they benefit equally from such a program.

On-Site versus Home Exercise Programs: Psychological Benefits for Individuals with Arterial Claudication

1997 ◽  
Vol 5 (4) ◽  
pp. 311-328 ◽  
Author(s):  
Bernardine M. Pinto ◽  
Bess H. Marcus ◽  
Robert B. Patterson ◽  
Mary Roberts ◽  
Andrea Colucci ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Exercise Program ◽  
Home Exercise ◽  
Walking Ability ◽  
Psychological Benefits ◽  
Home Exercise Program ◽  
Supervised Exercise ◽  
Home Based ◽  
Pain Symptoms

Exercise has been shown to improve walking ability in individuals with arterial claudication. This study compared the effects of an on-site supervised exercise program and a home exercise program on quality of life and psychological outcomes in these individuals. Sixty individuals were randomly assigned to a 12-week on-site or a 12-week home-based exercise program. Quality of life, mood and pain symptoms, and walking ability were examined at baseline, posttreatment, and at 6 months follow-up. Individuals in the on-site exercise program showed significantly greater improvements in walking ability. Although sample size limited the ability to detect significant differences between groups on quality of life and psychological measures, both groups were comparable on improvements in quality of life and in mood. These data suggest that a home exercise program with weekly feedback may provide improved quality of life and mood benefits for individuals with arterial claudication but does not provide improvements in walking equivalent to those provided by an on-site exercise program.

scholarly journals PERAN LATIHAN DISUPERVISI PADA PASIEN DENGAN PENYAKIT ARTERI PERIFER EKSREMITAS BAWAH

2015 ◽  
Vol 37 (2) ◽  
pp. 151
Author(s):  
Eka Fithra Elfi
Keyword(s):  
Quality Of Life ◽  
Exercise Training ◽  
Medical Therapy ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Walking Distance ◽  
Primary Therapy ◽  
Arterial Blood ◽  
Supervised Exercise

AbstrakPenyakit arteri perifer (peripheral arterial disease, PAD) merupakan kumpulan kelainan yang menghambat aliran darah ke ekstremitas, pada umumnya terjadi akibat aterosklerosis dan bermanifestasi sebagai klaudikasio. Disamping terapi medikamentosa dan endovaskuler yang optimal, manajemen non farmakologi PAD terbukti efektif mengurangi gejala, meningkatkan kemampuan berjalan dan kualitas hidup. Telah dilaporkan laki-laki usia 58 tahun penderita klaudikasio intermitten karena oklusi arteri iliaka komunis sinistra. Pasien masih merasakan gejala setelah terapi medikamentosa dan angioplasty tranluminal percutaneous. Setelah dilakukan program latihan disupervisi, gejala, kemampuan berjalan, dan indeks brachial ankle meningkat signifikan. Program latihan disupervisi pada pasien PAD dinilai penting sebagai terapi primer untuk meningkatkan kapasitas fungsional dan kualitas hidup untuk manajemen jangka panjang.AbstractPeripheral arterial disease (PAD) is a disorder that obstruct the arterial blood supply to extremities, most commonly caused by atherosclerosis and manifests as claudicatio. Aside from optimal medical therapy and endovascular therapy, non pharmacological managements of PAD are proven effectively improving symptoms, increasing walking distance, and overall quality of life. The case report describe a 58 years old male with known claudicatio intermitten due to occlusion of left communis iliac artery. After medical therapy and percutaneous transluminal angioplasty, the patient still symptomatic. After supervised exercise training was prescribed to the patient, the symptom, walking distance, and ankle brachial index was improved significantly. Rehabilitation in PAD with supervised exercise training plays significant role as primary therapy in patients with PAD to improve functional capacity and quality of life in long term management.

Incentivizing physical activity through activity monitoring interventions in PAD – a pilot study

VASA ◽  
2020 ◽  
pp. 1-6
Author(s):  
Eri Fukaya ◽  
Scott Welden ◽  
Abdallah Bukari ◽  
Zeeshan Khan ◽  
Nicholas Leeper ◽  
...  
Keyword(s):  
Pilot Study ◽  
Financial Incentives ◽  
Exercise Program ◽  
Activity Monitoring ◽  
Walking Distance ◽  
Control Group ◽  
Study Group ◽  
Ample Evidence ◽  
Supervised Exercise ◽  
Home Based

Summary: Background: There is ample evidence to show that supervised exercise is efficacious and cost effective for improving claudication symptoms in patients with peripheral artery disease (PAD). Home based exercise therapy can be an effective alternative to supervised exercise however, the results of this is variable depending on the level of motivation and engagement of the patient. Patients and methods: We performed a pilot study in 41 patients to determine whether a home based exercise program with the use of an activity tracking device with personalized feedback and financial incentives can increase daily activity, improve walking and sustain engagement in the exercise regimen in patients with PAD. In this randomized pilot study, the patients in the study group were fitted with an activity monitoring device and given behavioral monitoring, motivational updates and feedback regarding their exercise program. This study group was further divided in to two groups. One half of these patients in the study group were also given financial incentives if they reached their set targets. The control group wore the device with no feedback or ability to see their number of steps walked. Results: Results showed that at the end of the 12 week period, patients in the study groups walked more compared to the controls and the financial incentive structure resulted in an additional 38–63% increase in average daily steps. Conclusions: This pilot study revealed that a home-based exercise program with activity monitoring, feedback and financial incentives resulted increased daily steps, 6-minute walking distance and overall compliance with the program in PAD patients with claudication.

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