Exercise Training and Revascularization in the Management of Symptomatic Peripheral Artery Disease

We employed near-infrared optical techniques, diffuse correlation spectroscopy (DCS), and frequency-domain near-infrared spectroscopy (FD-NIRS) to test the hypothesis that supervised exercise training increases skeletal muscle microvascular blood flow and oxygen extraction in patients with peripheral artery disease (PAD) who experience claudication. PAD patients ( n = 64) were randomly assigned to exercise and control groups. Patients in the exercise group received 3 mo of supervised exercise training. Calf muscle blood flow and oxygen extraction were optically monitored before, during, and after performance of a graded treadmill protocol at baseline and at 3 mo in both groups. Additionally, measurements of the ankle-brachial index (ABI) and peak walking time (PWT) to maximal claudication were made during each patient visit. Supervised exercise training was found to increase the maximal calf muscle blood flow and oxygen extraction levels during treadmill exercise by 29% (13%, 50%) and 8% (1%, 12%), respectively [ P < 0.001; median (25th percentile, 75th percentile)]. These improvements across the exercise group population were significantly higher than corresponding changes in the control group ( P < 0.004). Exercise training also increased PWT by 49% (18%, 101%) ( P = 0.01). However, within statistical error, the ABI, resting calf muscle blood flow and oxygen extraction, and the recovery half-time for hemoglobin\myoglobin desaturation following cessation of maximal exercise were not altered by exercise training. The concurrent monitoring of both blood flow and oxygen extraction with the hybrid DCS/FD-NIRS instrument revealed enhanced muscle oxidative metabolism during physical activity from exercise training, which could be an underlying mechanism for the observed improvement in PWT. NEW & NOTEWORTHY We report on noninvasive optical measurements of skeletal muscle blood flow and oxygen extraction dynamics before/during/after treadmill exercise in peripheral artery disease patients who experience claudication. The measurements tracked the effects of a 3-mo supervised exercise training protocol and revealed that supervised exercise training improved patient ability to increase microvascular calf muscle blood flow and oxygen extraction during physical activity.

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Gait changes after supervised exercise training in patients with symptomatic lower extremity peripheral artery disease

Vascular Medicine ◽

10.1177/1358863x20984831 ◽

2021 ◽

pp. 1358863X2098483

Author(s):

Stefano Lanzi ◽

Joël Boichat ◽

Luca Calanca ◽

Pauline Aubertin ◽

Davide Malatesta ◽

...

Keyword(s):

Exercise Training ◽

Lower Extremity ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Stride Frequency ◽

Peripheral Artery ◽

Phase Duration ◽

Supervised Exercise ◽

Gait Parameters ◽

Artery Disease

This study aimed to investigate the effects of supervised exercise training (SET) on walking performance and spatiotemporal gait changes in patients with symptomatic lower extremity peripheral artery disease (PAD). In this single-arm prospective nonrandomized cohort study, patients with Fontaine stage II PAD following a 3-month SET program were included. Before and after SET, a constant-load treadmill test was performed to determine the pain-free and maximal walking distances (PFWD and MWD, respectively). During this test, spatiotemporal gait parameters were assessed. The ankle–brachial index (ABI) and toe–brachial index (TBI) were also measured. Twenty-seven patients with PAD (64.0 ± 1.9 y, 74% men) were included. Following SET, the PFWD (+68%; p = 0.001) and MWD (+79%; p ⩽ 0.001) significantly increased. The ABI and TBI did not change significantly. Following SET, the stride duration, stride frequency, stride length, and double support phase duration did not change significantly. In contrast, subphases of stance showed significant changes: the loading response (+8%; p = 0.03) and foot-flat (+2%; p = 0.01) phases were significantly longer, whereas the push-off phase (–7%; p = 0.002) was significantly shorter. A significant positive correlation was found between changes in the foot-flat phase and changes in PFWD ( r = 0.43, p = 0.03). A significant negative correlation was found between changes in the push-off phase and changes in PFWD ( r = −0.39, p = 0.05). No significant correlations were found between changes in relative durations of the subphases of stance and MWD. These results indicate that changes in temporal gait parameters during the foot contact phase potentially constitute an underlying mechanism of delayed claudication distance in patients with symptomatic PAD.

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Improvement in 6-Minute Walking Distance after Supervised Exercise Training Is Related to Changes in Quality of Life in Patients with Lower Extremity Peripheral Artery Disease

Journal of Clinical Medicine ◽

10.3390/jcm10153330 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3330

Author(s):

Stefano Lanzi ◽

Luca Calanca ◽

André Berchtold ◽

Lucia Mazzolai

Keyword(s):

Quality Of Life ◽

Exercise Training ◽

Lower Extremity ◽

Peripheral Artery Disease ◽

Walking Distance ◽

Peripheral Artery ◽

Supervised Exercise ◽

Sf 36 ◽

Artery Disease

This study aimed to investigate the relationship between supervised exercise training (SET)-induced changes in treadmill performance and 6 min walking distance, and changes in general (physical and mental) self-perceived health-related quality of life (HRQoL) in symptomatic patients with lower extremity peripheral artery disease (PAD). This is an observational study investigating Fontaine stage II PAD patients participating in 3-month SET. Before and following SET, treadmill performance (pain-free (PFWD) and maximal (MWD)), and 6 min walking distance (6MWD) were assessed. Self-perceived HRQoL was assessed with the Medical Outcomes Study Short-Form 36 (SF-36). Ankle- and toe-brachial indexes were also measured. One-hundred forty-seven patients with PAD were included (64.9 ± 9.6 y, 70% men). After SET, PFWD (+102%, p ≤ 0.001), MWD (+87%, p ≤ 0.001), and 6MWD (+14%, p ≤ 0.001) significantly increased. All eight SF-36 subscale scores significantly improved following SET (p ≤ 0.04). SET significantly improved physical and mental component summaries of the SF-36 (p ≤ 0.001). Larger increases in 6MWD were associated with greater improvements in physical (β = 0.19; p = 0.02) and mental (β = 0.24; p = 0.005) component summaries of the SF-36. No significant relationship was observed between changes in treadmill performance and changes in physical and mental component summaries of the SF-36. These results show that improvements in 6MWD following SET are related to improvements in general self-perceived HRQoL in patients with symptomatic lower extremity PAD. On the contrary, changes in treadmill performance were not related to improvements in HRQoL. These results suggest that the 6 min walking test is an essential outcome measure to assess overall patient functional status following interventions in patients with PAD.

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Exercise Training Increases Resting Calf Muscle Oxygen Metabolism in Patients with Peripheral Artery Disease

Metabolites ◽

10.3390/metabo11120814 ◽

2021 ◽

Vol 11 (12) ◽

pp. 814

Author(s):

Zhe Li ◽

Erin K. Englund ◽

Michael C. Langham ◽

Jinchao Feng ◽

Kebin Jia ◽

...

Keyword(s):

Exercise Training ◽

Peripheral Artery Disease ◽

Oxygen Metabolism ◽

Calf Muscle ◽

Optical Measurements ◽

Oxygen Extraction Fraction ◽

Peripheral Artery ◽

Muscle Oxygen ◽

Supervised Exercise ◽

Artery Disease

Exercise training can mitigate symptoms of claudication (walking-induced muscle pain) in patients with peripheral artery disease (PAD). One adaptive response enabling this improvement is enhanced muscle oxygen metabolism. To explore this issue, we used arterial-occlusion diffuse optical spectroscopy (AO-DOS) to measure the effects of exercise training on the metabolic rate of oxygen (MRO2) in resting calf muscle. Additionally, venous-occlusion DOS (VO-DOS) and frequency-domain DOS (FD-DOS) were used to measure muscle blood flow (F) and tissue oxygen saturation (StO2), and resting calf muscle oxygen extraction fraction (OEF) was calculated from MRO2, F, and blood hemoglobin. Lastly, the venous/arterial ratio (γ) of blood monitored by FD-DOS was calculated from OEF and StO2. PAD patients who experience claudication (n = 28) were randomly assigned to exercise and control groups. Patients in the exercise group received 3 months of supervised exercise training. Optical measurements were obtained at baseline and at 3 months in both groups. Resting MRO2, OEF, and F, respectively, increased by 30% (12%, 44%) (p < 0.001), 17% (6%, 45%) (p = 0.003), and 7% (0%, 16%) (p = 0.11), after exercise training (median (interquartile range)). The pre-exercise γ was 0.76 (0.61, 0.89); it decreased by 12% (35%, 6%) after exercise training (p = 0.011). Improvement in exercise performance was associated with a correlative increase in resting OEF (R = 0.45, p = 0.02).

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Exercise Training Modalities in Lower Limb Peripheral Artery Disease

Practical Issues in Geriatrics - Rehabilitation Medicine for Elderly Patients ◽

10.1007/978-3-319-57406-6_44 ◽

2017 ◽

pp. 439-444

Author(s):

Stefano Lanzi ◽

Lucia Mazzolai ◽

Luca Calanca

Keyword(s):

Exercise Training ◽

Peripheral Artery Disease ◽

Lower Limb ◽

Peripheral Artery ◽

Artery Disease ◽

Training Modalities

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PC088. Greater Exercise Pressor Response at Baseline Is Associated With Improvement in Claudication Outcomes After Exercise Training in Symptomatic Peripheral Artery Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.337 ◽

2019 ◽

Vol 69 (6) ◽

pp. e230

Author(s):

Marcos T. Kuroki ◽

Polly S. Montgomery ◽

Biyi Shen ◽

Danielle J. Kim ◽

Ming Wang ◽

...

Keyword(s):

Exercise Training ◽

Peripheral Artery Disease ◽

Pressor Response ◽

Peripheral Artery ◽

Artery Disease

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Impacts of aquatic walking on arterial stiffness, exercise tolerance, and physical function in patients with peripheral artery disease: a randomized clinical trial

Journal of Applied Physiology ◽

10.1152/japplphysiol.00209.2019 ◽

2019 ◽

Vol 127 (4) ◽

pp. 940-949 ◽

Cited By ~ 4

Author(s):

Song-Young Park ◽

Yi-Sub Kwak ◽

Elizabeth J. Pekas

Keyword(s):

Body Composition ◽

Exercise Training ◽

Arterial Stiffness ◽

Physical Function ◽

Peripheral Artery Disease ◽

Exercise Tolerance ◽

Muscular Strength ◽

Peripheral Artery ◽

Walking Exercise ◽

Artery Disease

Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity [maximal volume of oxygen consumption (V̇o2max)], exercise tolerance [6-min walking distance (6MWD)], physical function, muscular strength, and body composition in patients with PAD. Patients with PAD ( n = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, n = 35) or a control group (CON, n = 37). The AQ group performed walking and leg exercises in waist-to-chest-deep water. Leg arterial stiffness [femoral-to-ankle pulse wave velocity (legPWV)], heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇o2max, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. There were significant group × time interactions ( P < 0.05) after 12 wk for legPWV and HR, which significantly decreased ( P < 0.05) in AQ, and V̇o2max, 6MWD, physical function, and muscular strength, which significantly increased ( P < 0.05) in AQ, compared with no changes in CON. There were no significant differences ( P > 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD.

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