Review of Article: McDermott, M.M., et al. Effect of low-intensity vs. high-intensity home-based walking exercise on walk distance in patients with peripheral artery disease. JAMA. 2021; 325(13):1266-1276

Restless leg syndrome (RLS) disrupts sleep, affecting the quality of life of patients with various chronic diseases. We assessed the prevalence of RLS in peripheral artery disease (PAD) patients and the effects of a pain-free exercise program. A total of 286 patients with claudication were enrolled in a home-based low-intensity exercise program prescribed at the hospital. RLS was determined through standardized questions. Hemodynamics, degree of calf deoxygenation, and mobility were assessed using the ankle-brachial-index, a treadmill test assisted by near-infrared spectroscopy and the 6-min walk test, respectively. During hospital visits, persistence of RLS, adherence to exercise, hemodynamics, and mobility were assessed. At the enrollment, 101 patients (35%) presented RLS, with higher prevalence among females (p = 0.032). Compared to RLS-free patients, they showed similar hemodynamics but more severe calf deoxygenation (p < 0.001) and lower mobility (p = 0.040). Eighty-seven RLS patients (83%) reported the disappearance of symptoms after 39 (36−70) days of exercise. This subgroup, compared to nonresponders, showed higher adherence (p < 0.001), hemodynamic (p = 0.041), and mobility improvements (p = 0.003). RLS symptoms were frequent in PAD but were reduced by a pain-free walking exercise aimed at inducing peripheral aerobic adaptations. The concomitant recovery of sleep and mobility may represent a synergistic action against the cardiovascular risk in PAD.

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Abstract 14802: Relation of Non-exercise Walking Activity With Exercise Performance in Patients With Peripheral Artery Disease

Circulation ◽

10.1161/circ.142.suppl_3.14802 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ryan J Mays ◽

Rachel Kahnke ◽

Erica N Schorr ◽

Diane J Treat-jacobson

Keyword(s):

Peripheral Artery Disease ◽

Exercise Performance ◽

Primary Outcome ◽

Performance Outcomes ◽

Peripheral Artery ◽

Maximal Distance ◽

Home Based ◽

Walking Activity ◽

Walking Exercise ◽

Artery Disease

Introduction: Structured exercise programs in home settings are beneficial for patients with peripheral artery disease (PAD). However, the impact of lower levels of walking activity accumulated separately from formal home exercise in PAD is unclear. The aim of this study was to determine the relation of non-exercise walking (NEW) activity with exercise performance in PAD. Methods: This was a post-hoc analysis from twenty patients with PAD enrolled in a 12-week structured home-based walking exercise program using diaries and accelerometry. Formal exercise sessions (3 sessions·week -1 ) were detected using patient-reported diary entries that corresponded with accelerometer step data. NEW activity was characterized as steps completed over five days each week, excluding steps during formal exercise sessions. The primary outcome for the intent-to-treat analysis was peak walking time (PWT) assessed on a graded treadmill. Secondary outcomes were claudication onset time (COT) from the graded treadmill test and maximal distance achieved during the six-minute walk test (6MWT). Pearson correlations evaluated the relation between NEW activity (step·week -1 ) and exercise performance outcomes using intensity (step·week -1 ) and duration (min·week -1 ) from formal exercise sessions as covariates. Results: NEW activity demonstrated a strong, positive correlation with change in PWT (r=0.50, p=0.04) when controlling for exercise intensity and duration during the 12-week intervention. Other exercise performance outcomes were not significantly related to NEW activity (COT: r=0.14; 6MWT maximal distance: r=0.27). Conclusions: A positive association was demonstrated between NEW activity and the primary outcome of PWT following 12 weeks of structured home-based walking exercise. Interventions to improve physical activity outside of formal exercise sessions may be beneficial for patients with PAD.

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