Indikationen und Limitationen des Gehtrainings bei Patienten mit Cladicatio intermittens

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Takashi Ohta ◽  
Sugimoto ◽  
Takeuchi ◽  
Hosaka ◽  
Ishibashi
Keyword(s):  
Exercise Training ◽  
Intermittent Claudication ◽  
Recovery Time ◽  
Ankle Brachial Index ◽  
Walking Distance ◽  
Hemodynamic Parameters ◽  
Arterial Reconstruction ◽  
Arteriosclerosis Obliterans ◽  
Degree Of Satisfaction ◽  
Selection Of

Background: The selection of candidates for exercise training among patients with intermittent claudication is still a matter of debate. Patients and methods: Forty-nine patients with intermittent claudication due to arteriosclerosis obliterans were tested. Forty-six patients were men and 3 were women, with an average age of 65 years (range, 46 to 76 years). The patients walked on a treadmill at 2.4 km/h on a 12% upgrade followed by an appropriate period of rest for 30 minutes twice a day during a 3-week hospitalization. Programs were individualized for each patient. Four parameters were assessed after exercise training: (1) Ankle-brachial index (ABI) at rest, (2) Fall in ABI after 40 m of treadmill walking (ABI Fall 40), (3) the recovery time (RT 40) required for the ABI to return to resting levels after 40 m of walking, and (4) the maximal walking distance (MWD) on the treadmill. Results: The average ABI at rest before the 3-week training period was 0.60 ± 0.02 (mean ± SE), and after training it was 0.62 ± 0.02. There was a small although not statistically significant increase in the ABI after training. This increase in the ABI did not exceed 0.21. The average ABI Fall 40 before training was 0.36 ± 0.01, and after training it was 0.30 ± 0.02. The average RT 40 before training was 9.9 ± 0.8 min, and after training it was 6.2 ± 0.6 min. There were significant decreases in the ABI Fall 40 and RT 40 after training (p < 0.01 and p < 0.001, respectively). The MWD increased after training in 48 of the 49 patients. The average MWD increased from 134 ± 13 m to 226 ± 32 m after training (p < 0.001). The occlusion levels did not influence the results as training effects and hemodynamic parameters. Fourteen of 49 patients desired arterial reconstruction after exercise training. Conclusions: Patients with shorter RT 40’s before training achieved greater increases in the MWD after training. In patients with an RT 40 under 12 min, exercise training is indicated. However, there is some discrepancy between the increase in MWD and the degree of satisfaction in individual patients.

Ventilatory threshold is related to walking tolerance in patients with intermittent claudication

VASA ◽  
2012 ◽  
Vol 41 (4) ◽  
pp. 275-281 ◽  
Author(s):  
da Rocha Chehuen ◽  
G. Cucato ◽  
P. dos Anjos Souza Barbosa ◽  
A. R. Costa ◽  
M. Ritti-Dias ◽  
...  
Keyword(s):  
Blood Flow ◽  
Oxygen Uptake ◽  
Intermittent Claudication ◽  
Lower Limb ◽  
Ventilatory Threshold ◽  
Reactive Hyperemia ◽  
Ankle Brachial Index ◽  
Metabolic Parameters ◽  
Walking Distance ◽  
The Relationship

Background: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). Patients and methods: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. Results: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). Conclusions: VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

Nordic Walking or Traditional Walking in Patients With Intermittent Claudication: A Critical Review

2015 ◽  
Vol 3 ◽  
pp. 612
Author(s):  
Irēna Upeniece ◽  
Daina Šmite ◽  
Voldemārs Arnis
Keyword(s):  
Intermittent Claudication ◽  
Comparative Effectiveness ◽  
Critical Analysis ◽  
Health Indicators ◽  
Walking Distance ◽  
Inclusion Criteria ◽  
Nordic Walking ◽  
Online Databases ◽  
Walking Programme ◽  
Selection Of

<p><em>Regular exercises can improve walking distance and reduce physical impairment in patients with intermittent claudication.</em> <em>The objective of the research is to summarise and analyse the existing proof about the comparative effectiveness of Nordic walking and traditional walking in the improvement of health indicators in patients with intermittent claudication. Methods: The following online databases were used as sources for data collection: Ebsco, Sience Direct, Clinical Key, ProQuest, Scopus. The selection of works of research was performed on the basis of key words “Nordic walking”, </em><em>“intermittent claudication”, “walking with poles”, “Nordic walking and walking and intermittent claudication” and the year of publishing (that is, from 2005 till 2015). Inclusion criteria met four works of research that were included in the critical analysis. Results and conclusions:</em> <em>There is no proof about the superiority of the Nordic walking programme over traditional walking (and there exist indications about the superiority of the traditional walking programme) in the improvement of helath indicators, but patients with intermittent claudication feel less discomfort during Nordic walking and they can cover a longer distance by using poles. </em></p>

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.

scholarly journals Simple assessment of quality of life and lower limb functional capacity during cilostazol treatment – results of the SHort-tERm cIlostazol eFFicacy and quality of life (SHERIFF) study

VASA ◽  
2020 ◽  
Vol 49 (3) ◽  
pp. 235-242 ◽  
Author(s):  
Katalin Farkas ◽  
Endre Kolossváry ◽  
Zoltán Járai
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Intermittent Claudication ◽  
Functional Capacity ◽  
Lower Limb ◽  
Ankle Brachial Index ◽  
Walking Distance ◽  
Treatment Results ◽  
Walking Capacity

Summary: Background: Symptomatic peripheral arterial disease (intermittent claudication) is a major cause of disability and mobility loss in older men and women and thus has a significant negative impact on the patients’ quality of life. Both surgical and endovascular revascularization procedures and noninvasive medical therapies, such as supervised training and drug treatment, can improve walking capacity. Cilostazol is the only drug having a class I (level of evidence A) recommendation for the treatment of intermittent claudication (IC). The aim of this study was to evaluate the effect of three-month cilostazol treatment on the health-related quality of life and on the lower limb functional capacity in patients with IC in the clinical practice. Patients and methods: The study was a multicenter, non-interventional trial, performed in Hungary in 2018. 812 PAD patients (Fontaine II stage, mean age: 67.17 years, male/female: 58.25/41.75 %) were enrolled, who received cilostazol (50 or 100 mg b.i.d.) for 3 months. 802 patients completed the study. Quality of life was evaluated with the EQ-5D-3L questionnaire functional capacity with the WELCH (Walking Estimated-Limitation Calculated by History) questionnaire. Pain-free and maximal walking distance, ankle-brachial index (ABI) were measured at baseline and after 3-month treatment. Results: Upon conclusion of the study, the EQ-5D-3L index improved (baseline: –0.46 ± 0.22, 3rd month: –0.26 ± 0.18; p < 0.0001) and there was a significant increase in the WELCH score as well (19 ± 14, 31 ± 18; respectively, p < 0.0001). Both pain-free and maximal walking distance improved significantly by 54.52 % (median: 53.85 %) and 42.5 % (median: 34.68 %); respectively (p < 0.001). Adverse events occurred in 10 patients, 1 patient stopped cilostazol treatment because of side effects. Conclusions: Three months cilostazol treatment significantly improved quality of life and lower limb functional capacity in patients with intermittent claudication. The WELCH questionnaire is a useful tool for the evaluation of intermittent claudication treatment in the clinical practice.

Antithrombotic Drugs in the Primary Medical Management of Intermittent Claudication: A Meta-analysis

1999 ◽  
Vol 81 (05) ◽  
pp. 715-722 ◽  
Author(s):  
Enrico Bernardi ◽  
Martin Prins ◽  
Jan Wouter ten Cate ◽  
Paolo Prandoni ◽  
Rohan Hettiarachchi ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Odds Ratio ◽  
Ankle Brachial Index ◽  
Lower Limbs ◽  
Walking Distance ◽  
Antithrombotic Drugs ◽  
Vascular Events ◽  
Manual Search ◽  
Level 1 ◽  
Revascularization Procedures

Summary Background. There is no consensus on the efficacy of the antithrombotic drugs available for patients with intermittent claudication. Methods. A Medline and manual search was used to identify relevant publications. Uncontrolled or retrospective studies, double reports or trials without clinical outcomes were excluded. Included studies were graded as level 1 (randomised and double- or assessor-blind), level 2 (open randomised), or level 3 (non-randomised comparative). Mortality, cerebro- or cardiovascular events, amputations, arterial occlusions or number of revascularization procedures performed in the lower limbs, pain-free and total walking distance, ankle brachial index and calf blood flow, were the main outcomes considered. When feasible, end of treatment results, either continuous or binary, were combined with appropriate statistical methods. Results. Mortality was significantly decreased by ticlopidine compared to placebo (common odds ratio 0.68, 95% C.I., 0.49 - 0.95); clopidogrel decreased vascular events in comparison to aspirin (odds ratio 0.76, 95% C.I., 0.63 - 0.92) in level 1 studies. Arterial occlusions and the number of revascularization procedures performed were statistically significantly decreased by aspirin and ticlopidine, respectively. A small but statistically significant improvement in pain-free walking distance was determined by picotamide, indobufen, low molecular weight heparins, sulodexide and defibrotide, in small studies. Conclusions. Clopidogrel and ticlopidine do reduce clinically important events in patients with intermittent claudication and could be added to the primary medical treatment of these patients. The use of aspirin in these patients cannot be based on direct evidence, but only on analogy with coronary and cerebral atherosclerosis, where it has documented efficacy. Other antithrombotic drugs were not properly evaluated in patients with intermittent claudication.

scholarly journals Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners

2020 ◽  
Vol 6 (1) ◽  
pp. e000897
Author(s):  
Amy E Harwood ◽  
Sean Pymer ◽  
Lee Ingle ◽  
Patrick Doherty ◽  
Ian C Chetter ◽  
...  
Keyword(s):  
Exercise Training ◽  
Intermittent Claudication ◽  
Mode Of Delivery ◽  
Lower Limbs ◽  
Walking Distance ◽  
Walking Ability ◽  
Aerobic Activity ◽  
Supervised Exercise ◽  
Home Based ◽  
Exercise Programmes

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.

Abstract 19720: Jay D. Coffman Early Career Investigator Award: Comparative Efficacy of Initial Endovascular Revascularization vs. Supervised Exercise Training in Patients With Intermittent Claudication: A Meta-analysis of Randomized Controlled Trials

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ambarish Pandey ◽  
Subhash Banerjee ◽  
Christian Ngo ◽  
Purav Mody ◽  
Steven Marso ◽  
...  
Keyword(s):  
Exercise Training ◽  
Randomized Controlled Trials ◽  
Intermittent Claudication ◽  
Meta Analysis ◽  
Walking Distance ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Supervised Exercise ◽  
Endovascular Revascularization

Introduction: Current guidelines recommend supervised exercise training (SET) as the initial treatment modality for patients with intermittent claudication (IC), in addition to optimal medical therapy. The role of endovascular revascularization (ER) as a primary treatment option has been controversial. We performed a meta-analysis to compare the efficacy of initial ER vs. initial SET in patients with IC using data from randomized controlled trials. Methods: The primary outcome was treadmill-measured maximum walking distance (MWD) at the end of follow-up. Secondary outcomes included resting ankle brachial index (ABI) and treadmill-measured ischemic claudication distance (ICD) on follow-up. Risk of adverse limb events (revascularization, amputations) was also compared between the two groups. Random effects models were used for all analyses. Results: We included 1,145 patients from nine trials with a mean follow up duration of 13.7 months (42% aortoiliac lesions; 35% stent use; mean baseline ABI 0.64 vs. 0.67 for ER vs. SET). Follow-up MWD was not significantly different between patients undergoing ER vs. SET [Weighted mean difference (WMD) (95% CI): 19.1 m (-79.6 to 117.8 m); publication bias p=0.86]. Metaregression did not identify significant differences based on stent use or presence of aortoiliac disease. ICD was also similar between the two groups [WMD (95% CI): 36.1 m (-99.4 to 171.5 m)]. In contrast, patients undergoing ER had higher resting ABI on follow-up [WMD (95% CI): 0.14 (0.11 to 0.17), p<0.0001]. Adverse limb event rates were similar [5.4% vs. 8.2%, p=0.21]. Conclusion: Compared with initial SET, initial ER significantly improves resting ABI values. Although longer walking distance and lower rates of adverse limb events also appeared favorable for ER, these differences were not statistically significant in these intermediate term studies. Longer-term studies and those incorporating contemporary revascularization techniques are necessary.

Integrative therapy in patients with intermittent claudication

VASA ◽  
2015 ◽  
Vol 44 (2) ◽  
pp. 85-91
Author(s):  
Erich Minar
Keyword(s):  
Intermittent Claudication ◽  
Modern Technology ◽  
Walking Distance ◽  
Interventional Treatment ◽  
Therapeutic Concept ◽  
Integrative Therapy ◽  
Risk Factor Modification ◽  
Supervised Exercise ◽  
Main Challenge ◽  
Exercise Programmes

The generally accepted first-line treatment in patients with intermittent claudication is risk factor modification, medical treatment and exercise training. In an era of reduced resources, the benefit of any further invasive intervention must be weighted against best conservative therapy for patients with claudication. According to some recent trials an integrative therapeutic concept combining best conservative treatment - including (supervised) exercise therapy - with endovascular therapy gives the best midterm results concerning walking distance and health-related quality of life. The improved mid- and long-term patency rate with use of modern technology further supports this concept. The conservative and interventional treatment strategy are more complimentary than competitive. The current main challenge is to overcome the economic barriers concerning the availability of exercise programmes.

scholarly journals The effectiveness of supplemental oxygen during exercise training in patients with chronic obstructive pulmonary disease who show severe exercise-induced desaturation: a protocol for a meta-regression analysis and systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Shohei Kawachi ◽  
Shuhei Yamamoto ◽  
Kenichi Nishie ◽  
Takayoshi Yamaga ◽  
Manaka Shibuya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Exercise Tolerance ◽  
Supplemental Oxygen ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Severe Exercise ◽  
Meta Regression ◽  
Exercise Induced

Abstract Background Supplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO2 of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline. Methods We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline. Discussion One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events. Systematic review registration Registration number, UMIN000039960.

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