Auricular vagal nerve stimulation in peripheral arterial disease patients

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 462-470 ◽  
Author(s):  
Gerald Hackl ◽  
Andreas Prenner ◽  
Philipp Jud ◽  
Franz Hafner ◽  
Peter Rief ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Nerve Stimulation ◽  
Short Form ◽  
Therapeutic Option ◽  
Arterial Disease ◽  
Walking Distance ◽  
Control Group ◽  
Sf 36 ◽  
Peripheral Arterial ◽  
Double Blinded

Abstract. Background: Auricular nerve stimulation has been proven effective in different diseases. We investigated if a conservative therapeutic alternative for claudication in peripheral arterial occlusive disease (PAD) via electroacupuncture of the outer ear can be established. Patients and methods: In this prospective, double-blinded trial an ear acupuncture using an electroacupuncture device was carried out in 40 PAD patients in Fontaine stage IIb. Twenty patients were randomized to the verum group using a fully functional electroacupuncture device, the other 20 patients received a sham device (control group). Per patient, eight cycles (1 cycle = 1 week) of electroacupuncture were performed. The primary endpoint was defined as a significantly more frequent doubling of the absolute walking distance after eight cycles in the verum group compared to controls in a standardized treadmill testing. Secondary endpoints were a significant improvement of the total score of the Walking Impairment Questionnaire (WIQ) as well as improvements in health related quality of life using the Short Form 36 Health Survey (SF-36). Results: There were no differences in baseline characteristics between the two groups. The initial walking distance significantly increased in both groups (verum group [means]: 182 [95 % CI 128–236] meters to 345 [95 % CI 227–463] meters [+ 90 %], p < 0.01; control group [means]: 159 [95 % CI 109–210] meters to 268 [95 % CI 182–366] meters [+ 69 %], p = 0.01). Twelve patients (60 %) in the verum group and five patients (25 %) in controls reached the primary endpoint of doubling walking distance (p = 0.05). The total score of WIQ significantly improved in the verum group (+ 22 %, p = 0.01) but not in controls (+ 8 %, p = 0.56). SF-36 showed significantly improvements in six out of eight categories in the verum group and only in one of eight in controls. Conclusions: Electroacupuncture of the outer ear seems to be an easy-to-use therapeutic option in an age of increasingly invasive and mechanically complex treatments for PAD patients.

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.

Cycling Exercise Training Enhances Platelet Mitochondrial Bioenergetics in Patients with Peripheral Arterial Disease: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Tieh-Cheng Fu ◽  
Ming-Lu Lin ◽  
Chih-Chin Hsu ◽  
Shu-Chun Huang ◽  
Yu-Ting Lin ◽  
...  
Keyword(s):  
Exercise Training ◽  
Peripheral Arterial Disease ◽  
Aerobic Capacity ◽  
Short Form ◽  
Arterial Disease ◽  
Control Group ◽  
Mitochondrial Bioenergetics ◽  
Cycling Exercise ◽  
Complex Ii ◽  
Peripheral Arterial

AbstractExercise training influences the risk of vascular thrombosis in patients with peripheral arterial disease (PAD). Mitochondrial functionalities in platelets involve the cellular bioenergetics and thrombogenesis. This study aimed to elucidate the effect of cycling exercise training (CET) on platelet mitochondrial bioenergetics in PAD patients. Forty randomly selected patients with PAD engaged in general rehabilitation (GR) with CET (i.e., cycling exercise at ventilation threshold for 30 minute/day, 3 days/week) (GR + CET, n = 20) or to a control group that only received GR course (n = 20) for 12 weeks. Systemic aerobic capacity and platelet mitochondrial bioenergetics that included oxidative phosphorylation (OXPHOS) and electron transport system (ETS) were measured using automatic gas analysis and high-resolution respirometry, respectively. The experimental results demonstrated that GR + CET for 12 weeks significantly (1) elevated VO2peak and lowered VE-VCO2 slope, (2) raised resting ankle-brachial index and enhanced cardiac output response to exercise, (3) increased the distance in 6-minute walk test and raised the Short Form-36 physical/mental component scores, and (4) enhanced capacities of mitochondrial OXPHOS and ETS in platelets by activating FADH2 (complex II)-dependent pathway. Moreover, changes in VO2peak levels were positively associated with changes in platelet OXPHOS and ETS capacities. However, no significant changes in systemic aerobic capacity, platelet mitochondrial bioenergetics, and health-related quality of life (HRQoL) occurred following GR alone. Hence, we conclude that CET effectively increases the capacities of platelet mitochondrial bioenergetics by enhancing complex II activity in patients with PAD. Moreover, the exercise regimen also enhanced functional exercise capacity, consequently improving HRQoL in PAD patients.

scholarly journals Feasibility and Clinical Relevance of a Mobile Intervention Using TrackPAD to Support Supervised Exercise Therapy in Patients With Peripheral Arterial Disease: Study Protocol for a Randomized Controlled Pilot Trial (Preprint)

2019 ◽  
Author(s):  
Katrin Paldán ◽  
Jan Simanovski ◽  
Greta Ullrich ◽  
Martin Steinmetz ◽  
Christos Rammos ◽  
...  
Keyword(s):  
Arterial Disease ◽  
Walking Distance ◽  
Control Group ◽  
Study Group ◽  
Walk Test ◽  
Patient Centered ◽  
Supervised Exercise ◽  
Mobile Intervention ◽  
Peripheral Arterial

BACKGROUND Peripheral arterial disease (PAD) is a common and severe disease with a highly increased cardiovascular morbidity and mortality. Through the circulatory disorder and the linked undersupply of oxygen carriers in the lower limbs, the ongoing decrease of the pain-free walking distance occurs with a significant reduction in patients’ quality of life. Studies including activity monitoring for patients with PAD are rare and digital support to increase activity via mobile health technologies is mainly targeted at patients with cardiovascular disease in general. The special requirement of patients with PAD is the need to reach a certain pain level to improve the pain-free walking distance. Unfortunately, both poor adherence and availability of institutional resources are major problems in patient-centered care. OBJECTIVE The objective of this trackPAD pilot study is to evaluate the feasibility of a mobile phone–based self tracking app to promote physical activity and supervised exercise therapy (SET) in particular. We also aim for a subsequent patient centered adjustment of the app prototype based on the results of the app evaluation and process evaluation. METHODS This study was designed as a closed user group trial, with assessors blinded, and parallel group study with face-to-face components for assessment with a follow-up of 3 months. Patients with symptomatic PAD (Fontaine stage IIa or IIb) and possession of a mobile phone were eligible. Eligible participants were randomly assigned into study and control group, stratified by their distance covered in the 6-min walk test, using the software TENALEA. Participants randomized to the study group received usual care and the mobile intervention (trackPAD) for the follow-up period of 3 months, whereas participants randomized to the control group received only usual care. TrackPAD records the frequency and duration of training sessions and pain level using manual user input. Clinical outcome data were collected at the baseline and after 3 months via validated tools (6-min walk test, ankle-brachial index, and duplex ultrasound at the lower arteries) and self-reported quality of life. Usability and quality of the app was determined using the user version of the Mobile Application Rating Scale. RESULTS The study enrolled 45 participants with symptomatic PAD (44% male). Of these participants, 21 (47%) were randomized to the study group and 24 (53%) were randomized to the control group. The distance walked in the 6-min walk test was comparable in both groups at baseline (study group: mean 368.1m [SD 77.6] vs control group: mean 394.6m [SD 100.6]). CONCLUSIONS This is the first trial to test a mobile intervention called trackPAD that was designed especially for patients with PAD. Its results will provide important insights in terms of feasibility, effectiveness, and patient preferences of an app-based mobile intervention supporting SET for the conservative treatment of PAD. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13651

Abstract 15110: Exercise Training for Management of Peripheral Arterial Disease: a Systematic Review and Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Belinda Parmenter ◽  
Gudrun Dieberg ◽  
Neil A Smart
Keyword(s):  
Exercise Training ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Stair Climbing ◽  
Walking Distance ◽  
Physical Component Score ◽  
Controlled Trials ◽  
Mild Pain ◽  
Sf 36 ◽  
Peripheral Arterial

Objective: To quantify expected benefits of exercise training in people with peripheral arterial disease (PAD). Hypothesis: Walking as a training modality and training to mild pain were optimal for improving peak VO 2 and symptoms. Methods: We conducted a systematic search (PubMed, CINAHL, Cochrane controlled trials registry; 1966-May 31, 2014).We included randomized controlled trials (RCT’s) of exercise training versus usual medical care in persons with PAD, 42 of 60 (70%) RCT’s met selection criteria. Results: Exercise training produced significant peak VO 2 improvements with Mean Difference (MD) 0.62 ml/kg/min (95% CI 0.47 to 0.77; p<0.00001); 6 minute walk initial claudication MD 52.7m (95%CI 24.7 to 80.6m; p=0.0002); total walking distance MD 34.9m (95%CI 25.6 to 44.1m; p<0.00001); graded treadmill initial claudication MD 68.8m (95%CI 54.4 to 83.2m; p<0.00001); absolute claudication distance MD 41.0m (95%CI 28.8 to 53.2m; p<0.00001)); but not ABI (p=0.12) or FMD (p=0.96). Sub-analyses of maximum change in Peak VO 2 showed arm cranking to be the superior modality MD 1.91 ml.kg -1 .min -1 (95% CI 1.28 to 2.54, p<0.00001). Sub-analysis of peak VO 2 according to pain thresholds suggested that exercise training with no or mild pain may be superior MD 0.79 ml.kg -1 .min -1 (95% CI 0.45 to 1.14, p<0.00001) to moderate/maximum pain MD 0.49 ml.kg -1 .min -1 (95% CI 0.31 to 0.66, p<0.00001). Exercise training significantly improved Walking Impairment Questionnaire (WIQ) speed [MD 9.90 (95% CI 7.10 to 12.71, p<0.00001)]; WIQ distance [MD 7.04 (95% CI 3.98 to 10.10, p<0.00001)] and WIQ stair climbing [MD 4.99 (95% CI 3.03 to 6.69, p<0.00001)]. Perceived symptoms were not improved. SF-36 physical score was significantly improved compared to control [MD 1.27 (95% CI 0.41 to 2.13, p=0.004)], but not SF-36 mental score. Conclusions and Relevance: Various modes of exercise improve cardio-respiratory fitness, pain free and total flat ground walking distances and graded treadmill performance in PAD. Alternative modes of exercise are understudied in terms of quality of life, however walking to some level of claudication pain improves WIQ speed, distance and stair climbing scores in PAD as well as SF-36 physical component score.

Cardiac rehabilitation in patients with peripheral arterial disease after revascularization

Vascular ◽  
2020 ◽  
pp. 170853812094553
Author(s):  
Farhad Sami ◽  
Sagar Ranka ◽  
Matthew Lippmann ◽  
Brian Weiford ◽  
Kirk Hance ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peripheral Arterial Disease ◽  
Cardiac Rehabilitation ◽  
Arterial Disease ◽  
Control Group ◽  
Life Questionnaire ◽  
Sf 36 ◽  
Peripheral Arterial ◽  
Change In Mean

Objectives To evaluate safety, feasibility, and benefit of cardiac rehabilitation (CR) in patients with peripheral arterial disease (PAD) who undergo revascularization. Methods We conducted a prospective, non-randomized, pilot study to assess the feasibility, safety, and benefit of CR in PAD patients after revascularization compared to standard of care (controls). CR feasibility was assessed by the ability to complete 36 sessions. Safety was defined as the absence of adverse cardiovascular events during CR. Quality of life (QoL) assessment was performed using SF-36 form (Medical Outcomes Study 36-Item Short-Form Health Survey) and PAD-specific quality of life questionnaire (VascuQOL6). Other endpoints included incidence of claudication during 6-minute walk test (6MWT), mean distance, and number of laps walked. All outcome data were collected before and after CR completion. Standard statistical tests were used for comparisons. Results This study enrolled 20 subjects (CR group = 10). Mean age was 60.70 (±7.13) and 63.1 (±9.17) years in CR and controls, respectively ( p-value > 0.05). Fifty percent and 60% were female in CR and control group, respectively. All subjects completed 36 CR sessions without adverse events. The increase in mean distance walked during 6MWT was higher in the CR group compared to control group (63.7 m vs. 10.5 m, p = 0.043). Change in mean number of laps walked was higher in the CR group (3.5 vs. –1.1; p < 0.01). Scores on 6 of 8 scales of SF-36 and VascuQOL6 were higher in the CR group, though not statistically significant. Conclusion CR is safe, feasible, and improves walking ability in ambulatory patients with PAD after arterial revascularization.

The influence of atorvastatin on walking performance in peripheral arterial disease

VASA ◽  
2009 ◽  
Vol 38 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Bregar ◽  
Poredoš ◽  
Šabovič ◽  
Jug ◽  
Šebeštjen
Keyword(s):  
Peripheral Arterial Disease ◽  
Ldl Cholesterol ◽  
Arterial Disease ◽  
Treated Group ◽  
Walking Distance ◽  
Control Group ◽  
Double Blind Study ◽  
Double Blind ◽  
Walking Performance ◽  
Peripheral Arterial

Background: Recently it has been shown that statins can improve walking distance in patients with peripheral arterial disease. We examined whether statins used in moderate dosages with the aim of reaching the target levels for hypercholesterolemia could improve walking performance in patients with peripheral arterial disease. Patients and methods: 37 patients with hypercholesterolemia (LDL cholesterol = 3.46 ± 0.13 mmol/l), who had previously not been treated by statins, were randomized in a double-blind study to a group receiving either atorvastatin at 20 mg/day (N = 20) or placebo (N = 17). All patients had stable intermittent claudication (Fontaine class IIa or IIb). At baseline, after one and three months the pain-free walking distance was measured in all patients. Results: After 3 months patients in the treated group had reached target cholesterol values (LDL cholesterol = 2,34 ± 0.9 mmol/l), whereas no significant change in lipids was observed in the control group. The ankle-brachial pressure index (ABPI) did not change significantly in either group. After 3 months the pain-free walking distance was increased significantly (p < 0.001), but similarly in both groups (at entry: 56 (53–108) m vs 53 (53–106) m; after 3 months: 79 (53–108) m vs 106 (66–159) m, for the treated and placebo group, respectively). Therefore this effect had to be attributed to regular exercise and not to statin use. Conclusions: Our results show that routine treatment with statin (atorvastatin 20 mg/day), which is effective in reducing the level of cholesterol, does not produce an improvement in walking performance in patients with peripheral arterial disease.

scholarly journals Cycling Exercise Training Enhances Mitochondrial Bioenergetics of Platelets in Patients with Peripheral Arterial Disease: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Ming-Lu Lin ◽  
Tieh-Cheng Fu ◽  
Chih-Chin Hsu ◽  
Shu-Chun Huang ◽  
Yu-Ting Lin ◽  
...  
Keyword(s):  
Exercise Training ◽  
Peripheral Arterial Disease ◽  
Aerobic Capacity ◽  
Short Form ◽  
Arterial Disease ◽  
Control Group ◽  
Mitochondrial Bioenergetics ◽  
Cycling Exercise ◽  
Complex Ii ◽  
Peripheral Arterial

Exercise training influences the risk of vascular thrombosis in patients with peripheral arterial disease (PAD). Mitochondrial functionalities in platelets involve the cellular bioenergetics and thrombogenesis. This study aimed to elucidate the effect of cycling exercise training (CET) on platelet mitochondrial bioenergetics in PAD patients. Forty randomly selected patients with PAD engaged in general rehabilitation (GR) with CET (i.e., cycling exercise at ventilation threshold for 30 min/day, 3 days/week) (GR+CET, n=20) or to a control group that only received GR course (n=20) for 12 weeks. Systemic aerobic capacity and platelet mitochondrial bioenergetics that included oxidative phosphorylation (OXPHOS) and electron transport system (ETS) were measured using automatic gas analysis and high-resolution respirometry, respectively. The experimental results demonstrated that GR+CET for 12 weeks significantly (i) elevated VO2peak and lowered VE-VCO2 slope, (ii) raised resting ankle-brachial index and enhanced cardiac output response to exercise, (iii) increased the distance in 6-minute walk test and raised the Short Form-36 physical/mental component scores, and (iv) enhanced capacities of mitochondrial OXPHOS and ETS in platelets by activating FADH2 (Complex II)-dependent pathway. Moreover, changes in VO2peak levels were positively associated with changes in platelet OXPHOS and ETS capacities. However, no significant changes in systemic aerobic capacity, platelet mitochondrial bioenergetics, and health-related quality of life (HRQoL) occurred following GR alone. Hence, we conclude that CET effectively increases the capacities of platelet mitochondrial bioenergetics by enhancing Complex II activity in patients with PAD. Moreover, the exercise regimen also enhanced functional exercise capacity, consequently improving HRQoL in PAD patients.

Relationship Between Psychological Factors and Wound Occurrence in Patients With Peripheral Arterial Disease in the Leg

2020 ◽  
pp. 153473462094381
Author(s):  
Ayaka Onoyama ◽  
Minoru Hoshiyama ◽  
Hiroki Yabe
Keyword(s):  
Peripheral Arterial Disease ◽  
Self Efficacy ◽  
Psychological Factors ◽  
Short Form ◽  
Arterial Disease ◽  
Functional Independence ◽  
Component Score ◽  
Sf 36 ◽  
Peripheral Arterial ◽  
Fontaine Classification

This prospective study investigated psychological factors affecting wound healing in patients with peripheral arterial disease (PAD). Fifty patients with PAD in a local hospital were enrolled. The Geriatric Depression Scale short version, Type-D scale 14, Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), Functional Independence Measure, Self-efficacy for Managing Chronic Disease Scale, Barriers Self-Efficacy Scale, and Mini Nutritional Assessment were applied to assess physical and psychological factors. Wound occurrence and healing were evaluated at 6 months after discharge, and 34 and 30 patients could be followed, respectively. The patient group with wound occurrence showed poorer mental component score (MCS) and better role/social component score (RCS) category scores of SF-36, and a higher stage in the Fontaine classification, than those without wound occurrence. On comparing Fontaine classification–matched subgroups, patients with wound occurrence showed poorer general health factor and MCS and better RCS of SF-36 than those without wound occurrence. Logistic analysis showed that MCS and RCS predicted wound occurrence and needs for local medical treatment, respectively. Among the psychological factors tested, MCS was a major factor associated with wound occurrence in the present study, with wide variation in clinical conditions and factors associated with PAD. Psychological factors were important as biological, physical, and social factors for patients with PAD during the long-term follow-up period, and an appropriate battery to evaluate psychological factors focused on patients with PAD should be developed.

scholarly journals Effects of Self RehAbilitation Video Exercises (SAVE) on Functional Restorations in Patients with Subacute Stroke

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 565
Author(s):  
Seung-Hwan Jung ◽  
Eunhee Park ◽  
Ju-Hyun Kim ◽  
Bi-Ang Park ◽  
Ja-Won Yu ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Short Form ◽  
Intervention Group ◽  
Exercise Program ◽  
Berg Balance Scale ◽  
Control Group ◽  
Early Recovery ◽  
Subacute Stroke ◽  
Sf 36 ◽  
State Examination

Background: Additional exercise therapy has been shown to positively affect acute stroke rehabilitation, which requires an effective method to deliver increased exercise. In this study, we designed a 4-week caregiver-supervised self-exercise program with videos, named “Self rehAbilitation Video Exercises (SAVE)”, to improve the functional outcomes and facilitate early recovery by increasing the continuity of rehabilitation therapy after acute stroke. Methods: This study is a non-randomized trial. Eighty-eight patients were included in an intervention group (SAVE group), who received conventional rehabilitation therapies and an additional self-rehabilitation session by watching bedside exercise videos and continued their own exercises in their rooms for 60 min every day for 4 weeks. Ninety-six patients were included in a control group, who received only conventional rehabilitation therapies. After 4 weeks of hospitalization, both groups assessed several outcome measurements, including the Berg Balance Scale (BBS), Modified Barthel Index (MBI), physical component summary (PCS) and the mental component summary of the Short-Form Survey 36 (SF-36), Mini-Mental State Examination, and Beck Depression Inventory. Results: Differences in BBS, MBI, and PCS components in SF-36 were more statistically significant in the SAVE group than that in the control group (p < 0.05). Patients in the SAVE group showed more significant improvement in BBS, MBI, and PCS components in SF-36 as compared to that in the control group. Conclusions: This evidence-based SAVE intervention can optimize patient recovery after a subacute stroke while keeping the available resources in mind.

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