Patients with peripheral arterial disease show an ameliorated proinflammatory status over 12 months non-supervised exercise training parallel to an increased walking distance

Increasing prevalence, high morbidity and mortality, and decreased health-related quality of life are hallmarks of peripheral arterial disease. About one-third of peripheral arterial disease patients have intermittent claudication with deleterious effects on everyday activities, such as walking. Exercise training improves peripheral arterial disease symptoms and is recommended as first line therapy for peripheral arterial disease. This review examines the effects of exercise training beyond improvements in walking distance, namely on vascular function, parameters of inflammation, activated hemostasis and oxidative stress, and quality of life. Exercise training not only increases walking distance and physiologic parameters in patients with peripheral arterial disease, but also improves the cardiovascular risk profile by helping patients achieve better control of hypertension, hyperglycemia, obesity and dyslipidemia, thus further reducing cardiovascular risk and the prevalence of coexistent atherosclerotic diseases. American guidelines suggest supervised exercise training, performed for a minimum of 30–45 min, at least three times per week, for at least 12 weeks. Walking is the most studied exercise modality and its efficacy in improving cardiovascular parameters in patients with peripheral arterial disease has been extensively proven. As studies have shown that supervised exercise training improves walking performance, cardiovascular parameters and quality of life in patients with peripheral arterial disease, it should be encouraged and more often prescribed.

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

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00151.2019 ◽

2019 ◽

Vol 316 (6) ◽

pp. H1495-H1506 ◽

Cited By ~ 10

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/ .

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Combined Lower Limb Revascularisation and Supervised Exercise Training for Patients with Peripheral Arterial Disease: A Systematic Review of Randomised Controlled Trials

Sports Medicine ◽

10.1007/s40279-016-0635-5 ◽

2016 ◽

Vol 47 (5) ◽

pp. 987-1002 ◽

Cited By ~ 11

Author(s):

Annelise L. Menêses ◽

Raphael M. Ritti-Dias ◽

Belinda Parmenter ◽

Jonathan Golledge ◽

Christopher D. Askew

Keyword(s):

Systematic Review ◽

Exercise Training ◽

Peripheral Arterial Disease ◽

Lower Limb ◽

Randomised Controlled Trials ◽

Arterial Disease ◽

Controlled Trials ◽

Supervised Exercise ◽

Peripheral Arterial ◽

Randomised Controlled

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The Completeness Of Intervention Descriptions In Randomised Trials Of Supervised Exercise Training In Peripheral Arterial Disease

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000485227.10860.75 ◽

2016 ◽

Vol 48 ◽

pp. 72

Author(s):

Garry A. Tew ◽

Sally Brabyn ◽

Liz Cook ◽

Emily Peckham

Keyword(s):

Exercise Training ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Randomised Trials ◽

Supervised Exercise ◽

Peripheral Arterial

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

Frontiers in Physiology ◽

10.3389/fphys.2021.792398 ◽

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.

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

Circulation ◽

10.1161/circ.130.suppl_2.15110 ◽

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.

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Therapeutic arteriogenesis in peripheral arterial disease: combining intervention and passive training

VASA ◽

10.1024/0301-1526/a000092 ◽

2011 ◽

Vol 40 (3) ◽

pp. 177-187 ◽

Cited By ~ 14

Author(s):

Bondke Persson ◽

Buschmann ◽

Lindhorst ◽

Troidl ◽

Langhoff ◽

...

Keyword(s):

Exercise Training ◽

Peripheral Arterial Disease ◽

Fluid Shear Stress ◽

Low Pressure ◽

Arterial Disease ◽

Collateral Flow ◽

Area At Risk ◽

Supervised Exercise ◽

Primary Treatment Modality ◽

Peripheral Arterial

The prevalence of peripheral arterial disease (PAD) is on the rise in an aging population, significantly affecting quality of life, morbidity and mortality. Besides medical treatment and surgical or interventional revascularization, supervised exercise programs are a primary treatment modality for PAD. Training may significantly increase pain-free walking time (+ 180 %) while avoiding the associated complications of (repeated) invasive revascularization. Training effects rely on an improvement of risk factor management, muscle function, economy of movement, hemorheology, vascular growth and collateral vessel growth. Exercise training upregulates pulsatile fluid shear stress on the vascular endothelium, prompting an improvement of endothelial function (eNOS, NO) and an outgrowth of preexistent collaterals (arteriogenesis) to functional conductance arteries outside the ischemic area at risk. However, the necessary intense minimum training intervals compromise patient compliance, and the impaired functional status of many PAD patients limits active exercise training. Strategies are necessary to a) increase training compliance, b) make the benefits of exercise training available to patients unable to exercise actively and c) therapeutically enhance the adaptive growth of biological bypasses (arteriogenesis). A modified form of passive exercise training derived from enhanced external counterpulsation (low-pressure ECP) which was originally developed for the therapy of heart failure, may prove to be an option for this group of patients. Therefore, this review article suggests a tailored combination therapy, consisting of a facilitating revascularization procedure to restore arterial inflow, succeeded by supervised exercise training, which has yielded promising therapeutic results in clinical trials. Further studies, using appropriate imaging methods and controls, are under way to (a) establish the efficacy of low-pressure EECP in PAD patients and (b) to directly correlate training-induced improvements of collateral flow to the functional improvements seen with exercise training.

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