Sports Medicine and Cardiac Rehabilitation for Coronary and Peripheral Artery Disease Patients

2018 ◽  
pp. 495-516
Author(s):  
Gregory S. Thomas ◽  
Myrvin H. Ellestad
Keyword(s):  
Cardiac Rehabilitation ◽  
Athletic Training ◽  
Peripheral Artery Disease ◽  
Sports Medicine ◽  
Exercise Program ◽  
Peripheral Artery ◽  
Large Populations ◽  
Habitual Exercise ◽  
Artery Disease ◽  
Asymptomatic Individuals

The chapter Sports Medicine and Cardiac Rehabilitation for Coronary and Peripheral Artery Disease (CAD) reviews the benefits and potential risks of physical activity and the opportunity for particular benefit in patients with coronary artery disease and peripheral artery disease (PAD). Longitudinal studies of large populations have found a benefit to habitual exercise on cardiovascular health, including decreasing cardiovascular mortality. A physiologic training effect is not required for benefit. Mild exercise is better than inactivity and increasing activity provides even greater benefit. Athletic training induces expected electrocardiographic changes at rest in athletes. Prescribing exercise with or without an exercise test is discussed in asymptomatic individuals as well as prior to participation in traditional cardiac rehabilitation or a supervised exercise program for patients with peripheral artery disease. PAD patients often do not have classic intermittent claudication yet are able to benefit from exercise therapy.

scholarly journals Cardiac Rehabilitation in Patients with Peripheral Artery Disease—A Literature Review in COVID-19 Era

2022 ◽  
Vol 11 (2) ◽  
pp. 416
Author(s):  
Razvan Anghel ◽  
Cristina Andreea Adam ◽  
Dragos Traian Marius Marcu ◽  
Ovidiu Mitu ◽  
Florin Mitu
Keyword(s):  
Quality Of Life ◽  
Cardiac Rehabilitation ◽  
Peripheral Artery Disease ◽  
Exercise Therapy ◽  
Peripheral Artery ◽  
Rehabilitation Programs ◽  
Supervised Exercise ◽  
Effective Manner ◽  
Artery Disease

Cardiac rehabilitation (CR) is an integral part of the management of various cardiovascular disease such as coronary artery disease (CAD), peripheral artery disease (PAD), or chronic heart failure (CHF), with proven morbidity and mortality benefits. This article aims to review and summarize the scientific literature related to cardiac rehabilitation programs for patients with PAD and how they were adapted during the COVID-19 pandemic. The implementation of CR programs has been problematic since the COVID-19 pandemic due to social distancing and work-related restrictions. One of the main challenges for physicians and health systems alike has been the management of PAD patients. COVID-19 predisposes to coagulation disorders that can lead to severe thrombotic events. Home-based walking exercises are more accessible and easier to accept than supervised exercise programs. Cycling or other forms of exercise are more entertaining or challenging alternatives to exercise therapy. Besides treadmill exercises, upper- and lower-extremity ergometry also has great functional benefits, especially regarding walking endurance. Supervised exercise therapy has a positive impact on both functional capacity and also on the quality of life of such patients. The most effective manner to acquire this seems to be by combining revascularization therapy and supervised exercise. Rehabilitation programs proved to be a mandatory part of the integrative approach in these cases, increasing quality of life, and decreasing stress levels, depression, and anxiety.

scholarly journals Minimal clinically important differences in treadmill, 6-minute walk, and patient-based outcomes following supervised and home-based exercise in peripheral artery disease

2018 ◽  
Vol 23 (4) ◽  
pp. 349-357 ◽  
Author(s):  
Andrew W Gardner ◽  
Polly S Montgomery ◽  
Ming Wang
Keyword(s):  
Peripheral Artery Disease ◽  
Exercise Program ◽  
Exercise Group ◽  
Treadmill Test ◽  
Peripheral Artery ◽  
Exercise Programs ◽  
Supervised Exercise ◽  
Home Based ◽  
Artery Disease ◽  
Minute Walk

We estimated minimal clinically important differences (MCIDs) for small, moderate, and large changes in measures obtained from a standardized treadmill test, a 6-minute walk test, and patient-based outcomes following supervised and home-based exercise programs in symptomatic patients with peripheral artery disease (PAD). Patients were randomized to either 12 weeks of a supervised exercise program ( n=60), a home-based exercise program ( n=60), or an attention-control group ( n=60). Using the distribution-based method to determine MCIDs, the MCIDs for small, moderate, and large changes in peak walking time (PWT) in the supervised exercise group were 38, 95, and 152 seconds, respectively, and the changes in claudication onset time (COT) were 35, 87, and 138 seconds. Similar MCID scores were noted for the home-based exercise group. An anchor-based method to determine MCIDs yielded similar patterns of small, moderate, and large change scores in PWT and COT, but values were 1–2 minutes longer than the distribution approach. In conclusion, 3 months of supervised and home-based exercise programs for symptomatic patients with PAD results in distribution-based MCID small, moderate, and large changes ranging from 0.5 and 2.5 minutes for PWT and COT. An anchor-based approach yields higher MCID values, ranging from a minimum of 73 seconds for COT to a maximum of 4 minutes for PWT. The clinical implication is that a goal for eliciting MCIDs in symptomatic PAD patients through a walking exercise intervention is to increase PWT and COT by up to 4 minutes, which corresponds to two work stages during the standardized progressive treadmill test.

scholarly journals Effectiveness of Home-Based Pain-Free Exercise versus Walking Advice in Patients with Peripheral Artery Disease: A Randomized Controlled Trial

2021 ◽  
Vol 4 (2) ◽  
pp. 29
Author(s):  
Fabio Manfredini ◽  
Nicola Lamberti ◽  
Luca Traina ◽  
Gladiol Zenunaj ◽  
Chiara Medini ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Controlled Trial ◽  
Ankle Brachial Index ◽  
Exercise Program ◽  
Walking Distance ◽  
Control Group ◽  
Peripheral Artery ◽  
Free Exercise ◽  
Home Based ◽  
Artery Disease

Exercise therapy in the intermediate stages of peripheral artery disease (PAD) represents an effective solution to improve mobility and quality of life (QoL). Home-based programs, although less effective than supervised programs, have been found to be successful when conducted at high intensity by walking near maximal pain. In this randomized trial, we aim to compare a low-intensity, pain-free structured home-based exercise (SHB) program to an active control group that will be advised to walk according to guidelines. Sixty PAD patients aged > 60 years with claudication will be randomized with a 1:1 ratio to SHB or Control. Patients in the training group will be prescribed an interval walking program at controlled speed to be performed at home; the speed will be increased weekly. At baseline and after 6 months, the following outcomes will be collected: pain-free walking distance and 6-min walking distance (primary outcome), ankle-brachial index, QoL by the VascuQoL-6 questionnaire, foot temperature by thermal camera, 5-time sit-to-stand test, and long-term clinical outcomes including revascularization rate and mortality. The home-based pain-free exercise program may represent a sustainable and cost effective option for patients and health services. The trial has been approved by the CE-AVEC Ethics Committee (898/20). Registration details: Clinicaltrials.gov NCT04751890 [Registered: 12 February 2021].

scholarly journals Don’t stop walking: an in-home rehabilitation program for peripheral artery disease patients during the COVID-19 pandemic.

2020 ◽  
Author(s):  
Nicola Lamberti ◽  
Sofia Straudi ◽  
Roberto Manfredini ◽  
Alfredo De Giorgi ◽  
Vincenzo Gasbarro ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Exercise Program ◽  
Rehabilitation Program ◽  
Walking Distance ◽  
Walking Ability ◽  
Peripheral Artery ◽  
Walking Program ◽  
External Conditions ◽  
Artery Disease

Abstract Aims: We studied the outcomes of peripheral artery disease (PAD) patients enrolled in a structured in-home walking program before the lockdown due to the SARS-CoV-2 epidemic emergency, to determine whether this intervention ensured the maintenance of mobility in the case of strict movement restrictions.Methods: We considered 83 patients (age 72±11, males n=65) enrolled in a rehabilitation program based on two daily 8-minute sessions of slow intermittent in-home walking at a prescribed cadence with circa-monthly hospital visits. During the lockdown period, the program was updated by phone. The 6-minute (6MWD) and pain-free walking distance (PFWD) were measured pre- and postlockdown. Body weight (BW), blood pressure (BP), and the ankle-brachial index (ABI) were also determined.Results: Sixty-six patients were measured 117±23 days after their previous visit. A safe, pain-free execution the prescribed sessions, with a median distance covered of 74 km, was reported. Overall, the 6MWD was stable, while PFWD improved (p<0.001). Decreased BW with stable BP and ABI values were also recorded. When considering the outcome values according to the time of enrollment before the lockdown, new-entry subjects (≤3 months; n=35) obtained significant improvements, while those previously enrolled (>3 months; n= 31) were stable.Conclusion: In PAD patients, a structured exercise program easily performed in a home corridor and guided with phone assistance was adhered to by patients and showed effectiveness in maintaining mobility and risk factor control during the COVID-19 pandemic. Safe structured exercise may involve frail subjects regardless of walking ability, type of home and external conditions.

scholarly journals Peripheral Vascular Intervention: A Review

2019 ◽  
Vol 34 (1) ◽  
pp. 58-67
Author(s):  
Mohsin Ahmed ◽  
Abul Hasan Muhammed Bashar ◽  
Abdullah Al Gaddafi
Keyword(s):  
Peripheral Arterial Disease ◽  
Peripheral Artery Disease ◽  
Exercise Program ◽  
Arterial Disease ◽  
Peripheral Artery ◽  
Vascular Intervention ◽  
Long Term Outcome ◽  
Supervised Exercise ◽  
Artery Disease ◽  
Peripheral Arterial

The prevalence of peripheral artery disease (PAD) continues to increase worldwide. It is important to identify patients with PAD because of the increased risk of myocardial infarction, stroke, and cardiovascular death and impaired quality of life because of a profound limitation in exercise performance.Lower extremity PAD affects approximately 10% of population, with 30% to 40% of these patients presenting with claudication symptoms. Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include duplex scanning, computed tomography angiogram, magnetic resonance angiography and invasive modalities peripheral angiogram is the gold standard. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (older than 40 years), hypertension, hyperlipidemia, and hyperhomocystinemia. Intermittent claudication may be improved by risk-factor modification, exercise, and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. Effective drug therapies for peripheral arterial disease include aspirin (with or without dipyridamole), clopidogrel, cilostazol, and pentoxifylline. By contrast, critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels. It is associated with a high risk of major amputation, cardiovascular events and death. The management of CLI should include an exercise program, guideline-based medical therapy to lower the cardiovascular risk. Most of the cases, revascularization is indicated to save limbs; an “endovascular first” approach and lastly surgical approach, if all measures were failed. The choice of the intervention is dependent on the anatomy of the stenotic or occlusive lesion; percutaneous interventions are appropriate when the lesion is focal and short but longer lesions must be treated with surgical revascularisation to achieve acceptable long-term outcome. Bangladesh Heart Journal 2019; 34(1) : 58-67

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