scholarly journals Safety of home-based exercise for people with intermittent claudication: A systematic review

2021 ◽  
pp. 1358863X2110603
Author(s):  
Alexander Waddell ◽  
Sally Seed ◽  
David R Broom ◽  
Gordon McGregor ◽  
Stefan T Birkett ◽  
...  
Keyword(s):  
Adverse Events ◽  
Intermittent Claudication ◽  
Complication Rate ◽  
Cochrane Library ◽  
Cardiac Screening ◽  
Supervised Exercise ◽  
Home Based ◽  
Artery Disease ◽  
Exercise Programmes ◽  
Classic Symptom

Intermittent claudication (IC) is a classic symptom of peripheral artery disease, with first line treatment being supervised exercise therapy (SET). Despite this, SET is frequently underutilised, and adherence is often poor. An alternative option are home-based exercise programmes (HBEP). Although HBEPs are well tolerated, to the authors’ knowledge, no research has assessed their safety. The aim of this review was to assess the safety of HBEPs in people living with IC. We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library databases. The main parameter of interest was complication rate, calculated as the number of related adverse events per patient-hours. Subanalysis was undertaken to determine differences in safety for studies that did and did not include pre-exercise cardiac screening, and for studies with exercise at low, moderate, and high levels of claudication pain. Our search strategy identified 8693 results, of which 27 studies were included for full review. Studies included 1642 participants completing 147,810 patient-hours of home-based exercise. Four related adverse events were reported, three of which were cardiac in origin, giving an all-cause complication rate of one event per 36,953 patient-hours. Three of these events occurred following exercise to high levels of claudication pain, and one occurred with pain-free exercise. All four events occurred in studies without cardiac screening. Based on the low number of related adverse events, HBEPs appear to be a safe method of exercise prescription for people with IC. Our results strengthen the rationale for providing alternative exercise options for this population. PROSPERO Registration No.: CRD42021254581

scholarly journals Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e032146 ◽  
Author(s):  
Farhad Rezvani ◽  
Dirk Heider ◽  
Martin Härter ◽  
Hans-Helmut König ◽  
Frank Bienert ◽  
...  
Keyword(s):  
Health Care ◽  
Usual Care ◽  
Intermittent Claudication ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Home Based ◽  
Artery Disease ◽  
Exercise Programmes ◽  
Randomised Controlled

IntroductionPeripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD.Methods and analysisThe investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months.Ethics and disseminationEthical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.

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.

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.

Supervised Exercise Therapy for Intermittent Claudication

2019 ◽  
Vol 100 (1) ◽  
pp. 8-13
Author(s):  
Débora Úrsula Fernandes Souza ◽  
Débora Pantuso Monteiro ◽  
Rafael Zambelli Pinto ◽  
Danielle Aparecida Gomes Pereira
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Scientific Evidence ◽  
Cochrane Review ◽  
Cochrane Library ◽  
Supervised Exercise ◽  
Cochrane Reviews ◽  
Clinical Scenarios

Abstract <LEAP> Highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions—medication, surgery, education, nutrition, and exercise—and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. Each article in this Physical Therapy (PTJ) series will summarize a Cochrane review or other scientific evidence resource on a single topic and will present clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on the effectiveness of supervised exercise therapy for intermittent claudication. Can supervised exercise therapy help a person with intermittent claudication?

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