scholarly journals Improvement in 6-Minute Walking Distance after Supervised Exercise Training Is Related to Changes in Quality of Life in Patients with Lower Extremity Peripheral Artery Disease

2021 ◽  
Vol 10 (15) ◽  
pp. 3330
Author(s):  
Stefano Lanzi ◽  
Luca Calanca ◽  
André Berchtold ◽  
Lucia Mazzolai
Keyword(s):  
Quality Of Life ◽  
Exercise Training ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Sf 36 ◽  
Artery Disease

This study aimed to investigate the relationship between supervised exercise training (SET)-induced changes in treadmill performance and 6 min walking distance, and changes in general (physical and mental) self-perceived health-related quality of life (HRQoL) in symptomatic patients with lower extremity peripheral artery disease (PAD). This is an observational study investigating Fontaine stage II PAD patients participating in 3-month SET. Before and following SET, treadmill performance (pain-free (PFWD) and maximal (MWD)), and 6 min walking distance (6MWD) were assessed. Self-perceived HRQoL was assessed with the Medical Outcomes Study Short-Form 36 (SF-36). Ankle- and toe-brachial indexes were also measured. One-hundred forty-seven patients with PAD were included (64.9 ± 9.6 y, 70% men). After SET, PFWD (+102%, p ≤ 0.001), MWD (+87%, p ≤ 0.001), and 6MWD (+14%, p ≤ 0.001) significantly increased. All eight SF-36 subscale scores significantly improved following SET (p ≤ 0.04). SET significantly improved physical and mental component summaries of the SF-36 (p ≤ 0.001). Larger increases in 6MWD were associated with greater improvements in physical (β = 0.19; p = 0.02) and mental (β = 0.24; p = 0.005) component summaries of the SF-36. No significant relationship was observed between changes in treadmill performance and changes in physical and mental component summaries of the SF-36. These results show that improvements in 6MWD following SET are related to improvements in general self-perceived HRQoL in patients with symptomatic lower extremity PAD. On the contrary, changes in treadmill performance were not related to improvements in HRQoL. These results suggest that the 6 min walking test is an essential outcome measure to assess overall patient functional status following interventions in patients with PAD.

scholarly journals Multimodal Supervised Exercise Training is Effective in Improving Long Term Walking Performance in Patients with Symptomatic Lower Extremity Peripheral Artery Disease

2021 ◽  
Vol 10 (10) ◽  
pp. 2057
Author(s):  
Barbara Ney ◽  
Stefano Lanzi ◽  
Luca Calanca ◽  
Lucia Mazzolai
Keyword(s):  
Exercise Training ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Walking Performance ◽  
Artery Disease ◽  
Fontaine Stage

This study aimed to evaluate the effect of a multimodal supervised exercise training (SET) program on walking performance for 12 months in patients with symptomatic lower extremity peripheral artery disease (PAD). Consecutive patients with Fontaine stage II PAD participating in the SET program of our hospital were retrospectively investigated. Walking performance, assessed using a treadmill with measures of the pain-free and maximal walking distance (PFWD, MWD, respectively), and 6 min walking distance (6MWD), were tested before and following SET, as well as at 6 and 12 months after SET completion. Ninety-three symptomatic patients with PAD (65.0 ± 1.1 y) were included in the study. Following SET, the walking performance significantly improved (PFWD: +145%, p ≤ 0.001; MWD: +97%, p ≤ 0.001; 6MWD: +15%, p ≤ 0.001). At 6 months, PFWD (+257%, p ≤ 0.001), MWD (+132%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-SET condition. At 12 months, PFWD (+272%, p ≤ 0.001), MWD (+130%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-training condition. The walking performance remained significantly improved in both women and men for up to 12 months (p ≤ 0.001). Multimodal SET is effective at improving walking performance in symptomatic patients with PAD, with improvements lasting up to 12 months.

scholarly journals Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (13) ◽  
Author(s):  
Diane Treat-Jacobson ◽  
Mary M. McDermott ◽  
Joshua A. Beckman ◽  
Marsha A. Burt ◽  
Mark A. Creager ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peripheral Artery Disease ◽  
Exercise Therapy ◽  
Outcome Measurement ◽  
The United States ◽  
Walking Ability ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Artery Disease

Patients with lower-extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD. Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD. This advisory provides a practical guide for delivering SET programs to patients with PAD according to Centers for Medicare & Medicaid Services criteria. It summarizes the Centers for Medicare & Medicaid Services process and requirements for referral and coverage of SET and provides guidance on how to implement SET for patients with PAD, including the SET protocol, options for outcome measurement, and transition to home-based exercise. This advisory is based on the guidelines established by the Centers for Medicare & Medicaid Services for Medicare beneficiaries in the United States and is intended to assist clinicians and administrators who are implementing SET programs for patients with PAD.

Gait changes after supervised exercise training in patients with symptomatic lower extremity peripheral artery disease

2021 ◽  
pp. 1358863X2098483
Author(s):  
Stefano Lanzi ◽  
Joël Boichat ◽  
Luca Calanca ◽  
Pauline Aubertin ◽  
Davide Malatesta ◽  
...  
Keyword(s):  
Exercise Training ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Stride Frequency ◽  
Peripheral Artery ◽  
Phase Duration ◽  
Supervised Exercise ◽  
Gait Parameters ◽  
Artery Disease

This study aimed to investigate the effects of supervised exercise training (SET) on walking performance and spatiotemporal gait changes in patients with symptomatic lower extremity peripheral artery disease (PAD). In this single-arm prospective nonrandomized cohort study, patients with Fontaine stage II PAD following a 3-month SET program were included. Before and after SET, a constant-load treadmill test was performed to determine the pain-free and maximal walking distances (PFWD and MWD, respectively). During this test, spatiotemporal gait parameters were assessed. The ankle–brachial index (ABI) and toe–brachial index (TBI) were also measured. Twenty-seven patients with PAD (64.0 ± 1.9 y, 74% men) were included. Following SET, the PFWD (+68%; p = 0.001) and MWD (+79%; p ⩽ 0.001) significantly increased. The ABI and TBI did not change significantly. Following SET, the stride duration, stride frequency, stride length, and double support phase duration did not change significantly. In contrast, subphases of stance showed significant changes: the loading response (+8%; p = 0.03) and foot-flat (+2%; p = 0.01) phases were significantly longer, whereas the push-off phase (–7%; p = 0.002) was significantly shorter. A significant positive correlation was found between changes in the foot-flat phase and changes in PFWD ( r = 0.43, p = 0.03). A significant negative correlation was found between changes in the push-off phase and changes in PFWD ( r = −0.39, p = 0.05). No significant correlations were found between changes in relative durations of the subphases of stance and MWD. These results indicate that changes in temporal gait parameters during the foot contact phase potentially constitute an underlying mechanism of delayed claudication distance in patients with symptomatic PAD.

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 Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Aozhou Wu ◽  
Josef Coresh ◽  
Elizabeth Selvin ◽  
Hirofumi Tanaka ◽  
Gerardo Heiss ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Older Individuals ◽  
Peripheral Artery ◽  
Artery Disease

Multimodal Supervised Exercise Significantly Improves Walking Performances Without Changing Hemodynamic Parameters in Patients With Symptomatic Lower Extremity Peripheral Artery Disease

2020 ◽  
Vol 54 (7) ◽  
pp. 605-611
Author(s):  
Luca Calanca ◽  
Stefano Lanzi ◽  
Barbara Ney ◽  
André Berchtold ◽  
Lucia Mazzolai
Keyword(s):  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Walking Distance ◽  
Hemodynamic Parameters ◽  
Peripheral Artery ◽  
Transcutaneous Oxygen ◽  
Supervised Exercise ◽  
Transcutaneous Oxygen Pressure ◽  
Toe Brachial Index ◽  
Artery Disease

We evaluated the outcome of multimodal supervised exercise training (SET) on walking performances and different hemodynamic parameters (ankle/toe-brachial index [ABI/TBI], and transcutaneous oxygen pressure [TcPO2]) in patients with symptomatic lower extremity peripheral artery disease (PAD). Whether hemodynamic parameters predict walking performances at baseline and following SET was also investigated. Fontaine stage II PAD’s patients following a 3-month SET were retrospectively included. Hemodynamic parameters and walking performances (pain-free [PFWD], maximal [MWD], and 6-minute [6MWD] walking distance) were measured in each patient. Eighty-five symptomatic PAD patients were included. Following SET, PFWD, MWD, and 6MWD significantly increased (+142%, +94%, +14%; respectively; P ≤ .001). Toe-brachial index significantly increased (MD: 0.04 ± 0.01; P = .02), whereas ABI and TcPO2 did not change significantly. At baseline, patients with higher TBI and TcPO2 performed significantly better (PFWD: β = 0.25, P = .01 for TBI; PFWD: β = 0.30, P = .005, and MWD: β = 0.22, P = .04, for TcPO2). No significant relationship was observed at baseline between ABI and walking performances. Baseline values of hemodynamic parameters did not significantly correlate with changes in walking performances. Multimodal SET significantly improves walking performances. Following SET, no significant changes in ABI and TcPO2 were observed. Toe-brachial index values significantly improved after SET. However, this increase was very modest and its clinical relevance remains questionable. Although baseline TBI and supine TcPO2 values predict baseline walking performances, no association was found between baseline hemodynamic parameters and changes in walking performances following SET.

Individual Differences in Response to Supervised Exercise Therapy for Peripheral Artery Disease

2020 ◽  
pp. 019394592097747
Author(s):  
Mary O. Whipple ◽  
Erica N. Schorr ◽  
Kristine M.C. Talley ◽  
Julian Wolfson ◽  
Ruth Lindquist ◽  
...  
Keyword(s):  
Older Adults ◽  
Peripheral Artery Disease ◽  
Exercise Therapy ◽  
Poor Response ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Meaningful Improvement ◽  
Supervised Exercise ◽  
Patient Reported ◽  
Artery Disease

Nonresponse to exercise has been extensively examined in young athletes but is seldom reported in studies of aerobic exercise interventions in older adults. This study examined the prevalence of nonresponse and poor response to exercise in functional and quality of life outcomes and response patterns between and among older adults undergoing 12-weeks of supervised exercise therapy for the management of peripheral artery disease ( N = 44, mean age 72.3 years, 47.7% female). The prevalence of nonresponse (no change/decline in performance) in walking distance was 31.8%. The prevalence of poor response (lack of a clinically meaningful improvement) was 43.2%. Similar patterns of response were observed in both objective and patient-reported measures of physical function. All participants improved in at least one outcome; only two participants improved in all measured outcomes. Additional research should examine modifiable predictors of response to inform programming and maximize an individual’s potential benefit from exercise therapy.

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