151
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Harwood AE, Smith GE, Cayton T, Broadbent E, Chetter IC. A Systematic Review of the Uptake and Adherence Rates to Supervised Exercise Programs in Patients with Intermittent Claudication. Ann Vasc Surg 2016; 34:280-9. [PMID: 27126713 DOI: 10.1016/j.avsg.2016.02.009] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intermittent claudication (IC) is a common and debilitating symptom of peripheral arterial disease and is associated with a significant reduction in a sufferer's quality of life. Guidelines recommend a supervised exercise program (SEP) as the primary treatment option; however, anecdotally there is a low participation rate for exercise in this group of patients. We undertook a systematic review of the uptake and adherence rates to SEPs for individuals with IC. METHODS The MEDLINE, Embase, and PubMed databases were searched up to January 2015 for terms related to supervised exercise in peripheral arterial disease. The review had 3 aims: first, to establish the rates of uptake to SEPs, second, the rates of adherence to programs, and finally to determine the reasons reported for poor uptake and adherence. Separate inclusion and/or exclusion criteria were applied in selecting reports for each aim of the review. RESULTS Only 23 of the 53 potentially eligible articles for uptake analysis identified on literature searches reported any details of screened patients (n = 7,517) with only 24.2% of patients subsequently recruited to SEPs. Forty-five percent of screen failures had no reason for exclusion reported. Sixty-seven articles with 4,012 patients were included for analysis of SEP adherence. Overall, 75.1% of patients reportedly completed an SEP; however, only one article defined a minimal attendance required for SEP completion. Overall, 54.1% of incomplete adherence was due to patient withdrawal and no reason for incomplete adherence was reported for 16% of cases. CONCLUSIONS Reporting of SEP trials was poor with regard to the numbers of subjects screened and reasons for exclusions. Only approximately 1 in 3 screened IC patients was suitable for and willing to undertake SEP. Levels of adherence to SEPs and definitions of satisfactory adherence were also lacking in most the current literature. Current clinical guidelines based on this evidence base may not be applicable to most IC patients and changes to SEPs may be needed to encourage and/or retain participants.
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Affiliation(s)
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | - Thomas Cayton
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
| | | | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, UK
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152
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Gardner AW, Parker DE, Montgomery PS, Sosnowska D, Casanegra AI, Ungvari Z, Csiszar A, Zhang SX, Wang JJ, Sonntag WE. INFLUENCE OF DIABETES ON AMBULATION AND INFLAMMATION IN MEN AND WOMEN WITH SYMPTOMATIC PERIPHERAL ARTERY DISEASE. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2015; 2:137-143. [PMID: 26835254 PMCID: PMC4730895 DOI: 10.1016/j.jcte.2015.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Diabetes and sex were correlated with ambulation and inflammation in patients with claudication. Men with diabetes have worse ambulation than men without diabetes. Women with diabetes have greater inflammation than women free of diabetes. Men and women with diabetes have evidence for high levels of angiogenic inhibition.
Objective To determine whether diabetes and sex were factors associated with ambulatory function, endothelial cell inflammation, oxidative stress, and apoptosis, and with circulating biomarkers of inflammation and antioxidant capacity in patients with peripheral artery disease (PAD) and claudication. Materials/Methods Ambulatory function of 180 symptomatic men and women with PAD was assessed during a graded maximal treadmill test, 6-minute walk test, and 4-meter walk test. Patients were further characterized on endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells, and on circulating inflammatory and vascular biomarkers. Results Men and women with diabetes had greater prevalence (p = 0.007 and p = 0.015, respectively) of coronary artery disease (CAD) than patients without diabetes. To assure that this difference did not influence planned comparisons, the data set was stratified on CAD. Diabetic men with CAD had a lower peak walking time (PWT) during the treadmill test and a slower 4-meter gait speed compared to non-diabetic men with CAD (p < 0.05). Diabetic women with CAD had a lower PWT compared to their non-diabetic counterparts (p < 0.01). Additionally, diabetic men with CAD had higher pigment epithelium-derived factor (p < 0.05) than their non-diabetic counterparts, and diabetic women with CAD had higher leptin (p < 0.01) and interleukin-8 levels (p < 0.05). Conclusions In patients with PAD, diabetic men and women with CAD had more severe claudication than their non-diabetic counterparts, as measured by shorter PWT, and the men had further ambulatory impairment manifested by slower 4-meter gait speed. Furthermore, the diabetic patients with CAD had elevations in interleukin-8, leptin, and PEDF.
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Affiliation(s)
- Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Donald E Parker
- Department of Biostatistics and Epidemiology, OUHSC, Oklahoma City, OK
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Danuta Sosnowska
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Ana I Casanegra
- Cardiovascular Section, Department of Medicine, OUHSC, Oklahoma City, OK
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Sarah X Zhang
- Departments of Ophthalmology and Biochemistry, University at Buffalo & SUNY Eye Institute, the State University of New York, Buffalo, NY
| | - Josh J Wang
- Departments of Ophthalmology and Biochemistry, University at Buffalo & SUNY Eye Institute, the State University of New York, Buffalo, NY
| | - William E Sonntag
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
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153
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Farah BQ, Ritti-Dias RM, Montgomery PS, Casanegra AI, Silva-Palacios F, Gardner AW. Sedentary behavior is associated with impaired biomarkers in claudicants. J Vasc Surg 2015; 63:657-63. [PMID: 26518099 DOI: 10.1016/j.jvs.2015.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Time spent in sedentary behavior has been associated with worse inflammation and cardiometabolic biomarkers in various populations. However, the association between time spent in sedentary behavior and biomarkers remains unknown in patients with intermittent claudication. The aim of the current study was to analyze the relationship between sedentary behavior and inflammatory and cardiometabolic biomarkers in patients with symptomatic peripheral arterial disease (PAD). METHODS The sample included 297 patients with intermittent claudication. Sedentary behavior was assessed using a step activity monitor. Biomarkers of inflammation, oxidative stress, lipid profile, insulin resistance, and endogenous fibrinolysis were assessed. Demographic data, body mass index, physical activity status, and measures of severity of PAD (ankle-brachial index, peak walking time, and ischemic window) also were obtained. RESULTS Time spent in sedentary behavior was related with high-sensitivity C-reactive protein (b = 0.187; P = .005), glucose (b = 0.238; P < .001), fibrinogen (b = 0.167; P = .017), plasminogen activator inhibitor 1 activity (b = 0.143; P = .036), and high-density lipoprotein cholesterol (b = -0.133; P = .029). After adjustment for sex, age, physical activity status, body mass index, and severity of PAD, sedentary behavior remained related with high-sensitivity C-reactive protein (b = 0.170; P = .015), glucose (b = 0.178; P = .004), fibrinogen (b = 0.189; P = .010), and high-density lipoprotein cholesterol (b = -0.128; P = .032). CONCLUSIONS Time spent in sedentary activities was associated with worse inflammatory and cardiometabolic profile in patients with intermittent claudication.
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Affiliation(s)
- Breno Q Farah
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil
| | - Raphael M Ritti-Dias
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil; Albert Einstein Hospital, São Paulo, Brazil
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla
| | - Ana I Casanegra
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla
| | - Federico Silva-Palacios
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla
| | - Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla.
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154
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Gardner AW, Parker DE, Montgomery PS. Sex-specific predictors of improved walking with step-monitored, home-based exercise in peripheral artery disease. Vasc Med 2015; 20:424-31. [PMID: 26240075 DOI: 10.1177/1358863x15596237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The aim of this study was to determine whether baseline clinical characteristics and the duration and intensity of ambulation during our step-monitored home-based exercise program were predictive of changes in ambulatory outcomes at completion of the program in symptomatic patients with peripheral artery disease (PAD). Twenty-two men (ankle-brachial index (ABI) = 0.71 ± 0.19) and 24 women (ABI = 0.66 ± 0.23) completed the home exercise program, consisting of intermittent walking to mild-to-moderate claudication pain for 3 months. Ambulatory outcome measures were peak walking time (PWT) and claudication onset time (COT) during a treadmill test, and the distance recorded during a 6-minute walk distance test (6MWD). Men experienced significant increases (p<0.01) in COT, PWT, and 6MWD following the home exercise program, and women had significant increases in 6MWD (p<0.01) and PWT (p<0.05). In women, average exercise cadence during the home exercise sessions was the only predictor that entered the model for change in COT (p=0.082), and was the first predictor in the model for change in PWT (p=0.029) and 6MWD (p=0.006). In men, the ABI was the only predictor that entered the model for change in 6MWD (p=0.002), and ABI was a predictor along with metabolic syndrome in the model for change in COT (p=0.003). No variables entered the model for change in PWT. Faster ambulatory cadence during the step-monitored home-based exercise program may predict greater improvements in ambulatory function in women, whereas having less severe PAD and comorbid burden at baseline may predict greater improvements in ambulatory function in men. ClinicalTrials.gov Identifier: NCT00618670.
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Affiliation(s)
- Andrew W Gardner
- Donald W Reynolds Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Donald E Parker
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Polly S Montgomery
- Donald W Reynolds Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
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155
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McDermott MM. Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia. Circ Res 2015; 116:1540-50. [PMID: 25908727 DOI: 10.1161/circresaha.114.303517] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lower extremity peripheral artery disease (PAD) is frequently underdiagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of patients with PAD report no exertional leg symptoms and ≈45% to 50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline are common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle, including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared with people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of patients with PAD, including in those who are asymptomatic or who have exertional leg symptoms other than claudication.
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Affiliation(s)
- Mary McGrae McDermott
- From the Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
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156
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de Müllenheim PY, Chaudru S, Mahé G, Prioux J, Le Faucheur A. Clinical Interest of Ambulatory Assessment of Physical Activity and Walking Capacity in Peripheral Artery Disease. Scand J Med Sci Sports 2015; 26:716-30. [PMID: 26173488 DOI: 10.1111/sms.12512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 12/14/2022]
Abstract
The purpose of the present review was to provide, for the first time, a comprehensive analysis and synthesis of the available studies that highlighted the clinical interest of the ambulatory assessment of either physical activity (PA) or walking capacity in patients with lower extremity peripheral artery disease (PAD). We identified 96 related articles published up to March 2015 through a computer-assisted search of the MEDLINE, EMBASE, and Web of Science databases. Ambulatory-measured PA or related energy expenditure (EE) in PAD patients was performed in 87 of the 96 included studies. The main clinical interests of these measurements were (a) the assessment of PA/EE pattern; (b) the characterization of walking pattern; and (c) the control of training load during home-based walking programs. Ambulatory-measured walking capacity was performed in the remaining studies, using either Global Positioning System receivers or the Peripheral Arterial Disease Holter Control device. Highlighted clinical interests were (a) the assessment of community-based walking capacity; (b) the use of new outcomes to characterize walking capacity, besides the conventional absolute claudication distance; and (c) the association with the patient's self-perception of walking capacity. This review also provides for the clinicians step-by-step recommendations to specifically assess PA or walking capacity in PAD patients.
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Affiliation(s)
- P-Y de Müllenheim
- Movement, Sport and Health Laboratory, University of Rennes 2, Rennes, France
| | - S Chaudru
- INSERM, Centre d'Investigation Clinique, Rennes, France
| | - G Mahé
- INSERM, Centre d'Investigation Clinique, Rennes, France.,CHU Rennes, Imagerie Coeur-Vaisseaux, Rennes, France
| | - J Prioux
- Movement, Sport and Health Laboratory, University of Rennes 2, Rennes, France.,Department of Sport Sciences and Physical Education, ENS Rennes, Bruz, France
| | - A Le Faucheur
- Movement, Sport and Health Laboratory, University of Rennes 2, Rennes, France.,INSERM, Centre d'Investigation Clinique, Rennes, France.,Department of Sport Sciences and Physical Education, ENS Rennes, Bruz, France
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157
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McDermott MM, Guralnik JM, Criqui MH, Ferrucci L, Liu K, Spring B, Tian L, Domanchuk K, Kibbe M, Zhao L, Lloyd Jones D, Liao Y, Gao Y, Rejeski WJ. Unsupervised exercise and mobility loss in peripheral artery disease: a randomized controlled trial. J Am Heart Assoc 2015; 4:JAHA.114.001659. [PMID: 25994445 PMCID: PMC4599403 DOI: 10.1161/jaha.114.001659] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease (PAD). Among people with PAD, we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control. Methods and Results One hundred ninety-four PAD participants were randomized. During months 1 to 6, the intervention group met weekly with other PAD participants and a facilitator. Group support and self-regulatory skills were used to help participants adhere to walking exercise. Ninety-percent of exercise was conducted at or near home. The control group attended weekly lectures. During months 6 to 12, each group received telephone contact only. Primary outcomes have been reported. Here we compare changes in exploratory outcomes of mobility loss (the inability to climb a flight of stairs or walk one-quarter mile without assistance), walking velocity, and the Short Physical Performance Battery. Compared to controls, fewer participants randomized to the intervention experienced mobility loss at 6-month follow-up: 6.3% versus 26.5%, P=0.002, odds ratio=0.19 (95% CI=0.06 to 0.58) and at 12-month follow-up: 5.2% versus 18.5%, P=0.029, odds ratio=0.24 (95% CI=0.06 to 0.97). The intervention improved fast-paced 4-m walking velocity at 6-month follow-up (P=0.005) and the Short Physical Performance Battery at 12-month follow-up (P=0.027), compared to controls. Conclusions In exploratory analyses, a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients. Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00693940.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.) Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.)
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (J.M.G.)
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA (M.H.C.)
| | | | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.)
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.)
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA (L.T.)
| | - Kathryn Domanchuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.)
| | - Melina Kibbe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (M.K.) Jesse Brown Veterans Affairs Medical Center, Chicago, IL (M.K.)
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.)
| | - Donald Lloyd Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.) Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.)
| | - Yihua Liao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.)
| | - Ying Gao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.)
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC (J.R.)
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158
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Tew GA, Humphreys L, Crank H, Hewitt C, Nawaz S, Al-Jundi W, Trender H, Michaels J, Gorely T. The development and pilot randomised controlled trial of a group education programme for promoting walking in people with intermittent claudication. Vasc Med 2015; 20:348-57. [PMID: 25858012 DOI: 10.1177/1358863x15577857] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED The aim of this study was to develop and pilot a group education programme for promoting walking in people with intermittent claudication. Patient focus groups (n=24) and literature reviews were conducted to inform the development of the education programme, which involves a three-hour group-based education workshop and follow-up telephone support. A pilot study was subsequently conducted in which 23 new patients (Rutherford category 1-3) were randomly assigned to usual care (control) or usual care plus the education programme. Outcomes were assessed at baseline and six weeks including daily steps (tri-axial accelerometer), walking capacity (six-minute walk test and Gardner treadmill test), and quality of life (Intermittent Claudication Questionnaire [ICQ]). Exit interviews were conducted to assess the acceptability and usefulness of the programme. Compared with controls, the intervention group had superior walking capacity and quality of life at six weeks. Mean differences in six-minute walk distance, treadmill maximum walking distance and ICQ score were 44.9 m (95% confidence interval [CI], 6.9 to 82.9), 173 m (95% CI, 23 to 322), and -10.6 (95% CI, -18.9 to -2.3), respectively. The daily step count did not differ between groups. The exit interviews indicated that participants valued attending the programme, that it gave them a greater understanding of their condition, and that they had been walking more for exercise since attending. The results suggest that the education programme is feasible, acceptable, and potentially useful for improving walking capacity and quality of life. A fully-powered trial exploring clinical and cost effectiveness is needed. TRIAL REGISTRATION NUMBER ISRCTN06733130 (http://www.controlled-trials.com).
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Affiliation(s)
- Garry A Tew
- York Trials Unit, Department of Health Sciences, University of York, UK
| | - Liam Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - Helen Crank
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, UK
| | - Shah Nawaz
- Sheffield Vascular Institute, Northern General Hospital, UK
| | | | - Hazel Trender
- Sheffield Vascular Institute, Northern General Hospital, UK
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159
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Mauer K, Exaire JE, Stoner JA, Saucedo JF, Montgomery PS, Gardner AW. Effect of exercise training on clot strength in patients with peripheral artery disease and intermittent claudication: An ancillary study. SAGE Open Med 2015; 3:2050312115575938. [PMID: 26770772 PMCID: PMC4679231 DOI: 10.1177/2050312115575938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/11/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives: Patients with peripheral artery disease have walking impairment, greater thrombotic risk, and are often treated with exercise training. We sought to determine the effect of a 3-month-long exercise program on clot strength among patients with peripheral artery disease and intermittent claudication. Methods: Twenty-three symptomatic peripheral artery disease patients were randomly assigned to a walking exercise program or to an attention control group who performed light resistance exercise. We investigated the effect of exercise training on clot strength and time to clot formation was assessed by thromboelastography. Results: After 3 months of exercise, clot strength (maximal amplitude) and time to clot formation (R) did not change significantly from baseline, even after improvements in claudication onset time (p < 0.01) and peak walking time (p < 0.05). Furthermore, changes in clot formation parameters were not significantly different between groups. Among the 10 individuals demonstrating a reduction in clot strength (reduced maximal amplitude), one was a smoker (10%) compared to 9 of 13 non-responders (69%) whose maximal amplitude was unchanged or increased (p = 0.0097). Conclusion: In this ancillary study, a 12-week walking program improved ambulatory function in peripheral artery disease patients with claudication, but does not modify clot strength or time to clot formation. Larger studies are needed to confirm these hypothesis generating findings and to determine whether a different amount or type of exercise may induce a change in clotting in this patient population.
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Affiliation(s)
- Karin Mauer
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - J Emilio Exaire
- Department of Cardiology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Jorge F Saucedo
- Department of Cardiology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA; Veterans Affairs Medical Center, Oklahoma City, OK, USA
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160
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Mays RJ, Hiatt WR, Casserly IP, Rogers RK, Main DS, Kohrt WM, Ho PM, Regensteiner JG. Community-based walking exercise for peripheral artery disease: An exploratory pilot study. Vasc Med 2015; 20:339-47. [PMID: 25755148 DOI: 10.1177/1358863x15572725] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease (PAD), but few exercise programs in community settings have been effective. The aim of this study was to determine the efficacy of a community-based walking exercise program with training, monitoring and coaching (TMC) components to improve exercise performance and patient-reported outcomes in PAD patients. This was a randomized, controlled trial including PAD patients (n=25) who previously received peripheral endovascular therapy or presented with stable claudication. Patients randomized to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks. Patients in the control group did not receive treatment beyond standard advice to walk. The primary outcome in the intent-to-treat (ITT) analyses was peak walking time (PWT) on a graded treadmill. Secondary outcomes included claudication onset time (COT) and patient-reported outcomes assessed via the Walking Impairment Questionnaire (WIQ). Intervention group patients (n=10) did not significantly improve PWT when compared with the control group patients (n=10) (mean ± standard error: +2.1 ± 0.7 versus 0.0 ± 0.7 min, p=0.052). Changes in COT and WIQ scores were greater for intervention patients compared with control patients (COT: +1.6 ± 0.8 versus -0.6 ± 0.7 min, p=0.045; WIQ: +18.3 ± 4.2 versus -4.6 ± 4.2%, p=0.001). This pilot using a walking program with TMC and an ITT analysis did not improve the primary outcome in PAD patients. Other walking performance and patient self-reported outcomes were improved following exercise in community settings. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size.
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Affiliation(s)
- Ryan J Mays
- School of Physical Therapy and Rehabilitation Science, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, MT, USA The International Heart Institute of Montana Foundation, Saint Patrick Hospital, Providence Medical Group, Missoula, MT, USA Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - William R Hiatt
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA CPC Clinical Research, Aurora, CO, USA
| | | | - R Kevin Rogers
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA CPC Clinical Research, Aurora, CO, USA
| | - Deborah S Main
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
| | - Wendy M Kohrt
- Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - P Michael Ho
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Aboyans V, Brodmann M, De Carlo M, Clement D, Mazzolai L, van Bortel L, van Sambeek MRH, Vlachopoulos C. The year in cardiology 2014: peripheral circulation. Eur Heart J 2015; 36:591-7. [DOI: 10.1093/eurheartj/ehu515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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