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Li Y, Li Z, Chang G, Wang M, Wu R, Wang S, Yao C. Effect of structured home-based exercise on walking ability in patients with peripheral arterial disease: a meta-analysis. Ann Vasc Surg 2014; 29:597-606. [PMID: 25449991 DOI: 10.1016/j.avsg.2014.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/07/2014] [Accepted: 10/15/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND The present study is designed to investigate the effect of structured home-based exercise (SHE) programs on maximal walking time (MWT), pain-free walking time (PFWT), and self-reported walking ability in patients with peripheral arterial disease (PAD). METHODS We searched the databases including MEDLINE, EMBASE, ISI Web of Knowledge, and the Cochrane Library from inception to December 2013 for randomized controlled trials (RCTs) that assessed the effect of SHE programs on walking ability in patients with PAD. Meta-analysis was performed based on the searched results, moreover, we made a systemic review regarding the results along with our knowledge. RESULTS Of all the 348 publications we got from the databases, 5 RCTs covering 547 patients reached the inclusion criteria and were involved in the present study. Both inverse-variance fixed-effects and random-effects model were used to perform meta-analysis. SHE programs improved MWT by mean difference of 66.78 sec (95% confidence interval [CI], 5.15-128.41; P = 0.03), heterogeneity across studies was significant. When the trial accounting for significant heterogeneity was omitted, SHE programs improved MWT by mean difference of 91.21 sec (95% CI, 51.96-130.45; P < 0.0001). In contrast, there was no significant heterogeneity across the studies with regard to PFWT and Walking Impairment Questionnaire (WIQ) score. SHE programs improved both PFWT and WIQ scores (mean difference of PFWT, 57.76s; 95% CI, 20.42-95.10; P = 0.002; mean difference of WIQ distance score, 8.67; 95% CI, 3.86-13.49; P = 0.0004; mean difference of WIQ speed score, 8.05, 95% CI, 4.46-11.64; P < 0.0001; mean difference of WIQ stair-climbing score, 6.44; 95% CI, 2.55-10.34; P = 0.001). CONCLUSIONS SHE programs improve walking ability in patients with PAD.
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Affiliation(s)
- Yonghui Li
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zilun Li
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangqi Chang
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mian Wang
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ridong Wu
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Chen Yao
- Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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202
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Parmenter BJ, Dieberg G, Smart NA. Exercise Training for Management of Peripheral Arterial Disease: A Systematic Review and Meta-Analysis. Sports Med 2014; 45:231-44. [DOI: 10.1007/s40279-014-0261-z] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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203
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Gardner AW, Parker DE, Montgomery PS, Blevins SM. Step-monitored home exercise improves ambulation, vascular function, and inflammation in symptomatic patients with peripheral artery disease: a randomized controlled trial. J Am Heart Assoc 2014; 3:e001107. [PMID: 25237048 PMCID: PMC4323792 DOI: 10.1161/jaha.114.001107] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background This prospective, randomized, controlled clinical trial compared changes in primary outcome measures of claudication onset time (COT) and peak walking time (PWT), and secondary outcomes of submaximal exercise performance, daily ambulatory activity, vascular function, inflammation, and calf muscle hemoglobin oxygen saturation (StO2) in patients with symptomatic peripheral artery disease (PAD) following new exercise training using a step watch (NEXT Step) home‐exercise program, a supervised exercise program, and an attention‐control group. Methods and Results One hundred eighty patients were randomized. The NEXT Step program and the supervised exercise program consisted of intermittent walking to mild‐to‐moderate claudication pain for 12 weeks, whereas the controls performed light resistance training. Change scores for COT (P<0.001), PWT (P<0.001), 6‐minute walk distance (P=0.028), daily average cadence (P=0.011), time to minimum calf muscle StO2 during exercise (P=0.025), large‐artery elasticity index (LAEI) (P=0.012), and high‐sensitivity C‐reactive protein (hsCRP) (P=0.041) were significantly different among the 3 groups. Both the NEXT Step home program and the supervised exercise program demonstrated a significant increase from baseline in COT, PWT, 6‐minute walk distance, daily average cadence, and time to minimum calf StO2. Only the NEXT Step home group had improvements from baseline in LAEI, and hsCRP (P<0.05). Conclusions NEXT Step home exercise utilizing minimal staff supervision has low attrition, high adherence, and is efficacious in improving COT and PWT, as well as secondary outcomes of submaximal exercise performance, daily ambulatory activity, vascular function, inflammation, and calf muscle StO2 in symptomatic patients with PAD. Clinical Trial Registration URL: ClinicalTrials.gov. Unique Identifier: NCT00618670.
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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 (A.W.G., P.S.M.) Veterans Affairs Medical Center, Oklahoma City, OK (A.W.G.)
| | - Donald E Parker
- Department of Biostatistics and Epidemiology, OUHSC, Oklahoma City, OK (D.E.P.)
| | - 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 (A.W.G., P.S.M.)
| | - Steve M Blevins
- General Internal Medicine Section, Department of Medicine, OUHSC, Oklahoma City, OK (S.M.B.)
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Jones DW, Siracuse JJ, Graham A, Connolly PH, Sedrakyan A, Schneider DB, Meltzer AJ. Safety and effectiveness of endovascular therapy for claudication in octogenarians. Ann Vasc Surg 2014; 29:34-41. [PMID: 25194550 DOI: 10.1016/j.avsg.2014.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/03/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Advanced age (≥ 80 years) has been associated with adverse outcomes after lower extremity bypass for critical limb ischemia (CLI), but endovascular therapy (ET) is reported to have comparable safety across age groups. Here, we assess the safety and effectiveness of advanced age on outcomes after ET for lifestyle-limiting intermittent claudication (IC). METHODS A retrospective review of a prospectively maintained institutional database (2007-2012) identified all patients undergoing ET for IC. Demographics, procedural details, and outcomes were assessed via univariate analysis and multivariate Cox regression. Effectiveness was assessed across a panel of outcome metrics including the following: overall survival, freedom from major adverse limb event (MALE), and freedom from reintervention, amputation, or restenosis (RAS). Freedom from MALE + perioperative death (MALE + POD) was the primary safety end point. RESULTS Two hundred thirty-six patients underwent primary ET for 284 affected limbs. Of these, 46 interventions (16%) were performed in patients ≥ 80 years old. The average age of octogenarians treated was 84.4 years compared with 67.4 years among those aged <80 (P < 0.001). Compared with younger claudicants, octogenarians were less likely to have hypercholesterolemia (43.5% vs. 63.9%, P = 0.01) and more likely to deny a history of smoking (41.3% vs. 14.7%, P < 0.001). Octogenarians were also more likely to undergo interventions involving the popliteal artery (50% vs. 31.9%, P = 0.03). There were no other significant differences in demographics, comorbidities, TransAtlantic Inter-Society Consensus II classification, or treated arterial segment. Thirty-day freedom from MALE + POD was 100% in octogenarians and 99.6% in patients <80 years, with no difference between age groups. There were no differences in freedom from MALE, freedom from RAS, or overall survival at 1- and 3-year follow-up. CONCLUSIONS Although age >80 years has been identified as an independent risk factor for poor outcomes in the surgical treatment of CLI, our results suggest that ET for selected octogenarians with lifestyle-limiting claudication is as safe and effective as ET in younger patients. Advanced age alone should not prohibit consideration of ET for patients with IC.
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Affiliation(s)
- Douglas W Jones
- Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
| | - Jeffrey J Siracuse
- Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY
| | - Ashley Graham
- Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY
| | - Peter H Connolly
- Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY
| | - Art Sedrakyan
- Department of Public Health, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY
| | - Darren B Schneider
- Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY
| | - Andrew J Meltzer
- Department of Vascular and Endovascular Surgery, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY
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McDermott MM, Guralnik JM, Criqui MH, Liu K, Kibbe MR, Ferrucci L. Six-minute walk is a better outcome measure than treadmill walking tests in therapeutic trials of patients with peripheral artery disease. Circulation 2014; 130:61-8. [PMID: 24982117 DOI: 10.1161/circulationaha.114.007002] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mary M McDermott
- From the Departments of Medicine (M.M.M.), Preventive Medicine (M.M.M., K.L.), and Surgery (M.K.), Northwestern University's Feinberg School of Medicine, Chicago, IL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (J.M.G.); Department of Family and Preventive Medicine University of California at San Diego, San Diego (M.H.C.); and Longitudinal Studies Section, National Institute on Aging, Baltimore, MD (L.F.).
| | - Jack M Guralnik
- From the Departments of Medicine (M.M.M.), Preventive Medicine (M.M.M., K.L.), and Surgery (M.K.), Northwestern University's Feinberg School of Medicine, Chicago, IL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (J.M.G.); Department of Family and Preventive Medicine University of California at San Diego, San Diego (M.H.C.); and Longitudinal Studies Section, National Institute on Aging, Baltimore, MD (L.F.)
| | - Michael H Criqui
- From the Departments of Medicine (M.M.M.), Preventive Medicine (M.M.M., K.L.), and Surgery (M.K.), Northwestern University's Feinberg School of Medicine, Chicago, IL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (J.M.G.); Department of Family and Preventive Medicine University of California at San Diego, San Diego (M.H.C.); and Longitudinal Studies Section, National Institute on Aging, Baltimore, MD (L.F.)
| | - Kiang Liu
- From the Departments of Medicine (M.M.M.), Preventive Medicine (M.M.M., K.L.), and Surgery (M.K.), Northwestern University's Feinberg School of Medicine, Chicago, IL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (J.M.G.); Department of Family and Preventive Medicine University of California at San Diego, San Diego (M.H.C.); and Longitudinal Studies Section, National Institute on Aging, Baltimore, MD (L.F.)
| | - Melina R Kibbe
- From the Departments of Medicine (M.M.M.), Preventive Medicine (M.M.M., K.L.), and Surgery (M.K.), Northwestern University's Feinberg School of Medicine, Chicago, IL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (J.M.G.); Department of Family and Preventive Medicine University of California at San Diego, San Diego (M.H.C.); and Longitudinal Studies Section, National Institute on Aging, Baltimore, MD (L.F.)
| | - Luigi Ferrucci
- From the Departments of Medicine (M.M.M.), Preventive Medicine (M.M.M., K.L.), and Surgery (M.K.), Northwestern University's Feinberg School of Medicine, Chicago, IL; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (J.M.G.); Department of Family and Preventive Medicine University of California at San Diego, San Diego (M.H.C.); and Longitudinal Studies Section, National Institute on Aging, Baltimore, MD (L.F.)
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206
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Morris DR, Rodriguez AJ, Moxon JV, Cunningham MA, McDermott MM, Myers J, Leeper NJ, Jones RE, Golledge J. Association of lower extremity performance with cardiovascular and all-cause mortality in patients with peripheral artery disease: a systematic review and meta-analysis. J Am Heart Assoc 2014; 3:jah3642. [PMID: 25122666 PMCID: PMC4310407 DOI: 10.1161/jaha.114.001105] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Peripheral artery disease (PAD) is associated with impaired mobility and a high rate of mortality. The aim of this systematic review was to investigate whether reduced lower extremity performance was associated with an increased incidence of cardiovascular and all‐cause mortality in people with PAD. Methods and Results A systematic search of the MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library databases was conducted. Studies assessing the association between measures of lower extremity performance and cardiovascular or all‐cause mortality in PAD patients were included. A meta‐analysis was conducted combining data from commonly assessed performance tests. The 10 identified studies assessed lower extremity performance by strength tests, treadmill walking performance, 6‐minute walk, walking velocity, and walking impairment questionnaire (WIQ). A meta‐analysis revealed that shorter maximum walking distance was associated with increased 5‐year cardiovascular (unadjusted RR=2.54, 95% CI 1.86 to 3.47, P<10−5, n=1577, fixed effects) and all‐cause mortality (unadjusted RR=2.23 95% CI 1.85 to 2.69, P<10−5, n=1710, fixed effects). Slower 4‐metre walking velocity, a lower WIQ stair‐climbing score, and poor hip extension, knee flexion, and plantar flexion strength were also associated with increased mortality. No significant associations were found for hip flexion strength, WIQ distance score, or WIQ speed score with mortality. Conclusions A number of lower extremity performance measures are prognostic markers for mortality in PAD and may be useful clinical tools for identifying patients at higher risk of death. Further studies are needed to determine whether interventions that improve measures of lower extremity performance reduce mortality.
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Affiliation(s)
- Dylan R Morris
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.)
| | - Alexander J Rodriguez
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.)
| | - Joseph V Moxon
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.)
| | | | - Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (M.M.M.D.)
| | - Jonathan Myers
- Division of Cardiovascular Medicine, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Stanford University, Stanford, CA (J.M.)
| | - Nicholas J Leeper
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA (N.J.L.)
| | - Rhondda E Jones
- Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, Australia (R.E.J.)
| | - Jonathan Golledge
- The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia (D.R.M., A.J.R., J.V.M., J.G.) Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia (J.G.)
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207
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Jakubsevičienė E, Vasiliauskas D, Velička L, Kubilius R, Milinavičienė E, Venclovienė J. Effectiveness of a new exercise program after lower limb arterial blood flow surgery in patients with peripheral arterial disease: a randomized clinical trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7961-76. [PMID: 25105547 PMCID: PMC4143843 DOI: 10.3390/ijerph110807961] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of a supervised exercise program (SEP) plus at home nonsupervised exercise therapy (non-SET) on functional status, quality of life (QoL) and hemodynamic response in post-lower-limb bypass surgery patients. RESULTS One hundred and seventeen patients were randomized to an intervention (n = 57) or a control group (n = 60). A new individual SEP was designed for patients with peripheral arterial disease (PAD) and applied to the studied subjects of the intervention group who also continued non-SET at home, whereas those assigned to the control group received just usual SEP according to a common cardiovascular program. The participants of the study were assessed by a 6-min walking test (6 MWT), an ankle-brachial index (ABI), and the Medical Outcomes Study Short Form-36 (SF-36) of QoL at baseline, at 1 and 6 months after surgery. A significant improvement was observed in the walked distance in the intervention group after 6 months compared with the control group (p < 0.001). The intervention group had significantly higher QoL score in the physical and mental component of SF-36 (p < 0.05). CONCLUSIONS A 6-month application of the new SEP and non-SET at home has yielded significantly better results in walking distance and QoL in the intervention group than in the controls.
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Affiliation(s)
- Edita Jakubsevičienė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių St. 17, Kaunas 50161, Lithuania.
| | - Donatas Vasiliauskas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių St. 17, Kaunas 50161, Lithuania.
| | - Linas Velička
- Department of Cardiothoracic and Vascular Surgery, Lithuanian University of Health Sciences, Eivenių St. 2, Kaunas 50009, Lithuania.
| | - Raimondas Kubilius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eivenių St. 2, Kaunas 50009, Lithuania.
| | - Eglė Milinavičienė
- Viršužiglis Hospital of Rehabilitation, Hospital of Lithuanian University of Health Sciences, Viršužiglis 53193, Lithuania.
| | - Jonė Venclovienė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukilėlių St. 17, Kaunas 50161, Lithuania.
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208
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Affiliation(s)
- Ryan J Mays
- From the School of Physical Therapy and Rehabilitation Science, College of Health Professions and Biomedical Sciences, University of Montana (R.J.M.), International Heart Institute of Montana Foundation, Saint Patrick Hospital, Providence Medical Group (R.J.M.), Missoula, MT; and Division of General Internal Medicine (R.J.M., J.G.R.), Center for Women's Health Research (R.J.M., J.G.R.), and Division of Cardiology (J.G.R.), Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
| | - Judith G Regensteiner
- From the School of Physical Therapy and Rehabilitation Science, College of Health Professions and Biomedical Sciences, University of Montana (R.J.M.), International Heart Institute of Montana Foundation, Saint Patrick Hospital, Providence Medical Group (R.J.M.), Missoula, MT; and Division of General Internal Medicine (R.J.M., J.G.R.), Center for Women's Health Research (R.J.M., J.G.R.), and Division of Cardiology (J.G.R.), Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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209
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Abstract
BACKGROUND Exercise programmes are a relatively inexpensive, low-risk option compared with other more invasive therapies for leg pain on walking (intermittent claudication (IC)). This is an update of a review first published in 1998. OBJECTIVES The prime objective of this review was to determine whether an exercise programme in people with intermittent claudication was effective in alleviating symptoms and increasing walking treadmill distances and walking times. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events and improving quality of life. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched September 2013) and CENTRAL (2013, Issue 8). SELECTION CRITERIA Randomised controlled trials of an exercise regimen versus control or versus medical therapy in people with IC due to peripheral arterial disease. Any exercise programme or regimen used in the treatment of intermittent claudication was included, such as walking, skipping and running. Inclusion of trials was not affected by the duration, frequency or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximal walking distance), ankle brachial index (ABI), quality of life, morbidity or amputation; if none of these were reported the trial was not included in this review. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality. MAIN RESULTS Eleven additional studies were included in this update making a total of 30 trials which met the inclusion criteria, involving a total of 1816 participants with stable leg pain. The follow-up period ranged from two weeks to two years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises; generally supervised sessions were at least twice a week. Most trials used a treadmill walking test for one of the outcome measures. Quality of the included trials was moderate, mainly due to an absence of relevant information. The majority of trials were small with 20 to 49 participants. Twenty trials compared exercise with usual care or placebo, the remainder of the trials compared exercise to medication (pentoxifylline, iloprost, antiplatelet agents and vitamin E) or pneumatic calf compression; people with various medical conditions or other pre-existing limitations to their exercise capacity were generally excluded.Overall, when taking the first time point reported in each of the studies, exercise significantly improved maximal walking time when compared with usual care or placebo: mean difference (MD) 4.51 minutes (95% confidence interval (CI) 3.11 to 5.92) with an overall improvement in walking ability of approximately 50% to 200%. Walking distances were also significantly improved: pain-free walking distance MD 82.29 metres (95% CI 71.86 to 92.72) and maximum walking distance MD 108.99 metres (95% CI 38.20 to 179.78). Improvements were seen for up to two years, and subgroup analyses were performed at three, six and 12 months where possible. Exercise did not improve the ABI (MD 0.05, 95% CI 0.00 to 0.09). The effect of exercise, when compared with placebo or usual care, was inconclusive on mortality, amputation and peak exercise calf blood flow due to limited data. No data were given on non-fatal cardiovascular events.Quality of life measured using the Short Form (SF)-36 was reported at three and six months. At three months, physical function, vitality and role physical all significantly improved with exercise, however this was a limited finding as this measure was only reported in two trials. At six months five trials reported outcomes of a significantly improved physical summary score and mental summary score secondary to exercise. Only two trials reported improvements in other domains, physical function and general health.Evidence was generally limited for exercise compared with antiplatelet therapy, pentoxifylline, iloprost, vitamin E and pneumatic foot and calf compression due to small numbers of trials and participants. AUTHORS' CONCLUSIONS Exercise programmes are of significant benefit compared with placebo or usual care in improving walking time and distance in people with leg pain from IC who were considered to be fit for exercise intervention.
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Affiliation(s)
- Risha Lane
- Vascular Unit, Hull Royal Infirmary, Anlaby Road, Hull, UK, HU3 2JZ
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Hiatt WR, Rogers RK, Brass EP. The Treadmill Is a Better Functional Test Than the 6-Minute Walk Test in Therapeutic Trials of Patients With Peripheral Artery Disease. Circulation 2014; 130:69-78. [PMID: 24982118 DOI: 10.1161/circulationaha.113.007003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William R Hiatt
- From the University of Colorado School of Medicine, Department of Medicine, Division of Cardiology and CPC Clinical Research, Aurora (W.R.H., R.K.R.); and Harbor-UCLA Centers for Clinical Pharmacology, Torrance, CA (E.P.B.).
| | - R Kevin Rogers
- From the University of Colorado School of Medicine, Department of Medicine, Division of Cardiology and CPC Clinical Research, Aurora (W.R.H., R.K.R.); and Harbor-UCLA Centers for Clinical Pharmacology, Torrance, CA (E.P.B.)
| | - Eric P Brass
- From the University of Colorado School of Medicine, Department of Medicine, Division of Cardiology and CPC Clinical Research, Aurora (W.R.H., R.K.R.); and Harbor-UCLA Centers for Clinical Pharmacology, Torrance, CA (E.P.B.)
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Ichihashi S, Kichikawa K. Role of the latest endovascular technology in the treatment of intermittent claudication. Ther Clin Risk Manag 2014; 10:467-74. [PMID: 25018633 PMCID: PMC4074187 DOI: 10.2147/tcrm.s40161] [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] [Indexed: 11/23/2022] Open
Abstract
Intermittent claudication is a serious symptom in patients with peripheral arterial disease, and severely limits activities of daily living. Conservative treatment (optimal medical therapy and exercise rehabilitation programs) and revascularization procedures (endovascular treatment [EVT] or open bypass surgery) can relieve intermittent claudication. Among these treatment options, EVT has developed dramatically during the past decade, and has enabled physicians to offer less invasive treatment options with increasing durability. EVT for aortoiliac lesions has matured, and its long-term patency now approaches that of open bypass surgery. The latest EVT technologies include drug-eluting stents, stent grafts, drug-coated balloons, and bioresorbable stents. The recently reported patency of stent grafts in the femoropopliteal lesions was comparable with that of the prosthetic bypass graft. In the course of the paradigm shift from bypass surgery to EVT, evidence of any long-term benefit of EVT compared with supervised exercise is still inconclusive. EVT could improve walking performance in the short-term, while supervised exercise could improve walking performance more efficiently in the long-term. Combined treatment with EVT and exercise may offer the most sustainable and effective symptom relief. This paper reviews the relevant literature on the treatment of intermittent claudication, focusing on the latest EVT technologies, and outlines a strategy for achieving long-term benefits.
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Affiliation(s)
- Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology, Nara Medical University, Kashihara, Nara, Japan
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McDermott MM, Guralnik JM, Criqui MH, Ferrucci L, Zhao L, Liu K, Domanchuk K, Spring B, Tian L, Kibbe M, Liao Y, Lloyd Jones D, Rejeski WJ. Home-based walking exercise in peripheral artery disease: 12-month follow-up of the GOALS randomized trial. J Am Heart Assoc 2014; 3:e000711. [PMID: 24850615 PMCID: PMC4309051 DOI: 10.1161/jaha.113.000711] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [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 We studied whether a 6‐month group‐mediated cognitive behavioral (GMCB) intervention for peripheral artery disease (PAD) participants, which promoted home‐based walking exercise, improved 6‐minute walk and other outcomes at 12‐month follow‐up, 6 months after completing the intervention, compared to a control group. Methods and Results We randomized PAD participants to a GMCB intervention or a control group. During phase I (months 1 to 6), the intervention used group support and self‐regulatory skills during weekly on‐site meetings to help participants adhere to home‐based exercise. The control group received weekly on‐site lectures on topics unrelated to exercise. Primary outcomes were measured at the end of phase I. During phase II (months 7 to 12), each group received telephone contact. Compared to controls, participants randomized to the intervention increased their 6‐minute walk distance from baseline to 12‐month follow‐up, (from 355.4 to 381.9 m in the intervention versus 353.1 to 345.6 m in the control group; mean difference=+34.1 m; 95% confidence interval [CI]=+14.6, +53.5; P<0.001) and their Walking Impairment Questionnaire (WIQ) speed score (from 36.1 to 46.5 in the intervention group versus 34.9 to 36.5 in the control group; mean difference =+8.8; 95% CI=+1.6, +16.1; P=0.018). Change in the WIQ distance score was not different between the 2 groups at 12‐month follow‐up (P=0.139). Conclusions A weekly on‐site GMCB intervention that promoted home‐based walking exercise intervention for people with PAD demonstrated continued benefit at 12‐month follow‐up, 6 months after the GMCB intervention was completed. Clinical Trial Registration URL: 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., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - 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.)
| | | | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Kathryn Domanchuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.)
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA (L.T.)
| | - 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.)
| | - Yihua Liao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - 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., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC (J.R.)
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213
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Scientific surgery. Br J Surg 2014. [DOI: 10.1002/bjs.9554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Although simple characterization of discomfort as cramps, heaviness, shooting pains, and so forth can be misleading, history and examination are key to accurate diagnosis. Absence of both dorsalis pedis and posterior tibial pulses strongly suggests peripheral arterial disease (PAD), and the presence of either pulse makes PAD less likely. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a common cause of lower extremity myalgias. Restless legs syndrome causes nocturnal discomfort but must be distinguished from confounding“mimics." Neurologic causes of leg symptoms include lumbar spinal stenosis, radiculopathy, distal symmetric polyneuropathy, and entrapment neuropathy. Many common causes of leg discomfort can be managed conservatively.
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Affiliation(s)
- Douglas Berger
- General Medicine Service, Department of Medicine, VA Puget Sound, University of Washington, 1660 South Columbian Way, Seattle, WA 98108, USA.
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215
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Perales F, del Pozo-Cruz J, del Pozo-Cruz J, del Pozo-Cruz B. On the associations between physical activity and quality of life: findings from an Australian nationally representative panel survey. Qual Life Res 2014; 23:1921-33. [PMID: 24519670 DOI: 10.1007/s11136-014-0645-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study is to provide a comprehensive analysis of the associations between the frequency of moderate or vigorous physical activity (MVPA) and quality of life (QoL) measures using longitudinal data and panel regression models on a large, representative sample of the Australian population. METHODS This study used yearly panel data on over 23,000 individuals collected by the Household, Income and Labour Dynamics in Australia Survey between 2001 and 2011. Ordinary least squares and fixed effects regression models were used to examine the associations between the weekly frequency of MVPA and several indicators of QoL, including both measures of health-related QoL (such as those derivable from the SF-36) and global subjective well-being assessments (such as self-reported life satisfaction), controlling for observable and unobservable factors. RESULTS Our results provided consistent evidence that the frequency of MVPA is related to QoL and proved to be robust. A higher frequency of MVPA was related to higher scores in each of the outcomes analysed and using either of two different estimation strategies. The most pronounced associations emerged between the frequency of MVPA and the physical and vitality dimensions of the SF-36. A change from undertaking no MVPA at all to undertaking such activity once a week was remarkably associated with higher QoL. The influence of MVPA on global life satisfaction was only partially channelled through physical and mental health. CONCLUSION We provide strong evidence that MVPA is related to QoL, thus adding to the large body of scientific literature demonstrating the benefits of becoming physically active.
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Affiliation(s)
- Francisco Perales
- Institute for Social Science Research, School of Social Science, The University of Queensland, Brisbane, Australia
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216
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Rejeski WJ, Spring B, Domanchuk K, Tao H, Tian L, Zhao L, McDermott MM. A group-mediated, home-based physical activity intervention for patients with peripheral artery disease: effects on social and psychological function. J Transl Med 2014; 12:29. [PMID: 24467875 PMCID: PMC3910685 DOI: 10.1186/1479-5876-12-29] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/24/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND PAD is a disabling, chronic condition of the lower extremities that affects approximately 8 million people in the United States. The purpose of this study was to determine whether an innovative home-based walking exercise program for patients with peripheral artery disease (PAD) improves self-efficacy for walking, desire for physical competence, satisfaction for physical functioning, social functioning, and acceptance of PAD related pain and discomfort. METHODS The design was a 6-month randomized controlled clinical trial of 194 patients with PAD. Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition. RESULTS Of the 194 participants randomized, 178 completed the baseline and 6-month follow-up visit. The mean age was 70.66 (±9.44) and was equally represented by men and women. Close to half of the cohort was African American. Following 6-months of treatment, the intervention group experienced greater improvement on self-efficacy (p = .0008), satisfaction with functioning (p = .0003), pain acceptance (p = .0002), and social functioning (p = .0008) than the control group; the effects were consistent across a number of potential moderating variables. Change in these outcomes was essentially independent of change in 6-minute walk performance. TRIAL REGISTRATION [ClinicalTrials.gov Identifier: NCT00693940].
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Affiliation(s)
- W Jack Rejeski
- Departments of Health and Exercise Science and Geriatric Medicine, Wake Forest University, Box 7867, Winston-Salem, NC 27109, USA
| | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn Domanchuk
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Huimin Tao
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Palo, Alto, CA, USA
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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217
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Tew GA, Nawaz S, Humphreys L, Ouedraogo N, Abraham P. Validation of the English version of the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire in patients with intermittent claudication. Vasc Med 2014; 19:27-32. [DOI: 10.1177/1358863x14520870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Walking Estimated-Limitation Calculated by History (WELCH) questionnaire has recently been proposed as a valid and simple instrument for assessing walking limitation in patients with intermittent claudication. The aim of this study was to validate an English version of the WELCH questionnaire in an English native population. Thirty-nine patients (ankle–brachial index 0.59 ± 0.16, age 65 ± 11 years, 82% male) completed an English version of the WELCH questionnaire. Maximum walking distance was measured objectively using the Gardner–Skinner treadmill test and the 6-minute walk test. The median WELCH score was 24 (9–39). Maximum walking distances were 412 m (149–675 m) for the treadmill test and 381 ± 88 m for the 6-minute walking test. The Spearman’s correlation coefficient was ρ = 0.59 between the WELCH score and treadmill distance ( p < 0.001) and ρ = 0.82 between the WELCH score and 6-minute walk distance ( p < 0.001). These findings suggest that the English version of the WELCH questionnaire is a valid instrument for assessing walking impairment in patients with intermittent claudication.
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Affiliation(s)
- Garry A Tew
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Shah Nawaz
- Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK
| | - Liam Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Nafi Ouedraogo
- Laboratory for Vascular Investigations, University Hospital of Angers, Angers, France
| | - Pierre Abraham
- Laboratory for Vascular Investigations, University Hospital of Angers, Angers, France
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218
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Poole J, Mavromatis K, Binongo JN, Khan A, Li Q, Khayata M, Rocco E, Topel M, Zhang X, Brown C, Corriere MA, Murrow J, Sher S, Clement S, Ashraf K, Rashed A, Kabbany T, Neuman R, Morris A, Ali A, Hayek S, Oshinski J, Yoon YS, Waller EK, Quyyumi AA. Effect of progenitor cell mobilization with granulocyte-macrophage colony-stimulating factor in patients with peripheral artery disease: a randomized clinical trial. JAMA 2013; 310:2631-9. [PMID: 24247554 PMCID: PMC9136711 DOI: 10.1001/jama.2013.282540] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Many patients with peripheral artery disease (PAD) have walking impairment despite therapy. Experimental studies in animals demonstrate improved perfusion in ischemic hind limb after mobilization of bone marrow progenitor cells (PCs), but whether this is effective in patients with PAD is unknown. OBJECTIVE To investigate whether therapy with granulocyte-macrophage colony-stimulating factor (GM-CSF) improves exercise capacity in patients with intermittent claudication. DESIGN, SETTING, AND PARTICIPANTS In a phase 2 double-blind, placebo-controlled study, 159 patients (median [SD] age, 64 [8] years; 87% male, 37% with diabetes) with intermittent claudication were enrolled at medical centers affiliated with Emory University in Atlanta, Georgia, between January 2010 and July 2012. INTERVENTIONS Participants were randomized (1:1) to received 4 weeks of subcutaneous injections of GM-CSF (leukine), 500 μg/day 3 times a week, or placebo. Both groups were encouraged to walk to claudication daily. MAIN OUTCOMES AND MEASURES The primary outcome was peak treadmill walking time (PWT) at 3 months. Secondary outcomes were PWT at 6 months and changes in circulating PC levels, ankle brachial index (ABI), and walking impairment questionnaire (WIQ) and 36-item Short-Form Health Survey (SF-36) scores. RESULTS Of the 159 patients randomized, 80 were assigned to the GM-CSF group. The mean (SD) PWT at 3 months increased in the GM-CSF group from 296 (151) seconds to 405 (248) seconds (mean change, 109 seconds [95% CI, 67 to 151]) and in the placebo group from 308 (161) seconds to 376 (182) seconds (change of 56 seconds [95% CI, 14 to 98]), but this difference was not significant (mean difference in change in PWT, 53 seconds [95% CI, -6 to 112], P = .08). At 3 months, compared with placebo, GM-CSF improved the physical functioning subscore of the SF-36 questionnaire by 11.4 (95% CI, 6.7 to 16.1) vs 4.8 (95% CI, -0.1 to 9.6), with a mean difference in change for GM-CSF vs placebo of 7.5 (95% CI, 1.0 to 14.0; P = .03). Similarly, the distance score of the WIQ improved by 12.5 (95% CI, 6.4 to 18.7) vs 4.8 (95% CI, -0.2 to 9.8) with GM-CSF compared with placebo (mean difference in change, 7.9 [95% CI, 0.2 to 15.7], P = .047). There were no significant differences in the ABI, WIQ distance and speed scores, claudication onset time, or mental or physical component scores of the SF-36 between the groups. CONCLUSIONS AND RELEVANCE Therapy with GM-CSF 3 times a week did not improve treadmill walking performance at the 3-month follow-up. The improvements in some secondary outcomes with GM-CSF suggest that it may warrant further study in patients with claudication. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01041417.
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Affiliation(s)
- Joseph Poole
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kreton Mavromatis
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - José N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ali Khan
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Qunna Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohamed Khayata
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth Rocco
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew Topel
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Xin Zhang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Charlene Brown
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Matthew A Corriere
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia6Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | - Salman Sher
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stephanie Clement
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Khuram Ashraf
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Amr Rashed
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Tarek Kabbany
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Neuman
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Alanna Morris
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Arshad Ali
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Salim Hayek
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - John Oshinski
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Young-sup Yoon
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Edmund K Waller
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia7Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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219
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Brunner G, Yang EY, Kumar A, Sun W, Virani SS, Negi SI, Murray T, Lin PH, Hoogeveen RC, Chen C, Dong JF, Kougias P, Taylor A, Lumsden AB, Nambi V, Ballantyne CM, Morrisett JD. The Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial (ELIMIT). Atherosclerosis 2013; 231:371-7. [PMID: 24267254 PMCID: PMC4545656 DOI: 10.1016/j.atherosclerosis.2013.09.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/23/2013] [Accepted: 09/28/2013] [Indexed: 11/28/2022]
Abstract
METHODS A total of 102 patients were randomized to either mono-therapy with simvastatin (40 mg daily) or triple-therapy with simvastatin (40 mg daily), extended-release niacin (1500 mg daily), and ezetimibe (10 mg daily). MRI was performed at baseline and 6, 12, and 24 months. SFA wall, lumen, and total vessel volumes were quantified. MRI-derived SFA parameters and lipids were analyzed with multilevel models and nonparametric tests, respectively. RESULTS Baseline characteristics did not differ between mono and triple-therapy groups, except for ethnicity (p = 0.02). SFA wall, lumen, and total vessel volumes increased non-significantly for both groups between baseline and 24-months. Non-high-density lipoprotein cholesterol was significantly reduced at 12 months with triple-therapy compared with mono-therapy (p = 0.01). CONCLUSION No significant differences were observed between mono-therapy using simvastatin and triple-therapy with simvastatin, extended-release niacin, and ezetimibe for 24-month changes in SFA wall, lumen, and total vessel volumes. CLINICAL TRIAL REGISTRATION INFORMATION NCT00687076; Link: http://clinicaltrials.gov/ct2/show/NCT00687076.
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Affiliation(s)
- Gerd Brunner
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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220
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Prévost A, Lafitte M, Pucheu Y, Couffinhal T. Education and home based training for intermittent claudication: functional effects and quality of life. Eur J Prev Cardiol 2013; 22:373-9. [DOI: 10.1177/2047487313512217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alain Prévost
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, Hôpital Cardiologique, Bordeaux, France
| | - Marianne Lafitte
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, Hôpital Cardiologique, Bordeaux, France
| | - Yann Pucheu
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, Hôpital Cardiologique, Bordeaux, France
| | - Thierry Couffinhal
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, Hôpital Cardiologique, Bordeaux, France
- Univ. Bordeaux, Adaptation cardiovasculaire à l'ischémie, Pessac, France
- INSERM, Adaptation cardiovasculaire à l'ischémie, Pessac, France
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221
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Community walking programs for treatment of peripheral artery disease. J Vasc Surg 2013; 58:1678-87. [PMID: 24103409 DOI: 10.1016/j.jvs.2013.08.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/14/2013] [Accepted: 08/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), although effective, are often not used due to barriers, including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option because they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methods and outcomes of community walking programs for PAD. METHODS A literature review using appropriate search terms was conducted within PubMed/MEDLINE and the Cochrane databases to identify studies in the English language that used community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. RESULTS Ten randomized controlled trials examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes, with no differences in peak walking time compared with supervised walking exercise groups. CONCLUSIONS Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs.
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222
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Domanchuk K, Ferrucci L, Guralnik JM, Criqui MH, Tian L, Liu K, Losordo D, Stein J, Green D, Kibbe M, Zhao L, Annex B, Perlman H, Lloyd-Jones D, Pearce W, Taylor D, McDermott MM. Progenitor cell release plus exercise to improve functional performance in peripheral artery disease: the PROPEL Study. Contemp Clin Trials 2013; 36:502-9. [PMID: 24080099 DOI: 10.1016/j.cct.2013.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/19/2013] [Accepted: 09/24/2013] [Indexed: 01/22/2023]
Abstract
Functional impairment, functional decline, and mobility loss are major public health problems in people with lower extremity peripheral artery disease (PAD). Few medical therapies significantly improve walking performance in PAD. We describe methods for the PROgenitor cell release Plus Exercise to improve functionaL performance in PAD (PROPEL) Study, a randomized controlled clinical trial designed to determine whether granulocyte-macrophage colony stimulating factor (GM-CSF) combined with supervised treadmill walking exercise improves six-minute walk distance more than GM-CSF alone, more than supervised treadmill exercise alone, and more than placebo plus attention control in participants with PAD, respectively. PROPEL Study participants are randomized to one of four arms in a 2 by 2 factorial design. The four study arms are GM-CSF plus supervised treadmill exercise, GM-CSF plus attention control, placebo plus supervised exercise therapy, or placebo plus attention control. The primary outcome is change in six-minute walk distance at 12-week follow-up. Secondary outcomes include change in brachial artery flow-mediated dilation (FMD), change in maximal treadmill walking time, and change in circulating CD34+ cells at 12-week follow-up. Outcomes are also measured at six-week and six-month follow-up. Results of the PROPEL Study will have important implications for understanding mechanisms of improving walking performance and preventing mobility loss in the large and growing number of men and women with PAD.
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Affiliation(s)
- Kathryn Domanchuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
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