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Stosic MB, Kaljevic J, Nikolic B, Tanaskovic M, Kolarov A. Smart Anklet Use to Measure Vascular Health Benefits of Preventive Intervention in a Nature-Based Environment-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:605. [PMID: 38791819 PMCID: PMC11121026 DOI: 10.3390/ijerph21050605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
The present study aimed to investigate the associations between nature-based intervention and peripheral pulse characteristics of patients with PAOD using new smart technology specifically designed for this purpose. A longitudinal panel study performed between 1 January 2022 and 31 December 2022 included 32 patients diagnosed with peripheral arterial occlusive disease (PAOD) who were treated in the vascular surgeons' hospital "Dobb" in Valjevo. These patients were exposed for six months to moderate-intensity physical activity (MPA) in a nature-based environment. They practiced 150 to 300 min of walking 6 km/h and cycling activities (16-20 km/h) weekly as recommended for patients with chronic conditions and those living with disability. Univariate logistic regression analysis was used to identify factors associated with major improvements in peripheral pulse characteristics of patients with PAOD. After six months of MPA, half of the patients (50%, 16/32) achieved minor, and half of them major improvements in peripheral pulse characteristics. The major improvements were associated with current smoking (OR = 9.53; 95%CI = 1.85-49.20), diabetes (OR = 4.84; 95%CI = 1.09-21.58) and cardiac failure, and concurrent pulmonary disease and diabetes (OR = 2.03; 95%CI = 1.01-4.11). Our pilot study showed that patients with PAOD along with other chronic conditions and risk factors benefited more from continuous physical activity in a nature-based environment.
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Affiliation(s)
- Maja B. Stosic
- Faculty for Health and Business Studies, Singidunum University, 14000 Valjevo, Serbia; (J.K.); (B.N.)
- Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”, Department for HIV, Hepatitis, STIs and Tuberculosis, 11000 Belgrade, Serbia
| | - Jelena Kaljevic
- Faculty for Health and Business Studies, Singidunum University, 14000 Valjevo, Serbia; (J.K.); (B.N.)
| | - Bojan Nikolic
- Faculty for Health and Business Studies, Singidunum University, 14000 Valjevo, Serbia; (J.K.); (B.N.)
| | - Marko Tanaskovic
- Faculty for Technical Science, Singidunum University, 11000 Belgrade, Serbia;
| | - Aleksandar Kolarov
- New Jersey Institute of Technology, Electrical and Computer Engineering Center, Ewing, NJ 07102, USA;
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Manfredini F, Traina L, Ficarra V, Gandolfi G, Argentoni A, Straudi S, Gasbarro V, Lamberti N. A "test in-train out" program versus a "go home and walk" intervention for home-based exercise therapy in patients with peripheral artery disease: A randomized controlled trial. Scand J Med Sci Sports 2024; 34:e14584. [PMID: 38349067 DOI: 10.1111/sms.14584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE In this single-blinded randomized controlled trial, we compared the "Test in-Train Out" structured home-based exercise program (TiTo-SHB) with the traditional "go home and walk" exercise intervention in people with peripheral artery disease (PAD). METHODS Peripheral artery disease patients at Leriche-Fontaine's stage II were randomized to receive TiTo-SHB or walking advice (C-WA). The TiTo-SHB group performed two daily 8-min sessions of pain-free interval walking at progressive low-to-moderate speed maintained with a metronome. The C-WA group was recommended to walk for 30 min at least three times per week and to endure claudication pain. Outcomes collected at baseline and at the end of the program (6 months) included: 6-min and pain-free walking distance (6MWD, PFWD), ankle-brachial index (ABI), 5-time sit-to-stand test (5STS), and health-related quality of life (HRQoL) by the VascuQoL-6 questionnaire. RESULTS A total of 68 patients were randomized (males n = 50; aged 73 ± 9; TiTo-SHB n = 34). At the end of the program, patients in the TiTo-SHB group compared with the C-WA group had significantly improved 6MWD (Δ + 60 ± 32 m vs. Δ - 5 ± 37 m; p < 0.001) and PFWD (Δ + 140 ± 92 m vs. Δ - 7 ± 87 m; p < 0.001). A significant between-group difference in favor of the TiTo-SHB group was also recorded for all the secondary outcomes, including 5STS (Δ - 2.6 ± 1.8 s vs. Δ + 0.8 ± 2.6 s; p < 0.001), ABI of the more impaired limb (Δ + 0.10 ± 0.11 vs. Δ + 0.02 ± 0.08; p = 0.003), and VascuQoL-6 score (Δ +2 ± 2 vs. -1 ± 4; p < 0.001). CONCLUSION In PAD patients with claudication, the pain-free in-home TiTo-SHB program was more effective in improving exercise capacity and HRQoL than the traditional walking advice recommendation.
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Program of Vascular Rehabilitation and Exercise Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Valentina Ficarra
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Giorgio Gandolfi
- School of Sports and Exercise Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Argentoni
- School of Sports and Exercise Medicine, University of Ferrara, Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Program of Vascular Rehabilitation and Exercise Medicine, University Hospital of Ferrara, Ferrara, Italy
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Crepaldi A, Caruso L, Piva G, Traina L, Gasbarro V, Manfredini R, Lamberti N, Rinaldo N, Manfredini F, Lopez-Soto PJ. Foot Temperature by Infrared Thermography in Patients with Peripheral Artery Disease before and after Structured Home-Based Exercise: A Gender-Based Observational Study. J Pers Med 2023; 13:1312. [PMID: 37763080 PMCID: PMC10532675 DOI: 10.3390/jpm13091312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Decreased arterial perfusion is a typical condition of patients with peripheral artery disease (PAD), with the microvascular picture particularly present among women. This observational study aimed to detect foot perfusion changes by infrared thermography (IRT) after a home-based exercise program in both sexes. A total of 76 PAD patients with claudication (72 ± 4 years; 52 males) were enrolled in a structured in-home exercise program composed of two daily 8 min interval walking sessions (1:1 walk:rest ratio) with progressively increasing speed. Outcome measures collected at baseline (T0) and at each hospital visit after 5 weeks, 12 weeks and 20 weeks included foot temperature measured by IRT (anterior tibial, posterior tibial, dorsalis pedis and arcuate artery regions), ankle brachial index and the 6 min walking test. After 20 weeks, foot temperature in both limbs showed a significant increasing trend, with a mean variation of 1.3 °C for the more impaired limb and 0.9 °C for the contralateral limb (t = 8.88, p < 0.001 and t = 5.36; p < 0.001, respectively), with significant changes occurring after 5 weeks of training. The sex-oriented analysis did not highlight any significant difference, with an improvement of mean foot temperature of 1.5 ± 0.6 °C in females versus 1.2 ± 0.5 °C in males (p = 0.42). Ankle brachial index and performance also significantly improved over time (p < 0.001) without gender differences. In patients with PAD, a structured low-intensity exercise program significantly improved foot temperature and exercise capacity without any sex-related difference.
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Affiliation(s)
- Anna Crepaldi
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, 14004 Cordoba, Spain; (A.C.); (P.J.L.-S.)
- Department of Nursing, Pharmacology and Physiotherapy, Universidad de Córdoba, 14004 Cordoba, Spain
- Department of Nursing, Hospital Universitario Reina Sofía de Córdoba, 14004 Cordoba, Spain
| | - Lorenzo Caruso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Giovanni Piva
- Department of Humanities, University of Ferrara, 44121 Ferrara, Italy;
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (V.G.)
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (V.G.)
- Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy;
| | - Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, 44124 Ferrara, Italy;
- University Center for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (N.L.); (N.R.)
| | - Natascia Rinaldo
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (N.L.); (N.R.)
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (N.L.); (N.R.)
- Program of Vascular Rehabilitation and Exercise Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Pablo Jesus Lopez-Soto
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, 14004 Cordoba, Spain; (A.C.); (P.J.L.-S.)
- Department of Nursing, Pharmacology and Physiotherapy, Universidad de Córdoba, 14004 Cordoba, Spain
- Department of Nursing, Hospital Universitario Reina Sofía de Córdoba, 14004 Cordoba, Spain
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Manfredini F, Zenunaj G, Traina L, Gasbarro V, Lamberti N. Exercise-based functional recovery from severe upper extremity arterial disease due to bilateral subclavian artery obstruction in a person with giant cell arteritis. J Vasc Surg Cases Innov Tech 2023; 9:101179. [PMID: 37427039 PMCID: PMC10323406 DOI: 10.1016/j.jvscit.2023.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/23/2023] [Indexed: 07/11/2023] Open
Abstract
We report the case of a 71-year-old woman diagnosed with giant cell arteritis with bilateral subclavian and axillary obstruction and severe arm claudication that occurred 3 months earlier and was non-regressed after corticosteroids. Before possible revascularization, the patient was initiated to a personalized home-based graded exercise program including walking, hand-bike pedaling, and muscle strength training. During the 9 months of treatment, the patient progressively improved radial pressure values (10 to 85 mmHg), hand temperature values by infrared-thermography (+2.1 °C), arm endurance, and forearm muscle oxygenation by near-infrared spectroscopy. Home-based graded exercise proved to be a noninvasive option for upper limb claudication.
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Gladiol Zenunaj
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Arita Y, Hirose K, Suetani Y, Shichijo K, Yamamoto S, Fukui T, Ogasawara N. Clinical Characteristics of the Patient With Unmeasurable Ankle-Brachial Index in Endovascular Treatment. Cureus 2023; 15:e39705. [PMID: 37398733 PMCID: PMC10309073 DOI: 10.7759/cureus.39705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Ankle-brachial index (ABI) is an important indicator to diagnose lower extremity arterial disease (LEAD). However, patients with unmeasurable ABI are sometimes excluded from the analysis and their clinical characteristics are poorly understood. Methods One hundred twenty-two consecutive Japanese subjects (mean age, 72 years), who underwent successful endovascular treatment (EVT) for lower extremity arteries at our hospital were retrospectively studied. Results Of the 122 patients, 23 (19%) patients presented an unmeasurable ABI before EVT. Five of 23 (22%) had still an unmeasurable ABI one day after EVT. Comorbidities including hypertension, diabetes, dyslipidemia, hemodialysis, smoking, ischemic heart disease, atrial fibrillation, and past-EVT history were not different between ABI measurable and unmeasurable patients. However, patients with unmeasurable ABI presented a significantly higher degree of Rutherford category and a smaller number of tibial vessel runoff than patients with measurable ABI before EVT (p<0.05 and p<0.01, respectively). There was no difference in the lesion site between the two groups. The event rate including all-cause mortality, re-EVT, lower limb amputation, and bypass surgery did not differ between two groups four years after EVT. ABI after four years of initial EVT did not differ between pre-EVT measurable and unmeasurable patients (0.96 vs. 0.84, p=0.48). Conclusions Patients with unmeasurable ABI before EVT were characterized by higher degree of Rutherford categorization and a small number of tibial vessel runoff, but there was no significant difference in outcomes during the follow-up period.
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Affiliation(s)
- Yoh Arita
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, JPN
| | - Kosuke Hirose
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, JPN
| | - Yuto Suetani
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, JPN
| | - Kana Shichijo
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, JPN
| | - Shohei Yamamoto
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, JPN
| | - Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, JPN
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, JPN
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Home-Based Exercise in Elderly Patients with Claudication and Chronic Kidney Disease Is Associated with Lower Progressive Renal Function Worsening: A 5-Year Retrospective Study. Metabolites 2022; 13:metabo13010056. [PMID: 36676981 PMCID: PMC9862132 DOI: 10.3390/metabo13010056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
This observational study aimed to monitor the 5-year trends of kidney function in patients with peripheral artery disease (PAD) and concomitant chronic kidney disease (CKD) enrolled or not enrolled into a rehabilitative exercise program. Sixty-six patients (aged 72 ± 10, males n = 52) at KDOQI stages III-IV and PAD at Rutherford's stage I-III were included in the study, with a group (Exercise, EX; n = 32) receiving a 6-month structured pain-free home-based walking program and a group (Control, CO; n = 34) receiving walking advice and optimal nephrological care. Outcomes included kidney function measured through serum creatinine (sCr) and clinical outcomes, including the rate of advance of CKD stages and admission to dialysis, revascularizations, and hospitalizations. At baseline, the two groups were comparable for age, nephropathy, medications, comorbidities, and PAD severity. Patients in the EX group safely completed the exercise program. SCr values were slightly increased in EX (baseline: 2.35 ± 0.32; 5-year: 2.71 ± 0.39 mg/dL) and progressively worsened in CO (baseline: 2.30 ± 0.31; 5-year 4.22 ± 0.42 mg/dL), with a significant between-group difference (p = 0.002). The control group also showed a higher number of dialysis admissions (5 vs. 0, p = 0.025) and advancing CKD stage as well a higher risks for lower limb revascularization (hazard ratio: 2.59; 95%CI: 1.11-6.02; p = 0.027) and for all-cause hospitalization (hazard ratio: 1.77; 95%CI: 1.05-2.97; p = 0.031). PAD-CKD patients enrolled in a low-moderate intensity home-exercise program showed more favorable long-term trends in kidney function and clinical outcomes than patients with usual care. These preliminary observations need to be confirmed in randomized trials.
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Semporé WY, Hersant J, Ramondou P, Hamel JF, Abraham P, Henni S. Exercise Oximetry Correlates Better With Exercise-Induced Lactate Increase, than Ankle Brachial Index or Walking Time, in Vascular Claudicants. Angiology 2022; 74:526-535. [PMID: 35816616 DOI: 10.1177/00033197221112132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In claudication, the correlation between walking-induced biomarkers and indices of clinical severity (e.g., walking distance or ankle brachial index (ABI)), is fair. We hypothesized that a correlation would be observed between the clinical estimation of ischemia severity with exercise transcutaneous oximetry (Ex-TcpO2) and lactate increase. A prospective study was performed among 377 patients with arterial claudication. We recorded age, sex, ABI, body mass index (BMI), systolic arterial blood pressure (SBP), and glycemia. Capillary blood lactate was measured at rest and 3 min after a constant load treadmill test. We recorded maximum walking time (MWT), heart rate (HRmax), the sum of minimal decrease from oxygen values for buttocks, thighs and calves Ex-TcpO2 (DROPmin), as well as the amplitude of chest-TcpO2 decrease. A multilinear regression model was used to assess the variables associated with lactate increase. BMI, SBP, HRmax, the amplitude of decrease in chest-TcpO2 and DROPmin, but not age, sex, ABI, MWT, diabetes mellitus nor glycemia, were significantly associated to lactate increase in the model. Because it accounts for the severity and diffusion of lower-limb exercise-induced ischemia and detects exercise induced hypoxemia, TcpO2 may be preferable to ABI or MWT to estimate the metabolic consequences of walking in claudicants.
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Affiliation(s)
- Wendsèndaté Yves Semporé
- 307960Centre MURAZ, National Institute of Public Health, Bobo Dioulasso, Burkina Faso.,MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France
| | - Jeanne Hersant
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| | - Pierre Ramondou
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| | - Jean François Hamel
- Department of Biostatistics, 26966University Hospital of Angers, Pays de la Loire, France
| | - Pierre Abraham
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France.,Sports Medicine, 26966University Hospital of Angers, Pays de la Loire, France
| | - Samir Henni
- Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
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Lamberti N, Piva G, Businaro F, Caruso L, Crepaldi A, Lòpez-Soto PJ, Manfredini F. A Fitness-Fatigue Model of Performance in Peripheral Artery Disease: Predicted and Measured Effects of a Pain-Free Exercise Program. J Pers Med 2022; 12:jpm12030397. [PMID: 35330397 PMCID: PMC8949585 DOI: 10.3390/jpm12030397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Banister impulse-response (IR) model estimates the performance in response to the training impulses (TRIMPs). In 100 patients with peripheral artery disease (PAD), we tested by an IR model the predictability of the effects of a 6-month structured home-based exercise program. The daily TRIMPs obtained from prescribed walking speed, relative intensity and time of exercise determined the fitness-fatigue components of performance. The estimated performance values, calculated from the baseline 6-min and pain-free walking distance (6MWD and PFWD, respectively) were compared with values measured at visits through regression models. Interval pain-free walking at controlled speed prescribed during circa-monthly hospital visits (5 ± 1) was safely performed at home with good adherence (92% of scheduled sessions, 144 ± 25 km walked in 50 ± 8 training hours). The mean TRIMP rose throughout the program from 276 to 601 a.u. The measured 6MWD and PFWD values increased (+33 m and +121 m, respectively) showing a good fit with those estimated by the IR model (6MWD: R2 0.81; PFWD: R2 0.68) and very good correspondence (correlation coefficients: 0.91 to 0.95), without sex differences. The decay of performance without training was estimated at 18 ± 3 weeks. In PAD, an IR model predicted the walking performance following a pain-free exercise program. IR models may contribute to design and verify personalized training programs.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.B.); (A.C.)
| | - Giovanni Piva
- PhD Program in Environmental Sustainability and Wellbeing, Department of Humanistic Studies, University of Ferrara, 44121 Ferrara, Italy;
| | - Federico Businaro
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.B.); (A.C.)
| | - Lorenzo Caruso
- Department of Environmental Sciences and Prevention, University of Ferrara, 44121 Ferrara, Italy;
| | - Anna Crepaldi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.B.); (A.C.)
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, 14005 Córdoba, Spain;
| | - Pablo Jesùs Lòpez-Soto
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, 14005 Córdoba, Spain;
- Department of Nursing, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.B.); (A.C.)
- Department of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy
- Correspondence: ; Tel.: +39-053-2236-187
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Lamberti N, Caruso L, Piva G, Traina L, Ficarra V, Zamboni P, Gasbarro V, Manfredini F. Beyond the Patient's Report: Self-Reported, Subjective, Objective and Estimated Walking Disability in Patients with Peripheral Artery Disease. Diagnostics (Basel) 2021; 11:diagnostics11111991. [PMID: 34829337 PMCID: PMC8623461 DOI: 10.3390/diagnostics11111991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
Among patients with peripheral artery disease, an altered estimation of walking ability reported to the physician may influence the choice of treatment. We compared claudication distance (CD) values reported by patients or assessed by validated protocols to elaborate a formula capable of estimating more reliable values. Three hundred fifty-nine patients with claudication were measured at the time of entry into a rehabilitation program. Walking performance was obtained by patients' reports (self-reported claudication distance, SR-CD) and was directly assessed to determine the claudication and maximal walking distance by the 6-min test (6-CD and 6-MWD) and an incremental treadmill test (T-CD and T-MWD). The degree of muscle deoxygenation was objectively determined at the calf by near-infrared spectroscopy (NIRS) during the treadmill test. Among the 289 subjects analyzed, SR-CD exceeded both 6-CD and T-CD (+155 and +182 m, respectively). SR-CD was moderately correlated with T-CD (r = 0.30), 6-CD (r = 0.32), and 6-MWD (r = 0.29) but not with muscle deoxygenation per meter walked, unlike T-CD and 6-CD. A formula adjusted for the presence of diabetes reduced patient overestimation by 92%. The patient's reported claudication distance was generally overestimated compared to objective measures, and it was made more reliable through a corrective factor for easy use in a clinical setting.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (L.C.)
| | - Lorenzo Caruso
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (L.C.)
| | - Giovanni Piva
- PhD Program in Environmental Sustainability and Wellbeing, University of Ferrara, Via Paradiso 12, 44121 Ferrara, Italy;
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (L.T.); (V.F.); (V.G.)
| | - Valentina Ficarra
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (L.T.); (V.F.); (V.G.)
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine for Romagna, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy;
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (L.T.); (V.F.); (V.G.)
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64, 44121 Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (L.C.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
- Correspondence: ; Tel.: +39-053-223-6187
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