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Peñín-Grandes S, López-Ortiz S, Maroto-Izquierdo S, Menéndez H, Pinto-Fraga J, Martín-Hernández J, Lista S, Lucia A, Santos-Lozano A. Winners do what they fear: exercise and peripheral arterial disease-an umbrella review. Eur J Prev Cardiol 2024; 31:380-388. [PMID: 37611200 DOI: 10.1093/eurjpc/zwad261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023]
Abstract
AIMS This systematic review aims to evaluate and summarize findings from published meta-analyses on the effects of regular exercise in patients with peripheral arterial disease (PAD). The review will assess the impact of exercise on functional parameters, health-related quality of life, haemodynamic parameters, physical activity levels, adverse events, and mortality. METHODS AND RESULTS A systematic search was performed in PubMed, Web of Science, Scopus, and Cochrane Library databases (up to May 2023) to identify meta-analyses including randomized controlled trials that examined the effects of regular exercise in patients with PAD. Sixteen studies, with a total of 198 meta-analyses, were identified. Results revealed with strong evidence that patients with PAD who exercised improved functional and health-related quality of life parameters. Specifically, supervised aerobic exercise (i.e. walking to moderate-maximum claudication pain) improves maximum walking distance [mean difference (MD): 177.94 m, 95% confidence interval (CI) 142.29-213.60; P < 0.00001; I2: 65%], pain-free walking distance (fixed MD: 68.78 m, 95% CI 54.35-83.21; P < 0.00001; I2: 67%), self-reported walking ability [i.e. distance score (MD: 9.22 points, 95% CI 5.74-12.70; P < 0.00001; I2: 0%), speed score (MD: 8.71 points, 95% CI 5.64-11.77; P < 0.00001, I2: 0%), stair-climbing score (MD: 8.02 points, 95% CI 4.84-11.21; P < 0.00001, I2: 0%), and combined score (MD: 8.76 points, 95% CI 2.78-14.74; P < 0.0001, I2: 0%)], aerobic capacity (fixed MD: 0.62 mL/kg/min, 95% CI 0.47-0.77, P < 0.00001, I2: 64%), and pain score (MD: 7.65, 95% CI 3.15-12.15; P = 0.0009; I2: 0%), while resistance exercise improves lower limb strength (standardized mean difference: 0.71, 95% CI 0.29-1.13, P = 0.0009; I2: 0%]. Regarding other outcomes, such as haemodynamic parameters, no significant evidence was found, while physical activity levels, adverse events, and mortality require further investigation. CONCLUSION Synthesis of the currently available meta-analyses suggests that regular exercise may be beneficial for a broad range of functional tasks improving health-related quality of life in patients with PAD. Supervised aerobic exercise is the best type of exercise to improve walking-related outcomes and pain, while resistance exercise is more effective to improve lower limb strength.
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Affiliation(s)
- Saúl Peñín-Grandes
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Susana López-Ortiz
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Sergio Maroto-Izquierdo
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Héctor Menéndez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - José Pinto-Fraga
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Juan Martín-Hernández
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('imas12' and 'PaHerg group'), Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), Padre Julio Chevalier Street, 2, 47012, Valladolid, Castilla y León, Spain
- Research Institute of the Hospital 12 de Octubre ('imas12' and 'PaHerg group'), Madrid, Spain
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Aronow WS, Avanesova AA, Frishman WH, Shamliyan TA. Inconsistent Benefits From Mobile Information Communication Technology in Adults With Peripheral Arterial Disease. Cardiol Rev 2024; 32:12-17. [PMID: 35674708 DOI: 10.1097/crd.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Quality of evidence regarding telemedicine in adults with peripheral arterial disease has not been systematically appraised. OBJECTIVES To explore benefits and harms from mobile information communication technology devices and applications in peripheral arterial disease. METHODS Systematic rapid evidence review and appraisal with the grading of recommendations assessment, development, and evaluation working group approach. RESULTS Sixteen randomized controlled clinical trials (RCT) examined various self-monitoring devices, telemedicine platforms, and individualized telephone counseling. Low-quality evidence suggested that the odds of treatment failure (pooled Peto odds ratio 0.8; 95% CI, 0.4-1.7; 5 RCTs), adverse effects (pooled Peto odds ratio 0.9; 95% CI, 0.5-1.5; 2 RCTs), and physical performance (standardized mean difference in 6-minute walking test 0.2; 95% CI, -0.3-0.7; 4 RCTs) did not differ between mobile interventions and usual care. Single RCTs suggested large but inconsistent improvement in the quality of life: EuroQol5D standardized mean difference = 5.0 (95% CI, 4.4-5.7; 1 RCT) after telehealth program for promoting patient self-management and standardized mean difference = 1.4 (95% CI, 0.4-2.3; 1 RCT) after structured rehabilitation with mobile self-monitoring. Inconsistent reporting of patient-centered outcomes and small sample sizes hampered the quality of evidence. CONCLUSIONS Improved quality of life after specific mobile applications should be confirmed in powered RCTs and large postmarketing studies.
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Affiliation(s)
- Wilbert S Aronow
- From the Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Anna A Avanesova
- North-Caucasus Federal University, Stavropol, Russian Federation
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Tremblay R, Marcotte-Chénard A, Hamelin-Morrissette J, Poirier L, Perron PN, Durivage A, Mampuya WM, Huard G, Riesco E. The Effect of Exercise Modalities on Walking Capacity in Patients With Intermittent Claudication: A NETWORK META-ANALYSIS. J Cardiopulm Rehabil Prev 2023; 43:318-328. [PMID: 36880959 DOI: 10.1097/hcr.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Despite extensive research on the effect of supervised exercise therapy on walking performance in patients with symptomatic peripheral arterial disease (PAD), it remains unclear which training modality provides the greatest improvement in walking capacity. The objective of this study was to compare the effect of different types of supervised exercise therapy on walking capacity in individuals with symptomatic PAD. METHODS A random-effect network meta-analysis was performed. The following databases were searched from January 1966 to April 2021: SPORTDiscus, CINAHL, MEDLINE, AMED, Academic Search Complete and, Scopus. Trials had to include at least one type of supervised exercise therapy for patients with symptomatic PAD, with an intervention lasting ≥2 wk with ≥5 training sessions, and an objective measure of walking capacity. RESULTS Eighteen studies were included for a total sample of 1135 participants. Interventions duration ranged from 6-24 wk and included aerobic exercise (treadmill walking, ergometer, and Nordic walking), resistance training (lower and/or upper body), a combination of both, and underwater exercise. Results showed that combined training improved treadmill walking capacity to a comparable extent to aerobic walking (+122.0 [24.2-219.8] m vs +106.8 [34.2-179.4] m), but with a larger effect size (1.20 [0.50-1.90] vs 0.67 [0.22-1.11]). Similar results were observed for the 6-min walk distance, with combined training being the most promising modality (+57.3 [16.2-98.5] m), followed by underwater training (+56.5 [22.4-90.5] m) and aerobic walking (+39.0 [12.8-65.1] m). CONCLUSION While not statistically superior to aerobic walking, combined exercise seems to be the most promising training modality. Aerobic walking and underwater training also improved walking capacity for patients with symptomatic PAD.
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Affiliation(s)
- Renaud Tremblay
- Faculty of Physical Activity Sciences (Messrs Tremblay and Marcotte-Chénard, Drs Hamelin-Morrissette and Riesco, and Ms Poirier) and Faculty of Medicine and Health Sciences (Drs Perron, Durivage, Mampuya, and Huard), University of Sherbrooke, Sherbrooke, Quebec, Canada; and Research Centre on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada (Messrs Tremblay and Marcotte-Chénard, Drs Hamelin-Morrissette and Riesco, and Ms Poirier)
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Hap K, Biernat K, Konieczny G. Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions. J Diabetes Res 2021; 2021:5122494. [PMID: 34056006 PMCID: PMC8131145 DOI: 10.1155/2021/5122494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes mellitus (DM) is one of the major public health problems that account for morbidity, mortality, and disability worldwide. The presence of DM increases the risk of peripheral artery disease (PAD), as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status. Unfortunately, alternative treatments for vascular complications in diabetes are poorly researched. Physiotherapy (kinesitherapy combined with different physical therapy agents) in individuals with DM and coexisting PAD may offer an important complementary therapy alternative. Early therapeutic measures can significantly improve patient outcomes, reduce cardiovascular risk, and improve daily life quality. The article provides an update on the current state of knowledge on physiotherapy interventions in the course of DM in patients with coexisting PAD.
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Affiliation(s)
- Katarzyna Hap
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Biernat
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Konieczny
- Faculty of Health Sciences and Physical Education, Witelon State University of Applied Sciences in Legnica, Poland
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Dziubek W, Stefańska M, Bulińska K, Barska K, Paszkowski R, Kropielnicka K, Jasiński R, Rachwalik A, Woźniewski M, Szuba A. Effects of Physical Rehabilitation on Spatiotemporal Gait Parameters and Ground Reaction Forces of Patients with Intermittent Claudication. J Clin Med 2020; 9:jcm9092826. [PMID: 32878323 PMCID: PMC7565509 DOI: 10.3390/jcm9092826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic ischemia of the lower extremities often presents as intermittent claudication characterized by lower limb pain which subsides after a short break. This study aimed to provide an assessment of the spatiotemporal parameters of gait and ground reaction forces in patients with PAD participating in three forms of supervised physical training. A total of 80 subjects completed a three-month supervised physical rehabilitation program with three sessions per week. The subjects were assigned to one of three programs: group 1—standard walking training on a treadmill (TT); group 2—Nordic walking (NW) training; group 3—strength and endurance training comprised of NW with isokinetic resistance training (NW + ISO). Gait biomechanics tests (kinematic and kinetic parameters of gait) and a six-minute walk test were carried out before and after three months of physical training. Nordic walking training led to the greatest improvements in the gait pattern of patients with PAD and a significant increase in the absolute claudication distance and total gait distance. Combined training (NW + ISO) by strengthening the muscles of the lower extremities increased the amplitude of the general center of gravity oscillation to the greatest extent. Treadmill training had little effect on the gait pattern. Nordic walking training should be included in the rehabilitation of patients with PAD as a form of gait training, which can be conducted under supervised or unsupervised conditions.
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Affiliation(s)
- Wioletta Dziubek
- Department of Physiotherapy, University School of Physical Education, 35 Paderewskiego Street, 51-612 Wrocław, Poland; (W.D.); (K.B.); (R.J.); (M.W.)
| | - Małgorzata Stefańska
- Department of Physiotherapy, University School of Physical Education, 35 Paderewskiego Street, 51-612 Wrocław, Poland; (W.D.); (K.B.); (R.J.); (M.W.)
- Correspondence:
| | - Katarzyna Bulińska
- Department of Physiotherapy, University School of Physical Education, 35 Paderewskiego Street, 51-612 Wrocław, Poland; (W.D.); (K.B.); (R.J.); (M.W.)
| | - Katarzyna Barska
- Department of Cardiology, Jelenia Góra Valley Provincial Hospital Center, Ogińskiego 6, 58-501 Jelenia Góra, Poland;
| | - Rafał Paszkowski
- Department of Angiology, Diabetology and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (R.P.); (A.R.); (A.S.)
| | - Katarzyna Kropielnicka
- WROVASC—An Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, H. Kamieńskiego 73a, 51-124 Wroclaw, Poland;
| | - Ryszard Jasiński
- Department of Physiotherapy, University School of Physical Education, 35 Paderewskiego Street, 51-612 Wrocław, Poland; (W.D.); (K.B.); (R.J.); (M.W.)
| | - Anna Rachwalik
- Department of Angiology, Diabetology and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (R.P.); (A.R.); (A.S.)
| | - Marek Woźniewski
- Department of Physiotherapy, University School of Physical Education, 35 Paderewskiego Street, 51-612 Wrocław, Poland; (W.D.); (K.B.); (R.J.); (M.W.)
| | - Andrzej Szuba
- Department of Angiology, Diabetology and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (R.P.); (A.R.); (A.S.)
- WROVASC—An Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, H. Kamieńskiego 73a, 51-124 Wroclaw, Poland;
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Jansen SC, Abaraogu UO, Lauret GJ, Fakhry F, Fokkenrood HJ, Teijink JA. Modes of exercise training for intermittent claudication. Cochrane Database Syst Rev 2020; 8:CD009638. [PMID: 32829481 PMCID: PMC8092668 DOI: 10.1002/14651858.cd009638.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND According to international guidelines and literature, all patients with intermittent claudication should receive an initial treatment of cardiovascular risk modification, lifestyle coaching, and supervised exercise therapy. In the literature, supervised exercise therapy often consists of treadmill or track walking. However, alternative modes of exercise therapy have been described and yielded similar results to walking. This raises the following question: which exercise mode produces the most favourable results? This is the first update of the original review published in 2014. OBJECTIVES To assess the effects of alternative modes of supervised exercise therapy compared to traditional walking exercise in patients with intermittent claudication. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 4 March 2019. We also undertook reference checking, citation searching and contact with study authors to identify additional studies. No language restriction was applied. SELECTION CRITERIA We included parallel-group randomised controlled trials comparing alternative modes of exercise training or combinations of exercise modes with a control group of supervised walking exercise in patients with clinically determined intermittent claudication. The supervised walking programme needed to be supervised at least twice a week for a consecutive six weeks of training. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data, and assessed the risk of bias for each study. As we included studies with different treadmill test protocols and different measuring units (metres, minutes, or seconds), the standardised mean difference (SMD) approach was used for summary statistics of mean walking distance (MWD) and pain-free walking distance (PFWD). Summary estimates were obtained for all outcome measures using a random-effects model. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS For this update, five additional studies were included, making a total of 10 studies that randomised a total of 527 participants with intermittent claudication (IC). The alternative modes of exercise therapy included cycling, lower-extremity resistance training, upper-arm ergometry, Nordic walking, and combinations of exercise modes. Besides randomised controlled trials, two quasi-randomised trials were included. Overall risk of bias in included studies varied from high to low. According to GRADE criteria, the certainty of the evidence was downgraded to low, due to the relatively small sample sizes, clinical inconsistency, and inclusion of three studies with risk of bias concerns. Overall, comparing alternative exercise modes versus walking showed no clear differences for MWD at 12 weeks (standardised mean difference (SMD) -0.01, 95% confidence interval (CI) -0.29 to 0.27; P = 0.95; 6 studies; 274 participants; low-certainty evidence); or at the end of training (SMD -0.11, 95% CI -0.33 to 0.11; P = 0.32; 9 studies; 412 participants; low-certainty evidence). Similarly, no clear differences were detected in PFWD at 12 weeks (SMD -0.01, 95% CI -0.26 to 0.25; P = 0.97; 5 studies; 249 participants; low-certainty evidence); or at the end of training (SMD -0.06, 95% CI -0.30 to 0.17; P = 0.59; 8 studies, 382 participants; low-certainty evidence). Four studies reported on health-related quality of life (HR-QoL) and three studies reported on functional impairment. As the studies used different measurements, meta-analysis was only possible for the walking impairment questionnaire (WIQ) distance score, which demonstrated little or no difference between groups (MD -5.52, 95% CI -17.41 to 6.36; P = 0.36; 2 studies; 96 participants; low-certainty evidence). AUTHORS' CONCLUSIONS This review found no clear difference between alternative exercise modes and supervised walking exercise in improving the maximum and pain-free walking distance in patients with intermittent claudication. The certainty of this evidence was judged to be low, due to clinical inconsistency, small sample size and risk of bias concerns. The findings of this review indicate that alternative exercise modes may be useful when supervised walking exercise is not an option. More RCTs with adequate methodological quality and sufficient power are needed to provide solid evidence for comparisons between each alternative exercise mode and the current standard of supervised treadmill walking. Future RCTs should investigate outcome measures on walking behaviour, physical activity, cardiovascular risk, and HR-QoL, using standardised testing methods and reporting of outcomes to allow meaningful comparison across studies.
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Affiliation(s)
- Sandra Cp Jansen
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ukachukwu Okoroafor Abaraogu
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Medical Rehabilitation, University of Nigeria, Nsukka, Nigeria
| | - Gert Jan Lauret
- Department of Vascular Surgery, Slingeland Hospital, Doetinchem, Netherlands
| | - Farzin Fakhry
- Department of Cardiology, Haga Teaching Hospital, The Hague, Netherlands
| | - Hugo Jp Fokkenrood
- Department of Vascular Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Joep Aw Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
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Nordic Walking for Overweight and Obese People: A Systematic Review and Meta-Analysis. J Phys Act Health 2020; 17:762-772. [PMID: 32502974 DOI: 10.1123/jpah.2019-0357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/11/2020] [Accepted: 04/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nordic walking (NW) is a potentially beneficial exercise strategy for overweight and obese people. To date, no reviews have synthesized the existing scientific evidence regarding the effects of NW on this population. This systematic review and meta-analysis aimed to identify the characteristics, methodological quality, and results of the investigations that have studied the effects of NW in overweight and obese individuals. METHODS Six electronic databases were searched up to June 2019 for studies that examined the effects of NW on people with a body mass index ≥ 25 kg/m2. The methodological quality of the included randomized controlled trials was retrieved from the physiotherapy evidence database or evaluated using the physiotherapy evidence database scale. RESULTS Twelve studies were included in the review. The investigations were mostly good-to-fair methodological quality. NW groups had a significant improvement on parameters such as fasting plasma glucose, abdominal adiposity, and body fat compared with the baseline, but no significant improvements were found when compared with control groups. CONCLUSIONS NW can potentially lead to improvements in parameters related to major health outcomes in overweight and obese people. The lack of control for confounding variables in the analyzed studies prevents further elaboration on its potential benefits.
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Wee IJY, Syn N, Choong AMTL. Nordic Walking in Patients with Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2018; 57:465. [PMID: 30509891 DOI: 10.1016/j.ejvs.2018.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ian J Y Wee
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Syn
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore
| | - Andrew M T L Choong
- SingVaSC, Singapore Vascular Surgical Collaborative, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Vascular Surgery, National University Heart Centre, Singapore.
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Golledge J, Moxon J, Morris D. Response to 'Re. Systematic Review and Meta-analysis of Clinical Trials Examining the Benefit of Exercise Programs Using Nordic Walking in Patients with Peripheral Artery Disease'. Eur J Vasc Endovasc Surg 2018; 57:465-466. [PMID: 30509893 DOI: 10.1016/j.ejvs.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
| | - Joseph Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Dylan Morris
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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Nordanstig J. Is There a Claudicating Elephant in the Room? Eur J Vasc Endovasc Surg 2018; 56:544. [PMID: 30007526 DOI: 10.1016/j.ejvs.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Joakim Nordanstig
- Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg University, Sweden.
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