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Waddell A, Denton F, Powell R, Broom DR, Birkett ST, McGregor G, Harwood AE. Home-based Circuit Training and Community Walking for Intermittent Claudication. Ann Vasc Surg 2024; 105:38-47. [PMID: 38579907 DOI: 10.1016/j.avsg.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Supervised exercise training is recommended for people with peripheral artery disease (PAD), yet it remains underutilized. Home-based exercise programs (HBEPs) are a potential alternative. The aim of this study was to assess the feasibility of conducting a full scale trial of a 12-week HBEP for people living with symptomatic PAD. METHODS In a randomized feasibility trial, patients with intermittent claudication were allocated to either an HBEP or a nonexercise control. The HBEP group was given a Fitbit to use during a 12-week exercise program comprising of personalized step goals and a resistance-based circuit to be undertaken at home twice weekly. The primary outcome was feasibility, assessed via eligibility, recruitment, attrition, tolerability, and adherence. Acceptability was assessed via semistructured interviews. Secondary analysis was undertaken to determine the feasibility of collecting clinical outcome data. RESULTS 188 people were screened, 133 were eligible (70.7%), 30 were recruited (22.6%) and one withdrew (3.33%). Mean adherence to the daily step goal was 53.5% (range = 29.8-90.5%), and 58.6% of prescribed circuits were completed of which 56.4% were at the desired intensity. Six adverse events were recorded, 3 of which were related to study involvement. No significant differences were observed in exploratory outcomes. Small clinically important differences were seen in walking speed and pain-free treadmill walking distance which should be confirmed or refuted in a larger trial. CONCLUSIONS The HBEP was feasible and well tolerated, with successful recruitment and minimal attrition. The intervention was acceptable, with walking seen as more enjoyable than circuit exercise. The WALKSTRONG program may be suitable for those who will not, or cannot, take part in supervised exercise outside of the home.
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Affiliation(s)
- Alexander Waddell
- Centre for Physical Activity, Sport and Exercise, Institute of Health and Wellbeing, Coventry University, Coventry, UK.
| | - Francesca Denton
- Centre for Physical Activity, Sport and Exercise, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Richard Powell
- Centre for Physical Activity, Sport and Exercise, Institute of Health and Wellbeing, Coventry University, Coventry, UK; Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - David R Broom
- Centre for Physical Activity, Sport and Exercise, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Stefan T Birkett
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Centre for Healthcare and Communities, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Amy E Harwood
- Centre for Physical Activity, Sport and Exercise, Institute of Health and Wellbeing, Coventry University, Coventry, UK; Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, UK
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Hagen P, Malatesta D, Calanca L, Mazzolai L, Lanzi S. The PAD-adapted 30-20-10 during Nordic walking: A new exercise training session in patients with symptomatic peripheral artery disease. Medicine (Baltimore) 2024; 103:e38601. [PMID: 38905371 PMCID: PMC11191894 DOI: 10.1097/md.0000000000038601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/24/2024] [Indexed: 06/23/2024] Open
Abstract
This study aimed to investigate the feasibility of a peripheral artery disease (PAD)-adapted 30-20-10 Nordic walking session in patients with symptomatic PAD and to compare the cardiovascular response of this new training session to a traditional walking (TW) and 4 × 4 minutes Nordic walking session. This is a prospective observational study. Patients with Fontaine stage II PAD were included. Patients participated in Nordic walking sessions, which were randomly assigned as TW, 4 × 4 minute intervals, and peripheral artery disease adapted 30-20-10 exercise session (PAD-adapted 30-20-10 sessions). PAD-adapted 30-20-10 and 4 × 4 minutes sessions consisted of 4 repetitions of 4 minutes of effort followed by 3 minutes of passive recovery. PAD-adapted 30-20-10 session was characterized by 4 continuous 1-min repetitions at 3 different walking speeds [high (30 seconds), moderate (20 seconds) and low (10 seconds)]. During the 4 × 4 minutes session, patients were asked to cover the maximal distance at a constant speed. During TW session, patients were asked to walk at a speed inducing moderate-to-severe claudication pain. Heart rate, rating of perceived exertion (RPE) and claudication pain intensity using a visual analog scale were assessed. The perceived enjoyment of each session was assessed using a visual analog scale ranging from 0 (not enjoyable) to 10 (very enjoyable). Eleven patients with chronic symptomatic PAD were included (62 ± 13 years; 54% women). The mean heart rate during the time of effort was significantly higher in PAD-adapted 30-20-10 group than in 4 × 4 minutes and TW groups (127 ± 12, 122 ± 12, 114 ± 11 bpm, respectively; P ≤ .001). The mean rating of perceived exertion (16 ± 1, 15 ± 1, 13 ± 1; P ≤ .001) and claudication pain intensity (8 ± 1, 7 ± 1; 7 ± 1 mm; P ≤ .019) were significantly higher during PAD-adapted 30-20-10 sessions than during 4 × 4 minutes and TW sessions. The perceived enjoyment was similar among sessions (8.7 ± 1.6 for TW, 8.6 ± 1.7 for 4 × 4 minutes, and 8.8 ± 1.8 mm for PAD-adapted 30-20-10 sessions; P = .935). The PAD-adapted 30-20-10 session is feasible and induces higher cardiovascular stimulation and claudication pain than 4 × 4 minutes and TW procedures in patients with symptomatic PAD. Despite these different responses, a similar perceived enjoyment among the sessions has been shown. Future investigations are needed to examine the effects of this new training session in these patients.
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Affiliation(s)
- Paolo Hagen
- Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Luca Calanca
- Angiology Department, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lucia Mazzolai
- Angiology Department, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
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Cai P, Pymer S, Ibeggazene S, Raza A, Hitchman L, Chetter I, Smith G. Extracorporeal Shockwave for Intermittent Claudication and Quality of Life: A Randomized Clinical Trial. JAMA Surg 2024; 159:625-632. [PMID: 38598227 PMCID: PMC11007658 DOI: 10.1001/jamasurg.2024.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/07/2024] [Indexed: 04/11/2024]
Abstract
Importance Intermittent lower limb claudication limits function and quality of life. Supervised exercise programs are not readily available, and a noninvasive alternative is needed. Objective To assess extracorporeal corporeal shockwave therapy in improving quality of life in patients with claudication. Design, Setting, and Participants In this double-blind, placebo-controlled randomized clinical trial, patients in the outpatient setting at a single tertiary center for vascular surgery were randomized in a 1:1 ratio to extracorporeal shockwave therapy or placebo therapy with no shockwaves delivered. Recruitment was between June 2015 and January 2020, with 12-week follow-up ending in March 2020. A convenience sample of patients with claudication and conservative treatment requirements who refused or were unable to participate in supervised exercise were eligible. Patients receiving anticoagulation therapy or with an active cancer were excluded. Of 522 patients screened, 389 were eligible, 138 were enrolled, and 110 completed follow-up and were included in the primary analysis. Statistical analysis was completed by May 2021. Intervention In the intervention group, patients received 100 impulses of 0.1mJ/mm/cm2 in an area of the gastrocnemius muscle 3 times weekly for 3 weeks. The steps for treatment were replicated for the control group without delivering the treatment. Main Outcomes and Measures The primary outcome was the Physical Functioning domain of the 36-item Short-Form Quality of Life Questionnaire at 12-week follow-up. Secondary outcomes included walking distances, ankle brachial pressure index, and other quality-of-life measures. Results Of 138 patients recruited and randomized, 92 (67%) were male, and the mean (SD) age of the study population was 67 (9.6) years. The intervention group had a significantly higher physical function score at 12 weeks (estimated median difference 3.8; 95% CI, 0.0-7.7; P = .03). However, this significance did not remain when adjusting for covariates. At 12 weeks, the intervention group had significantly longer pain-free and maximum walking distances (pain-free estimated median difference, 34.1, 95% CI, 11.4-56.8; P = .004; maximum estimated median difference, 51.4; 95% CI, 10.7-86.5; P = .01). Conclusions and Relevance To our knowledge, this is the first double-blind, placebo-controlled, randomized clinical trial to consider extracorporeal shockwave therapy for the management of intermittent claudication. It demonstrated efficacy for walking distances, may have a positive effect on quality of life, and may provide a safe, noninvasive alternative therapy for patients with intermittent claudication. Trial Registration ClinicalTrials.gov Identifier: NCT02652078.
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Affiliation(s)
- Paris Cai
- Academic Vascular Surgery Unit, Hull York Medical School, Hull, United Kingdom
| | - Sean Pymer
- Academic Vascular Surgery Unit, Hull York Medical School, Hull, United Kingdom
- Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom
| | - Said Ibeggazene
- Academic Vascular Surgery Unit, Hull York Medical School, Hull, United Kingdom
- Sheffield Hallam University, Sheffield, United Kingdom
| | - Ali Raza
- Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom
| | - Louise Hitchman
- Academic Vascular Surgery Unit, Hull York Medical School, Hull, United Kingdom
- Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgery Unit, Hull York Medical School, Hull, United Kingdom
- Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom
| | - George Smith
- Academic Vascular Surgery Unit, Hull York Medical School, Hull, United Kingdom
- Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom
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Pymer S, Harwood AE, Ibeggazene S, McGregor G, Huang C, Nicholls AR, Ingle L, Long J, Rooms M, Chetter IC, Twiddy M. High INtensity Interval Training in pATiEnts with Intermittent Claudication: A Qualitative Acceptability Study. Ann Vasc Surg 2024; 102:17-24. [PMID: 38301846 DOI: 10.1016/j.avsg.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND A novel high-intensity interval training (HIIT) program has demonstrated feasibility for patients with intermittent claudication (IC). The aim of this study was to explore patient perspectives of the HIIT program to inform refinement and future research. METHODS All patients screened and eligible for the 'high intensity interval training in patients with intermittent claudication (INITIATE)' study were eligible to take part in a semistructured interview. A convenience subsample of patients was selected from 3 distinct groups: 1) those who completed the HIIT program, 2) those who prematurely discontinued the HIIT program, and 3) those who declined the HIIT program. Interviews considered patients views of the program and experiences of undertaking and/or being invited to undertake it. Interviews were audio recorded, transcribed verbatim, and analyzed via thematic analysis. RESULTS Eleven out of 31 participants who completed the program and 12 out of 38 decliners were interviewed. No participants who withdrew from the program agreed to interview. The 3 key themes were; personal reflections of the program; program facilitators and barriers; and perceived benefits. Completers enjoyed taking part, reported symptomatic improvement and would complete it again. Practical and psychological barriers exist, such as transport and motivation. Changes to the program were suggested. CONCLUSIONS Findings support the acceptability of this novel HIIT program, which in combination with the feasibility findings, suggest that a fully powered randomized controlled trial, comparing HIIT to usual-care supervised exercise programs is warranted.
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Affiliation(s)
- Sean Pymer
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK.
| | - Amy E Harwood
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Saïd Ibeggazene
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Gordon McGregor
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK; Centre for Sport Exercise & Life Sciences, Coventry University, Coventry, UK; Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Chao Huang
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
| | - Adam R Nicholls
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lee Ingle
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Judith Long
- Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Marjorie Rooms
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Maureen Twiddy
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
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Gardner AW, Montgomery PS, Wang M, Liang M. Effects of Long-Term Home Exercise in Participants With Peripheral Artery Disease. J Am Heart Assoc 2023; 12:e029755. [PMID: 37929770 PMCID: PMC10727372 DOI: 10.1161/jaha.122.029755] [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: 04/11/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Background This randomized controlled trial compared long-term changes in peak walking time (PWT) and exercise time-to-minimum calf muscle oxygen saturation (StO2) in symptomatic participants with peripheral artery disease following a long-term home exercise program (HEP), a short-term supervised exercise therapy (SET) program that transitioned to a long-term HEP (SET/HEP), and a control intervention. Methods and Results For the first 3 months, HEP and SET/HEP groups performed intermittent walking to mild-to-moderate claudication pain, whereas the control group performed light resistance training. For the subsequent 15 months, the HEP group continued their exercise program, the SET/HEP group transitioned from SET to the HEP program, and the control group transitioned to only receive walking advice. PWT increased significantly from baseline to month 18 in the HEP group (408±279 meters to 814±393 meters, P<0.001) and in the SET/HEP group (457±288 meters to 818±313 meters, P<0.001). Exercise time-to-minimum calf muscle StO2 increased significantly from baseline to month 18 in the HEP group (238±241 seconds to 497±485 seconds, P<0.05) and in the SET/HEP group (296±289 seconds to 620±450 seconds, P<0.001). These changes in PWT and exercise time-to-minimum calf muscle StO2 were greater than in the control group (P<0.001 and P<0.01, respectively). Additionally, the change in exercise time-to-minimum calf muscle StO2 was correlated with the change in PWT in both exercise groups combined (r=0.601, P=0.0015). Conclusions Long-term HEP and SET/HEP were efficacious in improving PWT and exercise time-to-minimum calf muscle StO2 in symptomatic participants with peripheral artery disease, and these changes were correlated with each other. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00618670.
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Affiliation(s)
| | | | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of MedicineCase Western Reserve UniversityClevelandOHUSA
| | - Menglu Liang
- Department of Epidemiology and Biostatistics, School of Public HealthUniversity of MarylandCollege ParkMDUSA
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6
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Ulfsdottir H, Bäck M, Cider Å, Jivegård L, Sandberg A, Nordanstig J, Svensson M. Cost-Effectiveness of Exercise Therapy in Patients with Intermittent Claudication-A Comparison of Supervised Exercise, Home-Based Structured Exercise, and Walk Advice from the SUNFIT Trial. J Clin Med 2023; 12:5277. [PMID: 37629318 PMCID: PMC10455939 DOI: 10.3390/jcm12165277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Hospital-based supervised exercise (SEP) is a guideline-recommended intervention for patients with intermittent claudication (IC). However, due to the limited availability of SEP, home-based structured exercise programs (HSEP) have become increasingly popular alongside the "go home and walk" advice. We evaluated the cost-effectiveness of walk advice (WA) with Nordic pole walking vs. SEP combined with WA or HSEP combined with WA. We used data from the SUNFIT RCT (NCT02341716) to measure quality-adjusted life-years (QALYs) over a 12-month follow-up, and economic costs were obtained from a hospital cost-per-patient accounting system. Incremental cost-effectiveness ratios (ICERs) were calculated, and uncertainty was assessed using nonparametric bootstrapping. The average health-care-cost per patient was similar in the WA (EUR 1781, n = 51) and HSEP (EUR 1820, n = 48) groups but higher in the SEP group (EUR 4619, n = 50, p-value < 0.01). Mean QALYs per patient during the follow-up were similar with no statistically significant differences. The findings do not support SEP as a cost-effective treatment for IC, as it incurred significantly higher costs without providing additional health improvements over WA with or without HSEP during the one-year observation period. The analysis also suggested that HSEP may be cost-effective compared to WA, but only with a 64% probability.
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Affiliation(s)
- Hildigunnur Ulfsdottir
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Sidekick Health, 413 90 Gothenburg, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; (M.B.); (Å.C.); (A.S.)
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Åsa Cider
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; (M.B.); (Å.C.); (A.S.)
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Lennart Jivegård
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Health Technology Assessment Centre Region Västra Götaland, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Anna Sandberg
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; (M.B.); (Å.C.); (A.S.)
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Joakim Nordanstig
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Department of Vascular Surgery, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Mikael Svensson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA
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An Updated Systematic Review and Meta-Analysis of Home-based Exercise Programmes for Individuals with Intermittent Claudication. J Vasc Surg 2021; 74:2076-2085.e20. [PMID: 34087396 DOI: 10.1016/j.jvs.2021.03.063] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/26/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Supervised exercise programmes (SEP) are effective for improving walking distance in patients with intermittent claudication (IC) but provision and uptake rates are sub-optimal. Access to such programmes has also been halted by the Coronavirus pandemic. The aim of this review is to provide a comprehensive overview of the evidence for home-based exercise programmes (HEP). DATA SOURCES Medline, EMBASE, CINAHL, PEDro and Cochrane CENTRAL were searched for terms relating to HEP and IC. REVIEW METHODS This review was conducted in according with the published protocol and PRISMA guidance. Randomised and non-randomised trials that compared a HEP to SEP, basic exercise advice or no exercise controls for IC were included. A narrative synthesis was provided for all studies and meta-analyses conducted using data from randomised trials. The primary outcome was maximal walking distance. Sub-group analyses were performed to consider the effect of monitoring. Risk of bias was assessed using the Cochrane tool and quality of evidence via GRADE. RESULTS 23 studies with 1907 participants were included. Considering the narrative review, HEPs were inferior to SEPs which was reflected in the meta-analysis (MD 139m, 95% CI 45 to 232m, p = .004, very-low-quality evidence). Monitoring was an important component, as HEPs adopting this were equivalent to SEPs (MD: 8m, 95% CI -81 to 97, p = .86; moderate-quality evidence). For HEPs versus basic exercise advice, narrative review suggested HEPs can be superior, though not always significantly so. For HEPs versus no exercise controls, narrative review and meta-analysis suggested HEPs were potentially superior (MD: 136m, -2-273m p = .05, very-low-quality evidence). Monitoring was also a key element in these comparisons.Other elements such as appropriate frequency (≥3x a week), intensity (to moderate-maximum pain), duration (20 progressing to 60 minutes) and type (walking) of exercise were important, as was education, self-regulation, goal setting, feedback and action planning. CONCLUSION When SEPs are unavailable, HEPs are recommended. However, to elicit maximum benefit they should be structured, incorporating all elements of our evidence-based recommendations. PROSPERO REGISTRATION NUMBER CRD42018091248.
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Harwood AE, Pymer S, Ibeggazene S, Parmenter B, Chetter IC. Non-pharmaceutical alternatives or adjuncts to exercise programmes for people with intermittent claudication. Hippokratia 2021. [DOI: 10.1002/14651858.cd014677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Amy Elizabeth Harwood
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences; Coventry University; Coventry UK
- Academic Vascular Surgical Unit, Hull York Medical School; Hull University Teaching Hospitals NHS Trust; Hull UK
| | - Sean Pymer
- Academic Vascular Surgical Unit, Hull York Medical School; Hull University Teaching Hospitals NHS Trust; Hull UK
| | - Saïd Ibeggazene
- College of Health, Wellbeing and Life Sciences; Sheffield Hallam University; Sheffield UK
| | - Belinda Parmenter
- Department of Exercise Physiology, Faculty of Medicine; UNSW; Sydney Australia
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull York Medical School; Hull University Teaching Hospitals NHS Trust; Hull UK
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Cornelis N, Buys R, Dewit T, Benoit D, Claes J, Fourneau I, Cornelissen V. Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study. JMIR Rehabil Assist Technol 2021; 8:e18739. [PMID: 33749616 PMCID: PMC8108570 DOI: 10.2196/18739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Current guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice. OBJECTIVE The aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises. METHODS A total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests. RESULTS All patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients' questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered. CONCLUSIONS Patients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking. TRIAL REGISTRATION ClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546.
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Affiliation(s)
- Nils Cornelis
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Tijl Dewit
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Dries Benoit
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Cardiovascular Sciences, Vascular Surgery, KU Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
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Considering the Feasibility, Tolerability, and Safety of High-Intensity Interval Training as a Novel Treatment for Patients With Intermittent Claudication. J Cardiopulm Rehabil Prev 2020; 41:188-193. [PMID: 33186201 DOI: 10.1097/hcr.0000000000000551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE This study assessed the feasibility, tolerability, safety, and potential efficacy of a novel, 6-wk, high-intensity interval training (HIIT) program for patients with intermittent claudication (IC). METHODS Patients referred to a usual-care supervised exercise program were invited to undertake a HIIT program. All recruited patients performed a baseline cardiopulmonary exercise test (CPX) to inform their exercise prescription. HIIT involved 10, 1-min high-intensity cycling intervals interspersed with 1-min recovery intervals, performed 3 d/wk for 6 wk. Outcomes included feasibility, tolerability, safety, walking distance, and quality of life. RESULTS A total of 144 patients with IC were referred, 95 met initial eligibility criteria (66%) and 30 (32%) were recruited for HIIT, of which 15 (50%) completed. Of the recruited patients, 90% were on optimal medical therapy and 40% had concomitant cardiac, cerebrovascular, and/or respiratory disease. Patients who completed the program attended 100% of the sessions and one serious adverse event was recorded. Improvements in walking distances and quality of life were observed. Following recruitment of the first 20 patients, the inclusion criteria were refined on the basis of CPX, leading to improved completion rates. CONCLUSIONS This study provides preliminary findings indicating that patients with IC can complete a short-term HIIT program. We provide very early evidence that HIIT may be safe and well-tolerated. In addition, walking distances seem to improve following HIIT. After a small change in the exclusion criteria, the intervention and inclusion/exclusion criteria now seem appropriate for this population, meaning further research to evaluate HIIT in patients with IC is warranted.
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Impact of aerobic exercise type on blood flow, muscle energy metabolism, and mitochondrial biogenesis in experimental lower extremity artery disease. Sci Rep 2020; 10:14048. [PMID: 32820213 PMCID: PMC7441153 DOI: 10.1038/s41598-020-70961-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Exercise training (ET) is recommended for lower extremity artery disease (LEAD) management. However, there is still little information on the hemodynamic and metabolic adaptations by skeletal muscle with ET. We examined whether hindlimb perfusion/vascularization and muscle energy metabolism are altered differently by three types of aerobic ET. ApoE−/− mice with LEAD were assigned to one of four groups for 4 weeks: sedentary (SED), forced treadmill running (FTR), voluntary wheel running (VWR), or forced swimming (FS). Voluntary exercise capacity was improved and equally as efficient with FTR and VWR, but remained unchanged with FS. Neither ischemic hindlimb perfusion and oxygenation, nor arteriolar density and mRNA expression of arteriogenic-related genes differed between groups. 18FDG PET imaging revealed no difference in the steady-state levels of phosphorylated 18FDG in ischemic and non-ischemic hindlimb muscle between groups, nor was glycogen content or mRNA and protein expression of glucose metabolism-related genes in ischemic muscle modified. mRNA (but not protein) expression of lipid metabolism-related genes was upregulated across all exercise groups, particularly by non-ischemic muscle. Markers of mitochondrial content (mitochondrial DNA content and citrate synthase activity) as well as mRNA expression of mitochondrial biogenesis-related genes in muscle were not increased with ET. Contrary to FTR and VWR, swimming was ineffective in improving voluntary exercise capacity. The underlying hindlimb hemodynamics or muscle energy metabolism are unable to explain the benefits of running exercise.
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Pymer S, Harwood A, Ibeggazene S, McGregor G, Huang C, Twiddy M, Nicholls AR, Ingle L, Carroll S, Long J, Rooms M, Chetter IC. High INtensity Interval Training In pATiEnts with intermittent claudication (INITIATE): protocol for a multicentre, proof-of-concept, prospective interventional study. BMJ Open 2020; 10:e038825. [PMID: 32636290 PMCID: PMC7342853 DOI: 10.1136/bmjopen-2020-038825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The first-line recommended treatment for patients with intermittent claudication (IC) is a supervised exercise programme (SEP), which includes a minimum of 2-hours of exercise per week over a 12-week period. However, provision, uptake and adherence rates for these SEP programmes are poor, with time constraints cited as a common participant barrier. High-intensity interval training (HIIT) is more time-efficient and therefore has the potential to overcome this barrier. However, evidence is lacking for the role of HIIT in those with IC. This proof-of-concept study aims to consider the safety, feasibility, tolerability and acceptability of a HIIT programme for patients with IC. METHODS AND ANALYSIS This multicentre, single-group, prospective, interventional feasibility study will recruit 40 patients with IC, who will complete 6 weeks of HIIT, 3 times a week. HIIT will involve a supervised programme of 10×1 min high-intensity cycling intervals at 85%-90% peak power output (PPO), interspaced with 10×1 min low intensity intervals at 20%-25% PPO. PPO will be determined from a baseline cardiopulmonary exercise test (CPET) and it is intended that patients will achieve ≥85% of maximum heart rate from CPET, by the end of the second HIIT interval. Primary outcome measures are safety (occurrence of adverse events directly related to the study), programme feasibility (including participant eligibility, recruitment and completion rates) and HIIT tolerability (ability to achieve and maintain the required intensity). Secondary outcomes include patient acceptability, walking distance, CPET cardiorespiratory fitness measures and quality of life outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained via a local National Health Service research ethics committee (Bradford Leeds - 18/YH/0112) and recruitment began in August 2019 and will be completed in October 2020. Results will be published in peer-reviewed journals and presented at international conferences and are expected to inform a future pilot randomised controlled trial of HIIT versus usual-care SEPs. TRIAL REGISTRATION NUMBER NCT04042311; Pre-results.
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Affiliation(s)
- Sean Pymer
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Amy Harwood
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, New South Wales, UK
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Said Ibeggazene
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, New South Wales, UK
- Department of Cardiac Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chao Huang
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Adam R Nicholls
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Sean Carroll
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Judith Long
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | | | - I C Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
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Rezvani F, Heider D, Härter M, König HH, Bienert F, Brinkmann J, Herbarth L, Kramer E, Steinisch P, Freudenstein F, Terhalle R, Grosse Y, Bock S, Posselt J, Beutel C, Reif F, Kirchhoff F, Neuschwander C, Löffler F, Brunner L, Dickmeis P, Heidenthal T, Schmitz L, Chase DP, Seelenmeyer C, Alscher MD, Tegtbur U, Dirmaier J. Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation. BMJ Open 2020; 10:e032146. [PMID: 32503866 PMCID: PMC7279623 DOI: 10.1136/bmjopen-2019-032146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD. METHODS AND ANALYSIS The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Frank Bienert
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Julia Brinkmann
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Lutz Herbarth
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Edith Kramer
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | - René Terhalle
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Yvonne Grosse
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Susanne Bock
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | - Corinna Beutel
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Franziska Reif
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | | | | | | | | | | | | | - Claudia Seelenmeyer
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Mark Dominik Alscher
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Uwe Tegtbur
- Department of Sports Medicine, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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Intermittent Claudication in Physiotherapists' Practice. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2470801. [PMID: 31641667 PMCID: PMC6766680 DOI: 10.1155/2019/2470801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/05/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022]
Abstract
Intermittent claudication is a symptom of atherosclerosis of the lower limbs (peripheral arterial disease (PAD)) and is characterized by pain and cramps of lower limb muscles during exercise. Claudication leads to a reduction in physical activity of patients. PAD is a systemic disease. Atherosclerotic lesions located in the arteries of the lower limbs not only pose the risk of the ischemic limb loss, but above all, they are an important prognostic factor. Patients with claudication are at significant risk of cardiovascular complications such as infarcts or strokes. Comprehensive rehabilitation of patients with intermittent claudication based on the current TASC II (Inter-Society Consensus for the Management of Peripheral Arterial Disease) guidelines, ESC (European Society of Cardiology) guidelines, and AHA (American Heart Association) guidelines includes supervised treadmill training, training on a bicycle ergometer, Nordic Walking, resistance exercises of lower limb muscles, and exercises of upper limbs. A trained, educated, and motivated patient has a chance to improve life quality as well as life expectancy.
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Salinas JJ, Parra-Medina D. Physical activity change after a promotora-led intervention in low-income Mexican American women residing in South Texas. BMC Public Health 2019; 19:782. [PMID: 31221117 PMCID: PMC6585106 DOI: 10.1186/s12889-019-7105-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 06/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine physical activity (PA) preferences associated with increases in moderate-to-vigorous physical activity (MVPA) and decrease in sedentary time in Mexican American (MA) women participating in a Promotora (community health worker)-led intervention on the U.S.-Mexico border. METHODS Enlace ('to link' in Spanish) was a randomized clinical trial to increase PA in low-income, MA women living in South Texas on the U.S.-Mexico border. A total of 620 participants were recruited into the study. The primary outcome was increase in moderate to vigorous physical activity (MVPA) using the Actigraph GT3X 16 Mb accelerometer. A modified version of the Community Health Activities Model Program for Seniors Physical Activity (CHAMPS) instrument was used to predict MVPA. Adjusted and unadjusted logistic regression models predicted change in MVPA by change in CHAMPS activities. ANOVA analysis determined the variance explained in change in MVPA by change in time engaged in activity. Individual effect sizes were then calculated for significant activity type change on MVPA increase. RESULTS There were significant increases in all CHAMPS activities except aerobic machines and errand walking. An increase in leisure walking (O.R. = 2.76, p = .046), errand (O.R. = 3.53, p = .051), and brisk walking (O.R. = 4.74, p = .011), dance (O.R. = 8.22, p = .003), aerobics class (O.R. = 32.7, p = .001), and light housework (O.R. = 6.75, p = .000), were associated with a decrease in sedentary time. Significant effect sizes for MVPA were observed for jogging (1.2, p = .050), general exercise (1.6, p = .024), and other exercise not specified (2.6, p = .003). Significant effect sizes for sedentary time were detected for leisure time (.031, p = .036), errands (.017, p = .022), brisk walking (.022, p = .003), dance (.042, p = .005), and aerobics class (.013, p = .009). DISCUSSION Participants who engaged in walking and aerobic activities through this intervention significantly increased their engagement in MVPA and decreased their sedentary time. These findings are novel, since preferences have not been examined in relation to MVPA or sedentary time in MA women. CONCLUSION PA preferences need to be considered when aiming to promote activities that reduce sedentary time and increase PA participation among marginalized groups, such as MA women. TRIAL REGISTRATION NCT02046343 .
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Affiliation(s)
- Jennifer J. Salinas
- Department of Family Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, Center of Emphasis in Cancer Research, 9849 Kenworthy St, El Paso, TX 79924 USA
| | - Deborah Parra-Medina
- Latino Research Initiative, The University of Texas at Austin, 210 W. 24th Street, Mailcode F9200, GWB 2.102, Austin, Texas 78712 USA
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Akerman AP, Thomas KN, van Rij AM, Body ED, Alfadhel M, Cotter JD. Heat therapy vs. supervised exercise therapy for peripheral arterial disease: a 12-wk randomized, controlled trial. Am J Physiol Heart Circ Physiol 2019; 316:H1495-H1506. [DOI: 10.1152/ajpheart.00151.2019] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Peripheral arterial disease (PAD) is characterized by lower limb atherosclerosis impairing blood supply and causing walking-induced leg pain or claudication. Adherence to traditional exercise training programs is poor due to these symptoms despite exercise being a mainstay of conservative treatment. Heat therapy improves many cardiovascular health outcomes, so this study tested if this was a viable alternative cardiovascular therapy for PAD patients. Volunteers with PAD were randomized to 12 wk of heat ( n = 11; mean age 76 ± 8 yr, BMI 28.7 ± 3.5 kg/m2, 4 females) or exercise ( n = 11; 74 ± 10 yr, 28.5 ± 6.8 kg/m2, 3 females). Heat involved spa bathing at ∼39°C, 3–5 days/wk for ≤30 min, followed by ≤30 min of callisthenics. Exercise involved ≤90 min of supervised walking and gym-based exercise, 1–2 days/wk. Following the interventions, total walking distance during a 6-min walk test increased (from ∼350 m) by 41 m (95% CI: [13, 69], P = 0.006) regardless of group, and pain-free walking distance increased (from ∼170 m) by 43 m ([22, 63], P < 0.001). Systolic blood pressure was reduced more following heat (−7 mmHg, [−4, −10], P < 0.001) than following exercise (−3 mmHg, [0, −6], P = 0.078), and diastolic and mean arterial pressure decreased by 4 mmHg in both groups ( P = 0.002). There were no significant changes in blood volume, ankle-brachial index, or measures of vascular health. There were no differences in the improvement in functional or blood pressure outcomes between heat and exercise in individuals with PAD. NEW & NOTEWORTHY Heat therapy via hot-water immersion and supervised exercise both improved walking distance and resting blood pressure in peripheral arterial disease (PAD) patients over 12 wk. Adherence to heat therapy was excellent, and the heat intervention was well tolerated. The results of the current study indicate that heat therapy can improve functional ability and has potential as an effective cardiovascular conditioning tool for individuals with PAD. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/heat-therapy-vs-exercise-in-peripheral-arterial-disease/ .
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Affiliation(s)
- Ashley P. Akerman
- School of Physical Education, Sport, and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Kate N. Thomas
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Andre M. van Rij
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - E. Dianne Body
- Physiotherapy Department, Dunedin Public Hospital, Dunedin, New Zealand
| | - Mesfer Alfadhel
- Cardiology Department, Dunedin Public Hospital, Dunedin, New Zealand
| | - James D. Cotter
- School of Physical Education, Sport, and Exercise Sciences, University of Otago, Dunedin, New Zealand
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Galea Holmes MN, Weinman JA, Bearne LM. A randomized controlled feasibility trial of a home-based walking behavior-change intervention for people with intermittent claudication. JOURNAL OF VASCULAR NURSING 2019; 37:135-143. [PMID: 31155161 DOI: 10.1016/j.jvn.2018.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
Walking treatment is recommended for improving intermittent claudication (IC), a debilitating symptom of leg pain caused by peripheral arterial disease. However, center-based exercise programs offered in a community or hospital setting are often not implemented or adhered to. We developed a home-delivered behavior-change intervention, MOtivating Structured walking Activity in Intermittent Claudication (MOSAIC), to increase walking in people with IC. A feasibility randomized controlled trial with nested qualitative interviews involving a subsample of trial participants was conducted. Feasibility criteria evaluated participant recruitment and retention; suitability of proposed outcome measures; and acceptability and adherence to the intervention and trial. Participants (adults aged ≥18 years diagnosed with IC identified from vascular outpatient clinics) were randomized 1:1 to receive MOSAIC treatment (two 60-minute home-based sessions and two 20-minute booster telephone calls incorporating behavior-change techniques) or an attention-control comparison. Outcomes (baseline and 16-week follow-up) included the 6-minute walking distance (meters), pedometer-assessed daily walking activity (steps/d), health-related quality of life, physical functioning, and beliefs about walking treatment, peripheral arterial disease, and self-regulatory processes. Twenty-four participants (mean age: 66.8 ± 9.4 years, 79% male) were included. Feasibility criteria achieved were recruitment rate (25%), participant retention (92%), and adherence to assigned treatment or attention-control sessions (71%). Missing data rates were <10% for all outcomes except for baseline daily walking activity (36%). The trial protocol and interventions were acceptable to participants and the clinician. In conclusion, the MOSAIC trial was feasible to conduct, with the exception of high missing pedometer data. The intervention is an acceptable approach to facilitate walking among people with IC.
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Affiliation(s)
- Melissa N Galea Holmes
- School of Population Health & Environmental Sciences, King's College London, Guy's Campus, London, United Kingdom.
| | - John A Weinman
- Institute of Pharmaceutical Sciences, King's College London, King's College London, Waterloo Campus, London, United Kingdom
| | - Lindsay M Bearne
- School of Population Health & Environmental Sciences, King's College London, Guy's Campus, London, United Kingdom
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Kropielnicka K, Dziubek W, Bulińska K, Stefańska M, Wojcieszczyk-Latos J, Jasiński R, Pilch U, Dąbrowska G, Skórkowska-Telichowska K, Kałka D, Janus A, Zywar K, Paszkowski R, Rachwalik A, Woźniewski M, Szuba A. Influence of the Physical Training on Muscle Function and Walking Distance in Symptomatic Peripheral Arterial Disease in Elderly. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1937527. [PMID: 30345295 PMCID: PMC6174806 DOI: 10.1155/2018/1937527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/10/2018] [Accepted: 07/25/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A typical symptom of chronic lower-limb ischaemia is lower-limb pain, which occurs during walking forcing the patient to stop, intermittent claudication (IC). Exercise rehabilitation is the basic form of treatment for these patients. AIM The aim of this study was to compare the effectiveness of three types of physical training programmes conducted over a 12-week period in patients with chronic lower-limb arterial insufficiency. MATERIALS AND METHODS Ninety-five people qualified for the 3-month supervised motor rehabilitation programme, conducted three times a week. The respondents were assigned to three types of rehabilitation programmes using a pseudo-randomization method: Group I (TW), subjects undertaking treadmill walking training; Group II (NW), subjects undertaking Nordic walking training; Group III (RES+NW), subjects undertaking resistance and Nordic walking training. Treadmill test, 6 Minute Walk Test (6MWT), and isokinetic test were repeated after 3 months of rehabilitation, which 80 people completed. RESULTS Combined training (RES+NW) is more effective than Nordic walking alone and supervised treadmill training alone for improving ankle force-velocity parameters (p<0.05) in patients with intermittent claudication. Each of the proposed exercise rehabilitation programmes increased walking distance of patients with intermittent claudication (p<0.05), especially in 6MWT (p=0.001). Significant relationships of force-velocity parameters are observed in the maximum distance obtained in 6MWT, both in Group III (RES + NW) and in Group II (NW) at the level of moderate and strong correlation strength, which indicates that if the lower limbs are stronger the walking distance achieved in 6MWT is longer. CONCLUSIONS Given both the force-velocity parameters and the covered distance, the training RES + NW gives the most beneficial changes compared to training TW alone and NW alone. All types of training increased walking distance, which is an important aspect of the everyday functioning of people with IC.
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Affiliation(s)
- Katarzyna Kropielnicka
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Wioletta Dziubek
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Katarzyna Bulińska
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
- WROVASC–an Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, ul. H. Kamińskiego 73a, 51-124 Wroclaw, Poland
| | - Małgorzata Stefańska
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Joanna Wojcieszczyk-Latos
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Ryszard Jasiński
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Urszula Pilch
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Grażyna Dąbrowska
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Katarzyna Skórkowska-Telichowska
- WROVASC–an Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, ul. H. Kamińskiego 73a, 51-124 Wroclaw, Poland
| | - Dariusz Kałka
- Medical University of Wroclaw, Department of Pathophysiology, ul. Marcinkowskiego 1, 50-368 Wroclaw, Poland
| | - Agnieszka Janus
- Wrocław Medical University Department of Internal Medicine, Occupational Diseases and Hypertension, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Katarzyna Zywar
- WROVASC–an Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, ul. H. Kamińskiego 73a, 51-124 Wroclaw, Poland
- Specialist District Hospital in Wroclaw, Department of Angiology, ul. Kamieńskiego 73a, 51-124 Wroclaw, Poland
| | - Rafał Paszkowski
- WROVASC–an Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, ul. H. Kamińskiego 73a, 51-124 Wroclaw, Poland
- Specialist District Hospital in Wroclaw, Department of Angiology, ul. Kamieńskiego 73a, 51-124 Wroclaw, Poland
| | - Anna Rachwalik
- WROVASC–an Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, ul. H. Kamińskiego 73a, 51-124 Wroclaw, Poland
- Specialist District Hospital in Wroclaw, Department of Angiology, ul. Kamieńskiego 73a, 51-124 Wroclaw, Poland
| | - Marek Woźniewski
- Faculty of Physiotherapy, University School of Physical Education, al. I. J. Paderewskiego 35, 51-612 Wroclaw, Poland
| | - Andrzej Szuba
- WROVASC–an Integrated Cardiovascular Centre, Specialist District Hospital in Wroclaw, Centre for Research and Development, ul. H. Kamińskiego 73a, 51-124 Wroclaw, Poland
- 4th Military Clinical Hospital with a Polyclinic in Wroclaw, Department of Internal Medicine, ul. Weigla 5, 50-981 Wroclaw, Poland
- Medical University of Wroclaw, Division of Angiology, Bartla 5 Str., 51-618 Wroclaw, Poland
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