Update on peripheral arterial disease and claudication rehabilitation

Effects of 12 Weeks of Supervised Exercise After Endovascular Treatment: A Randomized Clinical Trial

BACKGROUND AND PURPOSE

This study aimed to assess the effects of supervised exercise training (SET) after percutaneous transluminal angioplasty (PTA) compared with PTA alone on physical function, limb hemodynamics and health-related quality of life in patients with intermittent claudication.

METHODS

Fifty patients who all underwent PTA for intermittent claudication were included in the study. Both groups received usual post-operative care. In addition, the intervention group performed two sessions of hospital-based SET and one home-based exercise session per week for 12 weeks after PTA. The control group did not receive any additional follow-up regarding exercise. The primary outcome was the result of a standardized 6-minute walk test. Secondary outcomes were the treadmill maximum walking distance, treadmill pain-free walking distance, ankle-brachial index, pulse volume recording on the leg and ultrasound scanning. Health-related quality of life was measured using the Short Form 36 and the Claudication Scale.

RESULTS

All measures, except for the Short Form 36 domain of mental health, showed statistically significant positive changes from baseline to 3 months for both groups (p < 0.05). At 3 months, there was a trend towards better results for the intervention group compared with the control group. The median improvement from baseline to 3 months for the 6-minute walk test was 66 m for the intervention group and 45 m for the control group. For maximum walking distance, the median improvement was 251 m for the intervention group and 93 m for the control group.

DISCUSSION

Supervised exercise training after endovascular treatment for patients with intermittent claudication led to greater positive changes after 3 months in the intervention group compared with the control group. The present study's trends of better results with SET after PTA add to the emerging existing evidence, which should encourage physiotherapy practice to offer SET for this patient group.

Heel-rise test in the assessment of individuals with peripheral arterial occlusive disease

INTRODUCTION

The heel-rise test (HRT) is a clinical instrument relevant to vascular rehabilitation that has been proposed to assess the function of the triceps surae muscle. To use HRT in the assessment of individuals with peripheral arterial occlusive disease (PAOD), its ability to detect differences in the functional performance of patients with PAOD must be verified.

AIM

To verify whether the test is sensitive in differentiating between individuals with PAOD with distinct functional capacities.

MATERIALS AND METHODS

A transversal study in which individuals with PAOD were assessed using the HRT, the Walking Impairment Questionnaire (WIQ), and the Shuttle Walk Test. The following variables were analyzed: number of plantar flexions performed in the HRT (time in seconds) and velocity (plantar flexions per second) when performing plantar flexions up to the point of volunteer fatigue, maximum distance walked in the Shuttle Walk Test, and scores obtained in each WIQ domain.

RESULTS

Twenty-five individuals (14 male) were included in the study, with a mean age of 63.36 ± 9.83 years. The variables number of plantar flexions and time to perform the HRT were sensitive enough to differentiate between distinct functional capacities in individuals with PAOD (P = 0.003 and P = 0.009, respectively). However, this result was not found for the variable of velocity in the HRT. The number of plantar flexions in the HRT was sensitive enough to differentiate individuals of extreme classes on the WIQ domain, stairs (P = 0.008).

CONCLUSION

The HRT can be applied in clinical practice as a valid assessment of the distinct function capacities of individuals with PAOD.