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Rahman H, Leutzinger T, Hassan M, Schieber M, Koutakis P, Fuglestad MA, DeSpiegelaere H, Longo GM, Malcolm P, Johanning JM, Casale GP, Pipinos II, Myers SA. Peripheral artery disease causes consistent gait irregularities regardless of the location of leg claudication pain. Ann Phys Rehabil Med 2024; 67:101793. [PMID: 38118246 PMCID: PMC11009086 DOI: 10.1016/j.rehab.2023.101793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND The most common symptom of peripheral artery disease (PAD) is intermittent claudication that involves the calf, thigh, and/or buttock muscles. How the specific location of this leg pain is related to altered gait, however, is unknown. OBJECTIVES We hypothesized that because the location of claudication symptoms uniquely affects different leg muscle groups in people with PAD, this would produce distinctive walking patterns. METHODS A total of 105 participants with PAD and 35 age-matched older volunteers without PAD (CTRL) were recruited. Participants completed walking impairment questionnaires (WIQ), Gardner-Skinner progressive treadmill tests, the six-minute walk test, and we performed an advanced evaluation of the biomechanics of their overground walking. Participants with PAD were categorized into 4 groups according to their stated pain location(s): calf only (C, n = 43); thigh and calf (TC, n = 18); buttock and calf (BC, n = 15); or buttock, thigh, and calf (BTC, n = 29). Outcomes were compared between CTRL, C, TC, BC and BTC groups using a one-way ANOVA with post-hoc comparisons to identify and assess statistically significant differences. RESULTS There were no significant differences between CTRL, C, TC, BC and BTC groups in distances walked or walking speed when either pain-free or experiencing claudication pain. Each participant with PAD had significantly dysfunctional biomechanical gait parameters, even when pain-free, when compared to CTRL (pain-free) walking data. During pain-free walking, out of the 18 gait parameters evaluated, we only identified significant differences in hip power generation during push-off (in C and TC groups) and in knee power absorption during weight acceptance (in TC and BC groups). There were no between-group differences in gait parameters while people with PAD were walking with claudication pain. CONCLUSIONS Our data demonstrate that PAD affects the ischemic lower extremities in a diffuse manner irrespective of the location of claudication symptoms. DATABASE REGISTRATION ClinicalTrials.gov NCT01970332.
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Affiliation(s)
- Hafizur Rahman
- School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA; Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - Todd Leutzinger
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - Molly Schieber
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Matthew A Fuglestad
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Holly DeSpiegelaere
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - G Matthew Longo
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Johanning
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA.
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Maktouf W, Ferhi H, Boyas S, Beaune B, Gaied Chortane S, Portero P, Durand S. The influence of obesity and fat distribution on ankle muscle coactivation during gait. PLoS One 2024; 19:e0294692. [PMID: 38507359 PMCID: PMC10954167 DOI: 10.1371/journal.pone.0294692] [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: 05/23/2023] [Accepted: 11/07/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Excessive body weight is associated with gait alterations. In none of previous studies, body fat distribution has been considered as a factor that could change gait parameters and induce different neuromuscular adaptations. OBJECTIVE This multicenter, analytical, and cross-sectional study aimed to investigate the influence of the body mass distribution on gait parameters and ankle muscle coactivation in obese individuals. METHODS Three distinct groups were included in the study: a non-obese control group (CG, n = 15, average age = 32.8 ± 6.5 years, BMI = 21.4 ± 2.2 kg/m2), an obese-android group characterized by a Waist to Hip Ratio (WHR) greater than 1 (OAG, n = 15, age = 32.4 ± 3.9 years, BMI = 41.4 ± 3.9 kg/m2, WHR = 1.2 ± 0.2), and an obese-gynoid group with a WHR less than 1 (OGG, n = 15, age = 35.4 ± 4.1 years, BMI = 40.0 ± 5.7 kg/m2, WHR = 0.82 ± 0.3). All participants walked on an instrumented gait analysis treadmill at their self-selected walking speed for one minute. Spatiotemporal parameters, walking cycle phases, vertical ground reaction force (GRFv) and center of pressure (CoP) velocity were sampled from the treadmill software. Electromyography (EMG) activity of the gastrocnemius medialis (GM), the soleus (SOL) and tibialis anterior (TA) were collected during walking and used to calculate coactivation indexes (CI) between ankle plantar and dorsal flexors (GM/TA and SOL/TA) for the different walking cycle phases. RESULTS Compared to OAG, OGG walked with shorter and larger strides, lower CoP velocity and GRFv. During the single support phase, SOL/TA coactivation was higher in OAG compared to OGG (p < .05). During the propulsion phase, SOL/TA coactivation was higher in OGG compared to OAG (p < .05). CONCLUSION Gait parameters and ankle muscle coactivation in obese individuals seem to be strongly dependent on body mass distribution. From the biomechanical point of view, body mass distribution changes gait strategies in obese individuals inducing different neuromuscular adaptations during the single support and propulsion phases.
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Affiliation(s)
- Wael Maktouf
- Bioengineering, Tissues and Neuroplasticity, UR 7377, Université Paris-Est Créteil, Faculté de Médecine, Créteil, France
| | - Hamza Ferhi
- Research Unit (UR17JS01) « Sport Performance, Health & Society », Higher Institute of Sport and Physical Education of Ksar Saîd, University of “La Manouba”, Tunis, Tunisia
| | - Sébastien Boyas
- Department of Sport Sciences, Laboratory “Movement, Interactions, Performance” (UR 4334), Faculty of Sciences and Technologies, Le Mans University, Le Mans, France
| | - Bruno Beaune
- Department of Sport Sciences, Laboratory “Movement, Interactions, Performance” (UR 4334), Faculty of Sciences and Technologies, Le Mans University, Le Mans, France
| | - Sabri Gaied Chortane
- Research Unit (UR17JS01) « Sport Performance, Health & Society », Higher Institute of Sport and Physical Education of Ksar Saîd, University of “La Manouba”, Tunis, Tunisia
| | - Pierre Portero
- Bioengineering, Tissues and Neuroplasticity, UR 7377, Université Paris-Est Créteil, Faculté de Médecine, Créteil, France
| | - Sylvain Durand
- Department of Sport Sciences, Laboratory “Movement, Interactions, Performance” (UR 4334), Faculty of Sciences and Technologies, Le Mans University, Le Mans, France
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Jor A, Lau NWK, Daryabor A, Kobayashi T. Effects of ankle-foot orthoses on step activities in the community: a systematic review. Disabil Rehabil 2024; 46:464-477. [PMID: 36710007 DOI: 10.1080/09638288.2023.2169774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders. METHODS Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale. RESULTS Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life. CONCLUSIONS Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity.IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex.AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity.The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity.
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Affiliation(s)
- Abu Jor
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Noelle W K Lau
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aliyeh Daryabor
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Poredos P, Stanek A, Catalano M, Boc V. Ankle-Brachial Index: Diagnostic Tool of Peripheral Arterial Disease and Predictor of Cardiovascular Risk-An Update of Current Knowledge. Angiology 2024:33197241226512. [PMID: 38176685 DOI: 10.1177/00033197241226512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The ankle-brachial index (ABI) was introduced as a screening method for the diagnosis of lower extremity peripheral arterial disease (PAD). Later findings recognized ABI as a prognostic marker of adverse cardiovascular events due to its relation to atherosclerosis in other vascular territories. This narrative review aims to appraise the validity, reliability, and utility of ABI in the detection of PAD and the determination of global atherosclerotic cardiovascular risk. While the ABI value can be influenced by different physiological characteristics including age, sex, body position, and techniques used for ABI determination, it has high specificity and reproducibility in the assessment of vascular patients. In conclusion, when used correctly, the ABI remains a reliable and invaluable indicator of lower-limb perfusion and a useful tool for predicting the risk of future cardiovascular events. However, its underutilization in clinical settings is noteworthy.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
| | - Agata Stanek
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Mariella Catalano
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
- Inter-University Research Centre on Vascular Diseases, University of Milan, Milan, Italy
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Bapat GM, Bashir AZ, Malcolm P, Johanning JM, Pipinos II, Myers SA. A biomechanical perspective on walking in patients with peripheral artery disease. Vasc Med 2023; 28:77-84. [PMID: 36759931 PMCID: PMC9997455 DOI: 10.1177/1358863x221146207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The most common symptom of peripheral artery disease (PAD) is intermittent claudication, which consists of debilitating leg pain during walking. In clinical settings, the presence of PAD is often noninvasively evaluated using the ankle-brachial index and imaging of the arterial supply. Furthermore, various questionnaires and functional tests are commonly used to measure the severity and negative effect of PAD on quality of life. However, these evaluations only provide information on vascular insufficiency and severity of the disease, but not regarding the complex mechanisms underlying walking impairments in patients with PAD. Biomechanical analyses using motion capture and ground reaction force measurements can provide insight into the underlying mechanisms to walking impairments in PAD. This review analyzes the application of biomechanics tools to identify gait impairments and their clinical implications on rehabilitation of patients with PAD. A total of 18 published journal articles focused on gait biomechanics in patients with PAD were studied. This narriative review shows that the gait of patients with PAD is impaired from the first steps that a patient takes and deteriorates further after the onset of claudication leg pain. These results point toward impaired muscle function across the ankle, knee, and hip joints during walking. Gait analysis helps understand the mechanisms operating in PAD and could also facilitate earlier diagnosis, better treatment, and slower progression of PAD.
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Affiliation(s)
- Ganesh M Bapat
- Department of Mechanical Engineering, BITS Pilani K K Birla Goa Campus, Goa, India
| | - Ayisha Z Bashir
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.,Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
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Nishikawa K, Ebisawa S, Miura T, Kato T, Yusuke K, Abe N, Yokota D, Yanagisawa T, Senda K, Wakabayashi T, Oyama Y, Karube K, Itagaki T, Yui H, Maruyama S, Nagae A, Sakai T, Okina Y, Nakazawa S, Tsukada S, Saigusa T, Okada A, Motoki H, Kagoshima M, Kuwahara K. Impact of Frailty and Age on Clinical Outcomes in Patients Who Underwent Endovascular Therapy. J Endovasc Ther 2022; 29:845-854. [PMID: 34969317 DOI: 10.1177/15266028211067729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Information on the relationship between frailty and the outcome of endovascular therapy (EVT) in elderly patients with lower extremity peripheral artery disease (PAD) is scarce. This study aimed to reveal the impact of frailty on the prognosis of super-elderly patients who underwent EVT. MATERIALS AND METHODS From August 2015 to August 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we categorized 323 patients into 4 groups according to age and the presence or absence of frailty as follows: elderly with frailty (age ≥ 75, Clinical Frailty Scale [CFS] ≥ 5), elderly without frailty (age ≥ 75, CFS ≤ 4), young with frailty (age < 75, CFS ≥ 5), and young without frailty (age < 75, CFS ≤ 4); we analyzed them accordingly. The primary endpoints were major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation, and revascularization. The secondary endpoint was cardiovascular death. RESULTS The median follow-up period was 2.7 years. In the elderly with frailty, elderly without frailty, young with frailty, and young without frailty groups, the freedom rates from MACLE were 34.9%, 55.7%, 35.4%, and 63.0%, respectively (p<0.001) and from all-cause death were 43.5%, 73.4%, 50.7%, and 90.9%, respectively (p<0.001). The freedom rates from MACLE were significantly higher among elderly patients with frailty than among young patients without frailty (55.7% vs 35.4%, p=0.01). In multivariate analysis, frailty was independently associated with MACLE incidence. CONCLUSION Frailty as defined by CFS might be a predictor of MACLE incidence in patients with PAD who underwent EVT. By considering treatment indications for patients with PAD by focusing on frailty rather than age, we may examine whether EVT policies are appropriate and manage patient and caregiver expectations for potential improvement in functional outcomes. Further studies are expected to investigate whether changes in frailty after EVT change prognosis.
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Affiliation(s)
- Ken Nishikawa
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takashi Miura
- Department of Cardiovascular Medicine, Nagano Municipal Hospital, Nagano, Japan
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Kanzaki Yusuke
- Department of Cardiovascular Medicine, Shinonoi General Hospital, Nagano, Japan
| | - Naoyuki Abe
- Department of Cardiovascular Medicine, Japanese Red Cross Society Nagano Hospital, Nagano, Japan
| | - Daisuke Yokota
- Department of Cardiovascular Medicine, Iida Hospital, Nagano, Japan
| | - Takashi Yanagisawa
- Department of Cardiovascular Medicine, Saku Central Hospital, Nagano, Japan
| | - Keisuke Senda
- Department of Cardiovascular Medicine, Aizawa Hospital, Nagano, Japan
| | | | - Yushi Oyama
- Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Kenichi Karube
- Department of Cardiovascular Medicine, Okaya City Hospital, Nagano, Japan
| | - Tadashi Itagaki
- Department of Cardiovascular Medicine, Ina Central Hospital, Nagano, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yoshiteru Okina
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Shun Nakazawa
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Shunichi Tsukada
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Mitsuru Kagoshima
- Department of Cardiovascular Medicine, Joetsu General Hospital, Niigata, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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Al-Ramini A, Hassan M, Fallahtafti F, Takallou MA, Rahman H, Qolomany B, Pipinos II, Alsaleem F, Myers SA. Machine Learning-Based Peripheral Artery Disease Identification Using Laboratory-Based Gait Data. SENSORS (BASEL, SWITZERLAND) 2022; 22:7432. [PMID: 36236533 PMCID: PMC9572112 DOI: 10.3390/s22197432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 05/15/2023]
Abstract
Peripheral artery disease (PAD) manifests from atherosclerosis, which limits blood flow to the legs and causes changes in muscle structure and function, and in gait performance. PAD is underdiagnosed, which delays treatment and worsens clinical outcomes. To overcome this challenge, the purpose of this study is to develop machine learning (ML) models that distinguish individuals with and without PAD. This is the first step to using ML to identify those with PAD risk early. We built ML models based on previously acquired overground walking biomechanics data from patients with PAD and healthy controls. Gait signatures were characterized using ankle, knee, and hip joint angles, torques, and powers, as well as ground reaction forces (GRF). ML was able to classify those with and without PAD using Neural Networks or Random Forest algorithms with 89% accuracy (0.64 Matthew's Correlation Coefficient) using all laboratory-based gait variables. Moreover, models using only GRF variables provided up to 87% accuracy (0.64 Matthew's Correlation Coefficient). These results indicate that ML models can classify those with and without PAD using gait signatures with acceptable performance. Results also show that an ML gait signature model that uses GRF features delivers the most informative data for PAD classification.
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Affiliation(s)
- Ali Al-Ramini
- Mechanical Engineering Department, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Mohammad Ali Takallou
- Durham School of Architectural Engineering and Construction, University of Nebraska–Lincoln, Omaha, NE 68182, USA
| | - Hafizur Rahman
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
| | - Basheer Qolomany
- Cyber Systems Department, University of Nebraska at Kearney, Kearney, NE 68849, USA
| | - Iraklis I. Pipinos
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Fadi Alsaleem
- Durham School of Architectural Engineering and Construction, University of Nebraska–Lincoln, Omaha, NE 68182, USA
| | - Sara A. Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
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8
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Barden JM, Hoffert L, Ruf S, McCarville D, Kopriva D. The effect of peripheral arterial disease and intermittent claudication on gait regularity and symmetry. J Biomech 2022; 141:111205. [PMID: 35759975 DOI: 10.1016/j.jbiomech.2022.111205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
Peripheral arterial disease (PAD) affects 20-30% of older adults and is associated with intermittent claudication (IC), which is walking-induced pain. This study compared the regularity and symmetry of gait between healthy older adults and adults with PAD, and between IC and non-IC conditions in the PAD group. Eighteen control (70.7 ± 6.3 years) and 11 PAD participants (67.0 ± 10.1 years) walked overground at a continuous, self-selected speed. A waist-mounted accelerometer determined step time, stride time, gait speed and mediolateral (ML), vertical (V) and anteroposterior (AP) gait regularity (step/stride) and symmetry. Correlations between ankle-brachial index (ABI) scores and PAD gait regularity/symmetry were also investigated. PAD step and stride times were greater (p < 0.01), while gait speed, ML and AP step regularity and ML and V stride regularity were significantly less than the controls (p < 0.05). There were no significant differences in gait symmetry. Within the PAD group, post-IC step/stride time and speed increased and decreased, respectively, (p < 0.05), while post-IC step and stride regularity were significantly less in all three directions (p < 0.01). Similarly, ML and V post-IC gait asymmetry increased significantly (p < 0.05). ABI was significantly correlated with pre-and post-IC vertical stride regularity (p < 0.01), and with pre- and post-IC ML gait symmetry (p < 0.05). The results demonstrate that gait regularity decreases as a result of PAD and IC. The association between gait regularity/symmetry and ABI should be investigated further, as it may have clinical application to the assessment of PAD severity.
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Affiliation(s)
- John M Barden
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada.
| | - Lucas Hoffert
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Sarah Ruf
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - Don McCarville
- Division of Vascular Surgery, Saskatchewan Health Authority, Regina, SK, Canada.
| | - David Kopriva
- Division of Vascular Surgery, Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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9
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Guilleron C, Abraham P, Beaune B, Pouliquen C, Henni S, Durand S. Location of ischemia and ischemic pain intensity affect spatiotemporal parameters and leg muscles activity during walking in patients with intermittent claudication. Sci Rep 2021; 11:6809. [PMID: 33762658 PMCID: PMC7990938 DOI: 10.1038/s41598-021-86351-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/07/2021] [Indexed: 12/31/2022] Open
Abstract
The ways in which locations of ischemia and ischemic pain affect spatiotemporal gait parameters and leg electromyographic activity during walking have never been investigated in patients with peripheral arterial disease presenting intermittent claudication. Two groups were classified according to unilateral location of ischemia (distal, n = 10, or proximo-distal, n = 12). Patients described pain and three gait phases-initial pain-free, onset of pain and maximum pain-were analyzed. Patients with proximo-distal ischemia walked less (230 ± 111 m vs 384 ± 220 m), with increased step length, step time (+ 5.4% and + 5.8%) and reduced cadence (- 8.2%), than patients with distal ischemia. In both, the peaks of vertical ground reaction force were reduced in maximum pain (Peak1-distal: - 11.4%, Peak1-proximo-distal: - 10.3%; Peak2-distal: - 11.8%, Peak2-proximo-distal: - 9.0%). In the proximo-distal group, tibialis anterior activation peak and time were lower than in the distal group (- 4.5% and - 19.7%). During the maximum pain phase, this peak decreased only in the proximo-distal group (- 13.0%), and gastrocnemius medialis activation peak and time decreased in both groups (- 2.5% in distal and - 4.5% in proximo-distal). Thus, proximo-distal ischemia leads to more adverse consequences in gait than distal ischemia only. Increasing ischemic pain until maximum, but not onset of pain, induced gait adaptations.
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Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France.,UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France.,Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France
| | - Pierre Abraham
- Sports Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France.,UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Bruno Beaune
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France
| | - Camille Pouliquen
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France.,Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sylvain Durand
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France. .,Laboratory "Movement, Interactions, Performance", MIP, EA 4334, Le Mans University, Avenue Olivier Messiaen, 72085, Le Mans Cedex 9, France.
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10
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Nayak P, Guralnik JM, Polonsky TS, Kibbe MR, Tian L, Zhao L, Criqui MH, Ferrucci L, Li L, Zhang D, McDermott MM. Association of six-minute walk distance with subsequent lower extremity events in peripheral artery disease. Vasc Med 2020; 25:319-327. [DOI: 10.1177/1358863x20901599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognostic significance of the six-minute walk distance for lower extremity events in people with peripheral artery disease (PAD) is unknown. This longitudinal study assessed whether a poorer six-minute walk distance at baseline was associated with higher rates of subsequent lower extremity atherosclerotic disease events in PAD. A total of 369 patients (mean age 69.4 ± 10.0 years; mean ankle–brachial index (ABI) 0.67 ± 0.17; 31% women; 30% black individuals) from Chicago-area medical centers with PAD were enrolled. Participants underwent baseline six-minute walk testing and returned for annual study visits. Lower extremity events consisted of one or more of the following: ABI decline greater than 15% or medical record adjudicated lower extremity revascularization, critical limb ischemia, or amputation. At a mean follow-up of 33.3 months, lower extremity events occurred in 66/123 (53.7%) people in the first (worst) tertile of six-minute walk performance, 55/124 (44.4%) in the second tertile, and 56/122 (45.9%) in the third (best) tertile. After adjusting for age, sex, race, ABI, comorbidities, and other confounders, participants in the first (worst) tertile of six-minute walk distance at baseline had higher rates of lower extremity events during follow-up, compared to those in the best tertile at baseline (HR = 1.74, 95% CI 1.17–2.60, p = 0.0067). Among people with PAD, a poorer six-minute walk distance was associated with higher rates of subsequent lower extremity PAD-related events after adjusting for confounders. Further study is needed to determine whether interventions that improve six-minute walk distance can reduce lower extremity adverse events in people with PAD.
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Affiliation(s)
- Pooja Nayak
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, Baltimore, MD, USA
| | | | - Melina R Kibbe
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Lu Tian
- Department of Biomedical Science Data, Stanford University, Palo Alto, CA, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health University of California San Diego, La Jolla, CA, USA
| | - Luigi Ferrucci
- National Institute on Aging Division of Intramural Research, Baltimore, MD, USA
| | - Lingyu Li
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dongxue Zhang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary M McDermott
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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11
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McDermott MM, Kibbe MR, Guralnik JM, Ferrucci L, Criqui MH, Domanchuk K, Tian L, Zhao L, Li L, Patel K, Polonsky TS. Durability of Benefits From Supervised Treadmill Exercise in People With Peripheral Artery Disease. J Am Heart Assoc 2020; 8:e009380. [PMID: 30587066 PMCID: PMC6405705 DOI: 10.1161/jaha.118.009380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It is currently unknown whether 6 months of supervised treadmill exercise has a durable benefit on 6-minute walk performance, even after exercise is completed, in people with peripheral artery disease. Methods and Results A total of 156 participants with peripheral artery disease were randomized to 1 of 3 groups: supervised treadmill exercise, supervised resistance training, or attention control. Participants received supervised sessions during months 1 to 6 and telephone contact during months 6 to 12. Primary outcomes were change in 6-minute walk distance and short physical performance battery at 6-month follow-up and have been reported previously. Secondary outcomes were change in 6-minute walk and short physical performance battery at 12-month follow-up and are reported here. A group of 134 participants (86%) completed the 12-month follow-up. At 6-month follow-up, compared with control, 6-minute walk distance improved in the treadmill exercise group (+36.1 m, 95% CI =13.9-58.3, P=0.001). Between 6- and 12-month follow-up, 6-minute walk distance significantly declined (-28.6 m, 95% CI=-52.6 to -4.5, P=0.020) and physical activity declined -272 activity units (95% CI =-546 to +2, P=0.052) in the treadmill exercise group compared with controls. At 12-month follow-up, 6 months after completing supervised treadmill exercise, change in 6-minute walk distance was not different between the treadmill exercise and control groups (+7.5, 95% CI =-17.5 to +32.6, P=0.56). There were no differences in short physical performance battery change between either exercise group and control at 6-month or 12-month follow-up. Conclusions A 6-month supervised treadmill exercise intervention that improved 6-minute walk distance at 6-month follow-up did not have persistent benefit at 12-month follow-up. These results do not support a durable benefit of supervised treadmill exercise in peripheral artery disease. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Identifier: NCT 00106327.
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Affiliation(s)
- Mary M McDermott
- 1 Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.,2 Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Melina R Kibbe
- 3 Department of Surgery University of North Carolina Chapel Hill NC
| | - Jack M Guralnik
- 4 Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore MD
| | - Luigi Ferrucci
- 5 Longitudinal Studies Section of the Translational Gerontology Branch National Institute on Aging Baltimore MD
| | - Michael H Criqui
- 6 Department of Family Medicine and Public Health University of California San Diego La Jolla CA
| | - Kathryn Domanchuk
- 1 Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lu Tian
- 7 Department of Biomedical Data Science Stanford University Palo Alto CA
| | - Lihui Zhao
- 2 Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lingyu Li
- 1 Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Kruti Patel
- 8 University of Illinois College of Medicine at Chicago IL
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12
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McDermott MM, Guralnik JM, Tian L, Zhao L, Polonsky TS, Kibbe MR, Criqui MH, Zhang D, Conte MS, Domanchuk K, Li L, Sufit R, Leeuwenburgh C, Ferrucci L. Comparing 6-minute walk versus treadmill walking distance as outcomes in randomized trials of peripheral artery disease. J Vasc Surg 2019; 71:988-1001. [PMID: 31870756 DOI: 10.1016/j.jvs.2019.05.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Randomized trials of people with peripheral artery disease (PAD) and intermittent claudication have traditionally used maximal treadmill walking distance as the primary outcome, but the 6-minute walk test is increasingly used as a primary outcome in randomized trials of PAD. This study compared relative changes in maximal treadmill walking distance versus 6-minute walk distance in response to a therapeutic intervention or control in randomized trials of participants with PAD. METHODS Data from four randomized trials of therapeutic interventions in participants with PAD that measured both 6-minute walk and treadmill walking performance at baseline and the 6-month follow-up were combined. Two trials studied supervised treadmill exercise, one studied home-based walking exercise, and one studied resveratrol. RESULTS Of 467 participants (mean age, 69.8; standard deviation, 9.7), the mean ankle-brachial index was 0.66 (standard deviation, 0.17). At the 6-month follow-up, participants with PAD randomized to control or placebo significantly declined in 6-minute walk distance (-10.2 m; 95% confidence interval, -18.2 to -2.2; P = .013), but improved maximal treadmill walking distance (+25.7 m; 95% CI, +6.0 to +45.3 m; P = .010; difference between change in 6-minute walk versus maximal treadmill walking distance: -37.3 m; 95% CI, -56.4 to -18.2; P < .001). Home-based exercise improved the 6-minute walk distance by 43.2 m (95% CI, +28.4 to +57.9), and supervised treadmill exercise improved the 6-minute walk distance by 25.0 m (95% CI, +14.7 to +35.2; mean difference, +18.2 m favoring home-based exercise [95% CI, +0.2 to +36.2 m; P = .048]). Among all participants, the presence (vs absence) of treadmill exercise training was associated with a 141.3-m greater improvement in maximal treadmill walking distance compared to 6-minute walk distance (95% CI, 88.2-194.4; P < .001), suggesting a benefit from treadmill training on the treadmill outcome. CONCLUSIONS Maximal treadmill walking distance and the 6-minute walk distance are not interchangeable outcomes in participants with PAD. Participants with PAD randomized to control groups improved treadmill walking distance but simultaneously meaningfully declined in 6-minute walk distance. Supervised treadmill exercise training amplified improvement in treadmill walking distance because of a training to the outcome measure phenomenon.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, Baltimore, Md
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Palo Alto, Calif
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Melina R Kibbe
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California at San Diego, San Diego, Calif
| | - Dongxue Zhang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Michael S Conte
- Division of Endovascular and Vascular Surgery, University of California San Francisco, San Francisco, Calif
| | - Kathryn Domanchuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lingyu Li
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert Sufit
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, Md
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13
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Kitzman DW, Upadhya B, Duncan P. Falls, Subclinical Cardiovascular Disease, and a Nonagenarian's Sage Advice. J Am Geriatr Soc 2019; 67:1774-1776. [PMID: 31493354 DOI: 10.1111/jgs.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bharathi Upadhya
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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14
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Rhythmic Auditory Music Stimulation Enhances Walking Distance in Patients With Claudication. J Cardiopulm Rehabil Prev 2018; 38:E1-E5. [DOI: 10.1097/hcr.0000000000000300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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15
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Szymczak M, Krupa P, Oszkinis G, Majchrzycki M. Gait pattern in patients with peripheral artery disease. BMC Geriatr 2018; 18:52. [PMID: 29458330 PMCID: PMC5819174 DOI: 10.1186/s12877-018-0727-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background The aim of the present paper is to assess the gait pattern of patients with Peripheral Artery Disease (PAD). A more specific aim is to compare the gait pattern of PAD patients before and after the appearance of intermittent claudication symptoms. Methods The study involved 34 PAD patients with a claudication distance ≥200 m and 20 participants without PAD, who formed the control group. The gait pattern of PAD patients was assessed twice: before the appearance of intermittent claudication symptoms (pain-free conditions) and after the appearance of intermittent claudication symptoms (pain conditions). Results Compared to the control group, PAD patients presented a statistically significant decrease in step length both during pain-free conditions (52.6 ± 12.5 vs. 72.8 ± 18.5 cm, p = 0.008) and in pain conditions (53.3 ± 13.3 vs. 72.8 ± 18.5 cm, p = 0.006). As for the remaining spatiotemporal parameters, there were no differences observed between the patient group and the controls. Intermittent claudication symptom induced by the walking test on the treadmill did not bring about any new abnormalities in the gait pattern or intensify the existing abnormalities of the gait. Conclusions PAD patients have a tendency to shorten their step length regardless of the presence of intermittent claudication.
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Affiliation(s)
- Maria Szymczak
- Clinic of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznań, Poland.
| | - Paweł Krupa
- Faculty of Physical Education, Sport and Rehabilitation, E. Piasecki Academy of Physical Education, Poznań, Poland
| | - Grzegorz Oszkinis
- Clinic of General and Vascular Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Marian Majchrzycki
- Clinic of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznań, Poland
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16
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Toosizadeh N, Stocker H, Thiede R, Mohler J, Mills JL, Najafi B. Alterations in gait parameters with peripheral artery disease: The importance of pre-frailty as a confounding variable. Vasc Med 2016; 21:520-527. [PMID: 27634957 DOI: 10.1177/1358863x16660626] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although poor walking is the most common symptom of peripheral artery disease (PAD), reported results are inconsistent when comparing gait parameters between PAD patients and healthy controls. This inconsistency may be due to frailty, which is highly prevalent among PAD patients. To address this hypothesis, 41 participants, 17 PAD (74±8 years) and 24 aged-matched controls (76±7 years), were recruited. Gait was objectively assessed using validated wearable sensors. Analysis of covariate (ANCOVA) tests were used to compare gait parameters between PAD and non-PAD groups, considering age, gender, and body mass index as covariates, while stratified based on frailty status. According to the Fried frailty index, 47% of PAD and 50% of control participants were non-frail and the rest were classified as pre-frail. Within non-frail participants, gait speed, body sway during walking, stride length, gait cycle time, double-support, knee range of motion, speed variability, mid-swing speed, and gait initiation were significantly different between PAD and control groups (effect size d = 0.75±0.43). In the pre-frail group, however, most of the gait differences were diminished except for gait initiation and gait variability. Results suggest that gait initiation is the most sensitive parameter for detecting gait impairment in PAD participants when compared to controls, regardless of frailty status (d = 1.30-1.41; p<0.050). The observed interaction effect between frailty and PAD on gait parameters confirms the importance of assessing functionality in addition to age to provide more consistency in detecting motor performance impairments due to PAD.
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Affiliation(s)
- Nima Toosizadeh
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA.,Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Hannah Stocker
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Rebecca Thiede
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Jane Mohler
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA.,Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Joseph L Mills
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA.,Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA .,Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA.,Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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17
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McDermott MM, Greenland P, Guralnik JM, Ferrucci L, Green D, Liu K, Criqui MH, Schneider JR, Chan C, Ridker P, Pearce WH, Martin G, Clark E, Taylor L. Inflammatory markers, D-dimer, pro-thrombotic factors, and physical activity levels in patients with peripheral arterial disease. Vasc Med 2016; 9:107-15. [PMID: 15521700 DOI: 10.1191/1358863x04vm525oa] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Men and women with lower extremity peripheral arterial disease (PAD) have reduced physical activity levels compared with persons without PAD. We describe associations between physical activity levels with D-dimer, pro-coagulant factors, and inflammatory markers in patients with PAD. Participants were188 patients with PAD identified from non-invasive vascular laboratories. Physical activity was measured over 7 days with a vertical accelerometer. We measured the ankle brachial index (ABI) and levels of D-dimer, C-reactive protein (CRP), fibrinogen, serum amyloid A (SAA), prothrombin 1.2, t-PA antigen, PAI-1, and the t-PA antigen=PAI-1 ratio. Adjusting for age, sex, race, body mass index, ABI, comorbidities, smoking, total cholesterol=HDL ratio and statin use (for CRP only), we found significant inverse linear associations between physical activity levels and log D-dimer (p 1/4 0.002), log CRP (p < 0.001), fibrinogen (p 1/4 0.014), and log SAA (p 1/4 0.012). There were no significant associations between physical activity levels and other blood factors. In an analysis adjusting for all blood factors simultaneously along with known and potential confounders, log D-dimer was the only blood factor associated significantly with physical activity levels (p 1/4 0.036). Based on these findings, future studies should assess whether interventions to increase physical activity in patients with PAD reduce levels of D-dimer and inflammatory markers.
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Affiliation(s)
- Mary Mcgrae McDermott
- Northwestern Feinberg School of Medicine, Department of Medicine, Ste. 18-200, 675 North St Clair Street, Chicago, IL 60611-2923, USA.
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18
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Nehler MR, McDermott MM, Treat-Jacobson D, Chetter I, Regensteiner JG. Functional outcomes and quality of life in peripheral arterial disease: current status. Vasc Med 2016; 8:115-26. [PMID: 14518614 DOI: 10.1191/1358863x03vm483ra] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review examines current evidence for baseline functional impairment and changes with therapy in patients with peripheral arterial disease (PAD) - ranging from patients without claudication or critical limb ischemia (CLI) but other exertional leg symptoms (erroneously referred to as asymptomatic in the Fontaine classifi cation system), to patients with claudication and those with CLI. The review points out that the status of functional outcomes research is markedly different in focus and development in the different levels of disease severity - paradoxically less studied in the more severe CLI population than in patients with claudication, for example.
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Affiliation(s)
- Mark R Nehler
- Section of Vascular Surgery, Department of Surgery, University of Colorado Health Sciences Center, Denver, CO 80262-0312, USA.
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19
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Myers SA, Huben NB, Yentes JM, McCamley JD, Lyden ER, Pipinos II, Johanning JM. Spatiotemporal Changes Posttreatment in Peripheral Arterial Disease. Rehabil Res Pract 2015; 2015:124023. [PMID: 26770826 PMCID: PMC4681815 DOI: 10.1155/2015/124023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/16/2015] [Indexed: 11/26/2022] Open
Abstract
Accumulating evidence suggests revascularization of peripheral arterial disease (PAD) limbs results in limited improvement in functional gait parameters, suggesting underlying locomotor system pathology. Spatial and temporal (ST) gait parameters are well studied in patients with PAD at baseline and are abnormal when compared to controls. The purpose of this study was to systematically review and critically analyze the available data on ST gait parameters before and after interventions. A full review of literature was conducted and articles were included which examined ST gait parameters before and after intervention (revascularization and exercise). Thirty-three intervention articles were identified based on 154 articles that evaluated ST gait parameters in PAD. Four articles fully assessed ST gait parameters before and after intervention and were included in our analysis. The systematic review of the literature revealed a limited number of studies assessing ST gait parameters. Of those found, results demonstrated the absence of improvement in gait parameters due to either exercise or surgical intervention. Our study demonstrates significant lack of research examining the effectiveness of treatments on ST gait parameters in patients with PAD. Based on the four published articles, ST gait parameters failed to significantly improve in patients with PAD following intervention.
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Affiliation(s)
- Sara A. Myers
- Center for Research in Human Movement Variability, School of Health, Physical Education, and Recreation, University of Nebraska Omaha, 6160 University Drive South, Omaha, NE 68182-0860, USA
| | - Neil B. Huben
- Center for Research in Human Movement Variability, School of Health, Physical Education, and Recreation, University of Nebraska Omaha, 6160 University Drive South, Omaha, NE 68182-0860, USA
| | - Jennifer M. Yentes
- Center for Research in Human Movement Variability, School of Health, Physical Education, and Recreation, University of Nebraska Omaha, 6160 University Drive South, Omaha, NE 68182-0860, USA
| | - John D. McCamley
- Center for Research in Human Movement Variability, School of Health, Physical Education, and Recreation, University of Nebraska Omaha, 6160 University Drive South, Omaha, NE 68182-0860, USA
| | - Elizabeth R. Lyden
- College of Public Health, Department of Biostatistics, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Iraklis I. Pipinos
- Department of Surgery, Omaha Veterans Affairs Medical Center, 4101 Woolworth Avenue (121), Omaha, NE 68105, USA
- College of Medicine, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Jason M. Johanning
- Department of Surgery, Omaha Veterans Affairs Medical Center, 4101 Woolworth Avenue (121), Omaha, NE 68105, USA
- College of Medicine, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198, USA
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20
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Konik A, Kuklewicz S, Rosłoniec E, Zając M, Spannbauer A, Nowobilski R, Mika P. Effects of 12-week supervised treadmill training on spatio-temporal gait parameters in patients with claudication. Disabil Rehabil 2015; 38:1157-62. [PMID: 26314413 DOI: 10.3109/09638288.2015.1075073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED The purpose of the study was to evaluate selected temporal and spatial gait parameters in patients with intermittent claudication after completion of 12-week supervised treadmill walking training. The study included 36 patients (26 males and 10 females) aged: mean 64 (SD 7.7) with intermittent claudication. All patients were tested on treadmill (Gait Trainer, Biodex). Before the programme and after its completion, the following gait biomechanical parameters were tested: step length (cm), step cycle (cycle/s), leg support time (%), coefficient of step variation (%) as well as pain-free walking time (PFWT) and maximal walking time (MWT) were measured. Training was conducted in accordance with the current TASC II guidelines. After 12 weeks of training, patients showed significant change in gait biomechanics consisting in decreased frequency of step cycle (p < 0.05) and extended step length (p < 0.05). PFWT increased by 96% (p < 0.05). MWT increased by 100% (p < 0.05). After completing the training, patients' gait was more regular, which was expressed via statistically significant decrease of coefficient of variation (p < 0.05) for both legs. No statistically significant relation between the post-training improvement of PFWT and MWT and step length increase and decreased frequency of step cycle was observed (p > 0.05). IMPLICATIONS FOR REHABILITATION Twelve-week treadmill walking training programme may lead to significant improvement of temporal and spatial gait parameters in patients with intermittent claudication. Twelve-week treadmill walking training programme may lead to significant improvement of pain-free walking time and maximum walking time in patients with intermittent claudication.
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Affiliation(s)
- Anita Konik
- a Department of Clinical Rehabilitation , University School of Physical Education , Cracow , Poland .,b Department of Physiotherapy, Faculty of Physical Education in Gorzow Wielkopolski , University School of Physical Education in Poznan , Poland
| | - Stanisław Kuklewicz
- a Department of Clinical Rehabilitation , University School of Physical Education , Cracow , Poland
| | - Ewelina Rosłoniec
- a Department of Clinical Rehabilitation , University School of Physical Education , Cracow , Poland
| | - Marcin Zając
- a Department of Clinical Rehabilitation , University School of Physical Education , Cracow , Poland
| | - Anna Spannbauer
- c Department of Vascular Insufficiency , Collegium Medicum of Jagiellonian University , Cracow , Poland , and
| | - Roman Nowobilski
- d Faculty of Health Sciences , Institute of Physiotherapy, School of Medicine, Jagiellonian University , Cracow , Poland
| | - Piotr Mika
- a Department of Clinical Rehabilitation , University School of Physical Education , Cracow , Poland
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21
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de Müllenheim PY, Chaudru S, Mahé G, Prioux J, Le Faucheur A. Clinical Interest of Ambulatory Assessment of Physical Activity and Walking Capacity in Peripheral Artery Disease. Scand J Med Sci Sports 2015; 26:716-30. [PMID: 26173488 DOI: 10.1111/sms.12512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 12/14/2022]
Abstract
The purpose of the present review was to provide, for the first time, a comprehensive analysis and synthesis of the available studies that highlighted the clinical interest of the ambulatory assessment of either physical activity (PA) or walking capacity in patients with lower extremity peripheral artery disease (PAD). We identified 96 related articles published up to March 2015 through a computer-assisted search of the MEDLINE, EMBASE, and Web of Science databases. Ambulatory-measured PA or related energy expenditure (EE) in PAD patients was performed in 87 of the 96 included studies. The main clinical interests of these measurements were (a) the assessment of PA/EE pattern; (b) the characterization of walking pattern; and (c) the control of training load during home-based walking programs. Ambulatory-measured walking capacity was performed in the remaining studies, using either Global Positioning System receivers or the Peripheral Arterial Disease Holter Control device. Highlighted clinical interests were (a) the assessment of community-based walking capacity; (b) the use of new outcomes to characterize walking capacity, besides the conventional absolute claudication distance; and (c) the association with the patient's self-perception of walking capacity. This review also provides for the clinicians step-by-step recommendations to specifically assess PA or walking capacity in PAD patients.
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Affiliation(s)
- P-Y de Müllenheim
- Movement, Sport and Health Laboratory, University of Rennes 2, Rennes, France
| | - S Chaudru
- INSERM, Centre d'Investigation Clinique, Rennes, France
| | - G Mahé
- INSERM, Centre d'Investigation Clinique, Rennes, France.,CHU Rennes, Imagerie Coeur-Vaisseaux, Rennes, France
| | - J Prioux
- Movement, Sport and Health Laboratory, University of Rennes 2, Rennes, France.,Department of Sport Sciences and Physical Education, ENS Rennes, Bruz, France
| | - A Le Faucheur
- Movement, Sport and Health Laboratory, University of Rennes 2, Rennes, France.,INSERM, Centre d'Investigation Clinique, Rennes, France.,Department of Sport Sciences and Physical Education, ENS Rennes, Bruz, France
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Gernigon M, Le Faucheur A, Fradin D, Noury-Desvaux B, Landron C, Mahe G, Abraham P. Global positioning system use in the community to evaluate improvements in walking after revascularization: a prospective multicenter study with 6-month follow-up in patients with peripheral arterial disease. Medicine (Baltimore) 2015; 94:e838. [PMID: 25950694 PMCID: PMC4602526 DOI: 10.1097/md.0000000000000838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
UNLABELLED Revascularization aims at improving walking ability in patients with arterial claudication. The highest measured distance between 2 stops (highest-MDCW), the average walking speed (average-WSCW), and the average stop duration (average-DSCW) can be measured by global positioning system, but their evolution after revascularization is unknown.We included 251 peripheral artery diseased patients with self-reported limiting claudication. The patients performed a 1-hour stroll, recorded by a global positioning system receiver. Patients (n = 172) with confirmed limitation (highest-MDCW <2000m) at inclusion were reevaluated after 6 months. Patients revascularized during the follow-up period were compared with reference patients (ie, with unchanged lifestyle medical or surgical status). Other patients (lost to follow-up or treatment change) were excluded (n = 89).We studied 44 revascularized and 39 reference patients. Changes in highest-MDCW (+442 vs. +13 m) and average-WSCW (+0.3 vs. -0.2 km h) were greater in revascularized than in reference patients (both P < 0.01). In contrast, no significant difference in average-DSCW changes was found between the groups. Among the revascularized patients, 13 (29.5%) had a change in average-WSCW, but not in highest-MDCW, greater than the mean + 1 standard deviation of the change observed for reference patients.Revascularization may improve highest-MDCW and/or average-WSCW. This first report of changes in community walking ability in revascularized patients suggests that, beyond measuring walking distances, average-WSCW measurement is essential to monitor these changes. Applicability to other surgical populations remains to be evaluated. REGISTRATION http://www.clinicaltrials.gov/ct2/show/NCT01141361.
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Affiliation(s)
- Marie Gernigon
- From the Laboratory for Vascular Investigations. University Hospital (MG, PA); Laboratory of Physiology, CNRS, UMR6214; Inserm, U771; Medical School, University of Angers (MG, BN-D, PA); Movement, Sport and Health laboratory (M2S). EA 1274. UFR APS, University of Rennes, Rennes (ALF); Ecole normale supérieure de Rennes, Rennes (ENS Rennes); Department of Sports Science and Physical Education, Bruz (ALF); INSERM, Clinical Investigation Center (CIC 1414), Rennes (ALF, GM); Centre Hospitalier, Le Mans (DF, BN-D); IFEPSA, Apcoss (BN-D); Centre Hospitalier Universitaire, Poitiers (CL); and University Hospital of Rennes, Rennes, France (GM)
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23
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Koutakis P, Miserlis D, Myers SA, Kim JKS, Zhu Z, Papoutsi E, Swanson SA, Haynatzki G, Ha DM, Carpenter LA, McComb RD, Johanning JM, Casale GP, Pipinos II. Abnormal accumulation of desmin in gastrocnemius myofibers of patients with peripheral artery disease: associations with altered myofiber morphology and density, mitochondrial dysfunction and impaired limb function. J Histochem Cytochem 2015; 63:256-69. [PMID: 25575565 DOI: 10.1369/0022155415569348] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Patients with peripheral artery disease (PAD) develop a myopathy in their ischemic lower extremities, which is characterized by myofiber degeneration, mitochondrial dysfunction and impaired limb function. Desmin, a protein of the cytoskeleton, is central to maintenance of the structure, shape and function of the myofiber and its organelles, especially the mitochondria, and to translation of sarcomere contraction into muscle contraction. In this study, we investigated the hypothesis that disruption of the desmin network occurs in gastrocnemius myofibers of PAD patients and correlates with altered myofiber morphology, mitochondrial dysfunction, and impaired limb function. Using fluorescence microscopy, we evaluated desmin organization and quantified myofiber content in the gastrocnemius of PAD and control patients. Desmin was highly disorganized in PAD but not control muscles and myofiber content was increased significantly in PAD compared to control muscles. By qPCR, we found that desmin gene transcripts were increased in the gastrocnemius of PAD patients as compared with control patients. Increased desmin and desmin gene transcripts in PAD muscles correlated with altered myofiber morphology, decreased mitochondrial respiration, reduced calf muscle strength and decreased walking performance. In conclusion, our studies identified disruption of the desmin system in gastrocnemius myofibers as an index of the myopathy and limitation of muscle function in patients with PAD.
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Affiliation(s)
- Panagiotis Koutakis
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Dimitrios Miserlis
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Sara A Myers
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Nebraska (SAM)
| | - Julian Kyung-Soo Kim
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Zhen Zhu
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Evlampia Papoutsi
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Stanley A Swanson
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Gleb Haynatzki
- Department of Biostatistics, College of Public Health (GH)
| | - Duy M Ha
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Lauren A Carpenter
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | | | - Jason M Johanning
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP),Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska (JMJ, IIP)
| | - George P Casale
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Iraklis I Pipinos
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP),Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska (JMJ, IIP)
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24
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Green LB. Assessment of Habitual Physical Activity and Paretic Arm Mobility Among Stroke Survivors by Accelerometry. Top Stroke Rehabil 2014; 14:9-21. [DOI: 10.1310/tsr1406-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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McDermott MM, Guralnik JM, Criqui MH, Ferrucci L, Zhao L, Liu K, Domanchuk K, Spring B, Tian L, Kibbe M, Liao Y, Lloyd Jones D, Rejeski WJ. Home-based walking exercise in peripheral artery disease: 12-month follow-up of the GOALS randomized trial. J Am Heart Assoc 2014; 3:e000711. [PMID: 24850615 PMCID: PMC4309051 DOI: 10.1161/jaha.113.000711] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We studied whether a 6‐month group‐mediated cognitive behavioral (GMCB) intervention for peripheral artery disease (PAD) participants, which promoted home‐based walking exercise, improved 6‐minute walk and other outcomes at 12‐month follow‐up, 6 months after completing the intervention, compared to a control group. Methods and Results We randomized PAD participants to a GMCB intervention or a control group. During phase I (months 1 to 6), the intervention used group support and self‐regulatory skills during weekly on‐site meetings to help participants adhere to home‐based exercise. The control group received weekly on‐site lectures on topics unrelated to exercise. Primary outcomes were measured at the end of phase I. During phase II (months 7 to 12), each group received telephone contact. Compared to controls, participants randomized to the intervention increased their 6‐minute walk distance from baseline to 12‐month follow‐up, (from 355.4 to 381.9 m in the intervention versus 353.1 to 345.6 m in the control group; mean difference=+34.1 m; 95% confidence interval [CI]=+14.6, +53.5; P<0.001) and their Walking Impairment Questionnaire (WIQ) speed score (from 36.1 to 46.5 in the intervention group versus 34.9 to 36.5 in the control group; mean difference =+8.8; 95% CI=+1.6, +16.1; P=0.018). Change in the WIQ distance score was not different between the 2 groups at 12‐month follow‐up (P=0.139). Conclusions A weekly on‐site GMCB intervention that promoted home‐based walking exercise intervention for people with PAD demonstrated continued benefit at 12‐month follow‐up, 6 months after the GMCB intervention was completed. Clinical Trial Registration URL: ClinicalTrials.gov. Unique identifier: NCT00693940.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.) Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (J.M.G.)
| | - Michael H Criqui
- Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA (M.H.C.)
| | | | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Kathryn Domanchuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.)
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA (L.T.)
| | - Melina Kibbe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (M.K.) Jesse Brown Veterans Affairs Medical Center, Chicago, IL (M.K.)
| | - Yihua Liao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - Donald Lloyd Jones
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.) Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., L.Z., K.L., B.S., Y.L., D.L.J.)
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC (J.R.)
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Effects of Clustered Comorbid Conditions on Walking Capacity in Patients with Peripheral Artery Disease. Ann Vasc Surg 2014; 28:279-83. [DOI: 10.1016/j.avsg.2013.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/27/2012] [Accepted: 01/15/2013] [Indexed: 11/19/2022]
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McDermott MM, Liu K, Guralnik JM, Criqui MH, Spring B, Tian L, Domanchuk K, Ferrucci L, Lloyd-Jones D, Kibbe M, Tao H, Zhao L, Liao Y, Rejeski WJ. Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. JAMA 2013; 310:57-65. [PMID: 23821089 PMCID: PMC6007977 DOI: 10.1001/jama.2013.7231] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program. OBJECTIVE To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication. DESIGN, SETTING, AND PATIENTS Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012. INTERVENTIONS Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition. MAIN OUTCOMES AND MEASURES The primary outcome was 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey. RESULTS Participants randomized to the intervention group significantly increased their 6-minute walk distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P < .001), maximal treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09; mean difference, 1.01 minutes [95% CI, 0.07 to 1.95]; P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ distance score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004). CONCLUSION AND RELEVANCE A home-based walking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00693940.
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Affiliation(s)
- Mary M McDermott
- Northwestern University Feinberg School of Medicine Department of Medicine, Chicago, Illinois 60611, USA.
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McGrath D, Judkins TN, Pipinos II, Johanning JM, Myers SA. Peripheral arterial disease affects the frequency response of ground reaction forces during walking. Clin Biomech (Bristol, Avon) 2012; 27:1058-63. [PMID: 22967739 PMCID: PMC3501537 DOI: 10.1016/j.clinbiomech.2012.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/12/2012] [Accepted: 08/14/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Walking is problematic for patients with peripheral arterial disease. The purpose of this study was to investigate the frequency domain of the ground reaction forces during walking to further elucidate the ambulatory impairment of these patients. METHODS Nineteen bilateral peripheral arterial disease patients and nineteen controls were included in this study. Subjects were matched for age and gait speed. Participants walked over a force plate sampling at 600 Hz. PAD patients were tested before (pain-free condition) after the onset of claudication symptoms (pain). We calculated median frequency, frequency bandwidth, and frequency containing 99.5% of the signal for the vertical and anterior-posterior ground reaction forces. FINDINGS Our results showed reduced median frequency in the vertical and anterior-posterior components of the ground reaction forces between the control group and both peripheral arterial disease conditions. We found reduced frequency bandwidth in the anterior-posterior direction between controls and the peripheral arterial disease pain-free condition. There were no differences in median frequency or bandwidth between peripheral arterial disease pain-free and pain conditions, but an increase in the frequency content for 99.5% of the signal was observed in the pain condition. INTERPRETATION Reduced frequency phenomena during gait in peripheral arterial disease patients compared to velocity-matched controls suggests more sluggish activity within the neuromotor system. Increased frequency phenomena due to pain in these patients suggest a more erratic application of propulsive forces when walking. Frequency domain analysis thus offers new insights into the gait impairments associated with this patient population.
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Affiliation(s)
- Denise McGrath
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA
| | | | - Iraklis I. Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA,Department of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa
| | - Jason M. Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA,Department of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa
| | - Sara A. Myers
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA
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Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, Fowkes FGR, Hiatt WR, Jönsson B, Lacroix P, Marin B, McDermott MM, Norgren L, Pande RL, Preux PM, Stoffers HEJ, Treat-Jacobson D. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126:2890-909. [PMID: 23159553 DOI: 10.1161/cir.0b013e318276fbcb] [Citation(s) in RCA: 1057] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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30
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Ghidei W, Collins TC. African Americans and Peripheral Arterial Disease: A Review Article. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/165653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Peripheral arterial disease (PAD)—atherosclerosis of the abdominal aorta and arteries of the lower extremities—affects 12 million Americans. African Americans (AAs) are more than twice as likely as non-Hispanic whites to suffer from PAD. When compared to non-Hispanic whites with PAD, AAs with PAD have more severe disease and a greater reduction in walking distance, speed, and/or stair climbing. AAs with PAD are at increased risk for disease progression and worsening lower limb function. Reasons for the higher risk for disease progression have not been defined. One potential modifiable risk is a lower level of physical activity. Lower levels of physical activity are more common among African American seniors. Walking is a common type of physical activity. The benefits of walking therapy are only realized if the patient adheres to such therapy. Efforts are needed to increase walking in AAs with PAD. Additionally, risk factor management is key to reducing adverse events in AAs with PAD-yet few studies have targeted this high-risk group. In this paper, we discuss the management of PAD in AAs. Identifying current gaps will help to inform clinicians, researchers, and policy makers on next steps in identifying innovative approaches to increase home-based walking and reduce walking impairment in AAs with PAD.
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Affiliation(s)
- Winta Ghidei
- Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Tracie C. Collins
- Department of Preventive Medicine and Public Health, University of Kansas Medical School, 1010 N. Kansas St., Suite 1406, Wichita, KS 67214-3199, USA
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McDermott MM, Domanchuk K, Liu K, Guralnik JM, Tian L, Criqui MH, Ferrucci L, Kibbe M, Jones DL, Pearce WH, Zhao L, Spring B, Rejeski WJ. The Group Oriented Arterial Leg Study (GOALS) to improve walking performance in patients with peripheral arterial disease. Contemp Clin Trials 2012; 33:1311-20. [PMID: 23158112 DOI: 10.1016/j.cct.2012.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/10/2012] [Accepted: 08/01/2012] [Indexed: 11/24/2022]
Abstract
People with lower extremity peripheral artery disease (PAD) have greater functional impairment and faster functional decline than those without PAD. We describe methods for the Group Oriented Arterial Leg Study (GOALS), an ongoing randomized controlled clinical trial designed to determine whether a Group-Mediated Cognitive Behavioral (GMCB) intervention improves functional performance in PAD participants, compared to a health education control condition. In GOALS, PAD participants were randomized to either an intervention or a health education control condition in a parallel design. Both conditions consist of weekly group sessions with other PAD participants. In the intervention, cognitive behavioral techniques are used to assist participants in setting and adhering to home-based walking exercise goals. Participants are encouraged to walk for exercise at home at least 5 days/week. In the control condition, participants receive lectures on health-related topics. After 6 months of on-site weekly sessions, participants are transitioned to telephone follow-up for another 6 months. Participants in the intervention are asked to continue home walking exercise. The primary outcome is change in six-minute walk performance between baseline and six-month follow-up. Secondary outcomes include change in six-minute walk performance at 12-month follow-up, and change in treadmill walking performance, the Walking Impairment Questionnaire, quality of life, and physical activity at six and 12-month follow-up. In conclusion, if our group-mediated cognitive behavioral intervention is associated with improved walking performance in individuals with PAD, results will have major public health implications for the large and growing number of people with PAD.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Guidon M, McGee H. One-year effect of a supervised exercise programme on functional capacity and quality of life in peripheral arterial disease. Disabil Rehabil 2012; 35:397-404. [DOI: 10.3109/09638288.2012.694963] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McDermott MM, Liu K, Carroll TJ, Tian L, Ferrucci L, Li D, Carr J, Guralnik JM, Kibbe M, Pearce WH, Yuan C, McCarthy W, Kramer CM, Tao H, Liao Y, Clark ET, Xu D, Berry J, Orozco J, Sharma L, Criqui MH. Superficial femoral artery plaque and functional performance in peripheral arterial disease: walking and leg circulation study (WALCS III). JACC Cardiovasc Imaging 2011; 4:730-9. [PMID: 21757163 DOI: 10.1016/j.jcmg.2011.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/29/2011] [Accepted: 04/07/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We studied associations of magnetic resonance imaging measurements of plaque area and relative percent lumen reduction in the proximal superficial femoral artery with functional performance among participants with peripheral arterial disease. BACKGROUND The clinical significance of directly imaged plaque characteristics in lower extremity arteries is not well established. METHODS A total of 454 participants with an ankle brachial index <1.00 underwent magnetic resonance cross-sectional imaging of the proximal superficial femoral artery and completed a 6-min walk test, measurement of 4-m walking velocity at usual and fastest pace, and measurement of physical activity with a vertical accelerometer. RESULTS Adjusting for age, sex, race, body mass index, smoking, statin use, comorbidities, and other covariates, higher mean plaque area (1st quintile [least plaque]: 394 m, 2nd quintile: 360 m, 3rd quintile: 359 m, 4th quintile: 329 m, 5th quintile [greatest plaque]: 311 m; p trend <0.001) and smaller mean percent lumen area (1st quintile [greatest plaque]: 319 m, 2nd quintile: 330 m, 3rd quintile: 364 m, 4th quintile: 350 m, 5th quintile: 390 m; p trend <0.001) were associated with shorter distance achieved in the 6-min walk test. Greater mean plaque area was also associated with slower usual-paced walking velocity (p trend = 0.006) and slower fastest-paced 4-m walking velocity (p trend = 0.003). Associations of mean plaque area and mean lumen area with 6-min walk distance remained statistically significant even after additional adjustment for the ankle brachial index and leg symptoms. CONCLUSIONS Among participants with peripheral arterial disease, greater plaque burden and smaller lumen area in the proximal superficial femoral artery are associated independently with poorer functional performance, even after adjusting for the ankle brachial index and leg symptoms.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Myers SA, Pipinos II, Johanning JM, Stergiou N. Gait variability of patients with intermittent claudication is similar before and after the onset of claudication pain. Clin Biomech (Bristol, Avon) 2011; 26:729-34. [PMID: 21450380 PMCID: PMC3134603 DOI: 10.1016/j.clinbiomech.2011.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/02/2011] [Accepted: 03/03/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent research demonstrated that intermittent claudication patients have increased gait variability prior to the onset of claudication. However, it is unknown if these patients experience additional gait adaptations after the onset of claudication. Thus, we sought to determine how gait variability is affected by claudication in an effort to contribute to improved clinical management. METHODS Twenty-six intermittent claudication patients and 20 controls walked on a treadmill at self-selected speed; intermittent claudication patients were tested before (pain free) and after (pain) the onset of claudication. Variability of the ankle, knee, and hip joint angles was assessed using the largest Lyapunov exponent, standard deviation and coefficient of variation. Dependent t-tests were used to compare the pain free and pain conditions. Independent t-tests were used to compare intermittent claudication patients and controls. FINDINGS Pain free and pain conditions were not significantly different for any of the parameters evaluated except the ankle. Compared to controls, patients had significantly greater values for the largest Lyapunov exponent in both conditions for all joints. INTERPRETATION Gait variability was essentially the same before and after the onset of claudication at the knee and the hip, and was increased in both conditions compared to controls. This indicates altered cooperation between components of the locomotor system of intermittent claudication patients, likely due to the associated myopathy since differences were present even before the onset of claudication. This research helps provide essential biomechanical knowledge of intermittent claudication that contributes to improved clinical management.
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Affiliation(s)
- Sara A. Myers
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA
| | - Iraklis I. Pipinos
- Dept of Surgery, University of Nebraska Medical Center, Omaha, NE, USA,Dept of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, NE, USA
| | - Jason M. Johanning
- Dept of Surgery, University of Nebraska Medical Center, Omaha, NE, USA,Dept of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, NE, USA
| | - Nicholas Stergiou
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE, USA,College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Koutakis P, Johanning JM, Haynatzki GR, Myers SA, Stergiou N, Longo GM, Pipinos II. Abnormal joint powers before and after the onset of claudication symptoms. J Vasc Surg 2010; 52:340-7. [PMID: 20670775 DOI: 10.1016/j.jvs.2010.03.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 03/01/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Claudication is the most common manifestation of peripheral arterial disease, producing significant ambulatory compromise. Our study evaluated patients with bilateral lower limb claudication and characterized their gait abnormality based on advanced biomechanical analysis using joint torques and powers. METHODS Twenty patients with bilateral claudication (10 with isolated aortoiliac disease and 10 with combined aortoiliac and femoropopliteal disease) and 16 matched controls ambulated on a walkway while 3-dimensional biomechanical data were collected. Patients walked before and after onset of claudication pain. Joint torques and powers at early, mid, and late stance for the hip, knee, and ankle joints were calculated for claudicating patients before and after the onset of claudication pain and were compared to controls. RESULTS Claudicating patients exhibited significantly reduced hip and knee power at early stance (weight-acceptance phase) due to decreased torques produced by the hip and knee extensors. In mid stance (single-limb support phase), patients had significantly reduced knee and hip power due to the decreased torques produced by the knee extensors and the hip flexors. In late stance (propulsion phase), reduced propulsion was noted with significant reduction in ankle plantar flexor torques and power. These differences were present before and after the onset of pain, with certain parameters worsening in association with pain. CONCLUSIONS The gait of claudication is characterized by failure of specific and identifiable muscle groups needed to perform normal walking (weight acceptance, single-limb support, and propulsion). Parameters of gait are abnormal with the first steps taken, in the absence of pain, and certain of these parameters worsen after the onset of claudication pain.
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Affiliation(s)
- Panagiotis Koutakis
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Neb, USA
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Treatment with Pharmacological Agents in Peripheral Arterial Disease Patients Does Not Result in Biomechanical Gait Changes. J Appl Biomech 2010; 26:341-8. [DOI: 10.1123/jab.26.3.341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pharmacological treatment has been used to alleviate the claudication symptoms and improve walking performance in peripheral arterial disease (PAD) patients. However, the effects of claudication treatments on gait mechanics have not been objectively indentified with biomechanical techniques. For this study, 20 PAD patients were assigned to take either pentoxifylline (n= 11) or cilostazol (n= 9), the two FDA-approved pharmacological therapies used to treat intermittent claudication symptoms. All patients completed a gait evaluation protocol that involved the acquisition of kinematic and kinetic gait data before use of the medication and after 12 weeks of treatment. Results showed that treatment with either pentoxifylline or cilostazol resulted in limited overall improvement in gait parameters including joint angles and joint moments. Walking speed was unchanged, in either treatment group, as a result of the medication. These results suggest that to improve biomechanical walking parameters of PAD patients, clinicians cannot rely on drug therapies alone.
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Gardner AW, Ritti-Dias RM, Stoner JA, Montgomery PS, Scott KJ, Blevins SM. Walking economy before and after the onset of claudication pain in patients with peripheral arterial disease. J Vasc Surg 2010; 51:628-33. [PMID: 20206808 DOI: 10.1016/j.jvs.2009.09.053] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/08/2009] [Accepted: 09/27/2009] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine the walking economy before and after the onset of claudication pain in patients with peripheral arterial disease (PAD), and to identify predictors of the change in walking economy following the onset of claudication pain. METHODS A total of 39 patients with PAD were studied, in which 29 experienced claudication (Pain group) during a constant load, walking economy treadmill test (speed = 2.0 mph, grade = 0%) and 10 were pain-free during this test (Pain-Free group). Patients were characterized on walking economy (ie, oxygen uptake during ambulation), as well as on demographic characteristics, cardiovascular risk factors, baseline exercise performance measures, and the ischemic window calculated from the decrease in ankle systolic blood pressure following exercise. RESULTS During the constant load treadmill test, the Pain group experienced onset of claudication pain at 323 +/- 195 seconds (mean +/- standard deviation) and continued to walk until maximal pain was attained at 759 +/- 332 seconds. Walking economy during pain-free ambulation (9.54 +/- 1.42 ml x kg(-1) x min(-1)) changed (P < .001) after the onset of pain (10.18 +/- 1.56 ml x kg(-1) x min(-1)). The change in walking economy after the onset of pain was associated with ischemic window (P < .001), hypertension (P < .001), diabetes (P = .002), and height (P = .003). In contrast, the Pain-Free group walked pain-free for the entire 20-minute test duration without a change in walking economy (P = .36) from the second minute of exercise (9.20 +/- 1.62 ml x kg(-1) x min(-1)) to the nineteenth minute of exercise (9.07 +/- 1.54 ml x kg(-1) x min(-1)). CONCLUSION Painful ambulation at a constant speed is associated with impaired walking economy, as measured by an increase in oxygen uptake in patients limited by intermittent claudication, and the change in walking economy is explained, in part, by severity of PAD, diabetes, and hypertension.
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Affiliation(s)
- Andrew W Gardner
- CMRI Diabetes and Metabolic Research Program, Harold Hamm Oklahoma Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.
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Koutakis P, Pipinos II, Myers SA, Stergiou N, Lynch TG, Johanning JM. Joint torques and powers are reduced during ambulation for both limbs in patients with unilateral claudication. J Vasc Surg 2009; 51:80-8. [PMID: 19837536 DOI: 10.1016/j.jvs.2009.07.117] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 07/28/2009] [Accepted: 07/31/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Symptomatic peripheral arterial disease (PAD) results in significant gait impairment. In an attempt to fully delineate and quantify these gait alterations, we analyzed joint kinematics, torques (rotational forces), and powers (rotational forces times angular velocity) in patients with PAD with unilateral claudication for both the affected and nonaffected legs. METHODS Twelve patients with unilateral PAD (age, 61.69 +/- 10.53 years, ankle-brachial index [ABI]: affected limb 0.59 +/- 0.25; nonaffected limb 0.93 +/- 0.12) and 10 healthy controls (age, 67.23 +/- 12.67 years, ABI >1.0 all subjects) walked over a force platform to acquire gait kinetics, while joint kinematics were recorded simultaneously. Data were collected for the affected and nonaffected limbs during pain free (PAD-PF) and pain induced (PAD-P) trials. Kinetics and kinematics were combined to quantify torque and powers during the stance period from the hip, knee, and ankle joints. RESULTS The affected limb demonstrated significantly (P <.05) reduced ankle plantar flexion torque compared to controls during late stance in both PAD-PF and PAD-P trials. There were significant reductions in ankle plantar flexion power generation during late stance for both the affected (P <.05) and nonaffected limbs (P <.05) compared to control during PAD-PF and PAD-P trials. No significant differences were noted in torque comparing the nonaffected limbs in PAD-PF and PAD-P conditions to control for knee and hip joints throughout the stance phase. Significant reductions were found in knee power absorption in early stance and knee power generation during mid stance for both limbs of the patients with PAD as compared to control (P <.05). CONCLUSION Patients with PAD with unilateral claudication demonstrate significant gait impairments in both limbs that are present even before they experience any claudication symptoms. Overall, our data demonstrate significantly reduced ankle plantar flexion torque and power during late stance with reduced knee power during early and mid stance for the affected limb. Further studies are needed to determine if these findings are dependent on the location and the severity of lower extremity ischemia and whether the changes in the nonaffected limb are the result of underlying PAD or compensatory changes from the affected limb dysfunction.
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Affiliation(s)
- Panagiotis Koutakis
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Neb, USA
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Payvandi L, Dyer A, McPherson D, Ades P, Stein J, Liu K, Ferrucci L, Criqui MH, Guralnik JM, Lloyd-Jones D, Kibbe MR, Liang ST, Kane B, Pearce WH, Verta M, McCarthy WJ, Schneider JR, Shroff A, McDermott MM. Physical activity during daily life and brachial artery flow-mediated dilation in peripheral arterial disease. Vasc Med 2009; 14:193-201. [PMID: 19651668 DOI: 10.1177/1358863x08101018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We determined whether higher levels of physical activity in daily life are associated with better brachial artery flow-mediated dilation (FMD) among individuals with lower extremity peripheral arterial disease (PAD). Participants were 111 men and women with PAD (ankle-brachial index (ABI) <or= 0.95) who completed baseline testing in the Study to Improve Leg Circulation (SILC). We evaluated FMD of the brachial artery at baseline and at 60 seconds following 4 minutes of suprasystolic blood pressure cuff inflation. Physical activity was measured continuously over 7 days using a vertical accelerometer (Caltrac) and a pedometer (Digiwalker). Adjusting for age, sex, race, ABI, cardiovascular risk factors and other potential confounders, higher levels of physical activity were associated with a greater percent change in brachial artery FMD at 60 seconds post cuff deflation for both Caltrac (1st tertile of activity +4.81% change; 2nd tertile +4.60% change; 3rd tertile +7.23% change; p-trend = 0.018) and the Digiwalker (1st tertile of activity +3.76% change; 2nd tertile +6.25% change; 3rd tertile +7.25% change; p-trend = 0.001). Similar findings were observed for absolute change in brachial artery FMD 60 seconds after cuff deflation. In conclusion, higher levels of physical activity during daily life are associated significantly and independently with better brachial artery FMD among individuals with PAD, even after adjusting for confounders.
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Affiliation(s)
- Laila Payvandi
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Myers SA, Johanning JM, Stergiou N, Celis RI, Robinson L, Pipinos II. Gait variability is altered in patients with peripheral arterial disease. J Vasc Surg 2009; 49:924-931.e1. [PMID: 19217749 DOI: 10.1016/j.jvs.2008.11.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 10/31/2008] [Accepted: 11/03/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Claudication is the most common presentation of peripheral arterial disease (PAD), producing significant ambulatory compromise. Claudicating patients, most of whom are elderly, have reduced mobility and poor health outcomes, including an increased risk of falls. The gait of elderly fallers is characterized by increased variability. Increase in the variability of the locomotor system makes the gait more noisy and unstable. The purpose of this study is to investigate gait variability in patients with PAD. METHODS Nineteen symptomatic PAD patients (age, 63.6 +/- 9.8 years; body mass, 82.1 +/- 18.5 kg; height, 1.71 +/- 0.06 m) walked on a treadmill in the absence of pain or claudication symptoms while joint flexion and extension kinematics were captured. Results were compared with results obtained from 17 matched healthy controls (age, 65.2 +/- 12.5 years; body mass, 82.0 +/- 25.9.5 kg; height, 1.73 +/- 0.08 m). Relative joint angles were calculated for the ankle, knee, and hip flexion/extension, and the stride-to-stride variability of joint flexion and extension was calculated from at least 30 consecutive footfalls. Variability was expressed using the largest Lyapunov exponent, standard deviation, and coefficient of variation. Independent t tests were used to compare gait variability between groups. RESULTS Symptomatic PAD patients had significantly higher largest Lyapunov exponent values and coefficient of variation values for all joints, and higher standard deviation values at the ankle and the hip (P < .05). CONCLUSION Symptomatic PAD patients have increased gait variability at the ankle, knee, and hip joints at baseline ambulation in the absence of claudication pain. Our findings indicate significant baseline deterioration in the locomotor system of symptomatic PAD patients. This deterioration results in increased noise and instability of gait and is a potential contributing factor to the falls and mobility problems experienced by symptomatic PAD patients.
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Affiliation(s)
- Sara A Myers
- Nebraska Biomechanics Core Facility, University of Nebraska Medical Center, Omaha, Neb, USA
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Garg PK, Liu K, Tian L, Guralnik JM, Ferrucci L, Criqui MH, Tan J, McDermott MM. Physical activity during daily life and functional decline in peripheral arterial disease. Circulation 2009; 119:251-60. [PMID: 19118256 PMCID: PMC2888033 DOI: 10.1161/circulationaha.108.791491] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few modifiable behaviors have been identified that are associated with slower rates of functional decline in persons with lower-extremity peripheral arterial disease. We determined whether higher levels of physical activity during daily life are associated with less functional decline in persons with peripheral arterial disease. METHODS AND RESULTS The study population included 203 peripheral arterial disease participants who underwent vertical accelerometer-measured physical activity continuously over 7 days and were followed up annually for up to 4 years (mean, 33.6 months). Outcomes were average annual changes in 6-minute walk performance, usual-paced and fast-paced 4-m walking velocity, and the short performance physical battery. Analyses were adjusted for age, sex, race, comorbidities, body mass index, ankle brachial index, smoking, and walking exercise frequency. Higher baseline physical activity levels measured by a vertical accelerometer were associated with significantly less average annual decline in 6-minute walk performance (P for trend=0.010), fast-paced 4-m walking velocity (P for trend=0.002), and the short performance physical battery (P for trend=0.001). Compared with the lowest baseline quartile, those in the highest baseline quartile of physical activity had less annual decline in 6-minute walk performance (-50.82 versus -107.0 ft/y; P=0.019), fast-paced 4-m walking speed (-0.0034 versus -0.111 m . s(-1) . y(-1); P=0.002), and the short performance physical battery (-0.074 versus -0.829; P=0.005). CONCLUSIONS Higher physical activity levels during daily life are associated with less functional decline among people with peripheral arterial disease. These findings may be particularly important for the large number of peripheral arterial disease persons without access to supervised walking exercise programs.
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Affiliation(s)
| | - Kiang Liu
- Northwestern University’s Feinberg School of Medicine
| | - Lu Tian
- Northwestern University’s Feinberg School of Medicine
| | - Jack M. Guralnik
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging
| | - Luigi Ferrucci
- Laboratory of Clinical Epidemiology, National Institute on Aging
| | | | - Jin Tan
- Northwestern University’s Feinberg School of Medicine
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McDermott MM, Ades P, Guralnik JM, Dyer A, Ferrucci L, Liu K, Nelson M, Lloyd-Jones D, Van Horn L, Garside D, Kibbe M, Domanchuk K, Stein JH, Liao Y, Tao H, Green D, Pearce WH, Schneider JR, McPherson D, Laing ST, McCarthy WJ, Shroff A, Criqui MH. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA 2009; 301:165-74. [PMID: 19141764 PMCID: PMC3268032 DOI: 10.1001/jama.2008.962] [Citation(s) in RCA: 328] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease (PAD) without intermittent claudication have been established as beneficial. OBJECTIVE To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled clinical trial performed at an urban academic medical center between April 1, 2004, and August 8, 2008, involving 156 patients with PAD who were randomly assigned to supervised treadmill exercise, to lower extremity resistance training, or to a control group. MAIN OUTCOME MEASURES Six-minute walk performance and the short physical performance battery. Secondary outcomes were brachial artery flow-mediated dilation, treadmill walking performance, the Walking Impairment Questionnaire, and the 36-Item Short Form Health Survey physical functioning (SF-36 PF) score. RESULTS For the 6-minute walk, those in the supervised treadmill exercise group increased their distance walked by 35.9 m (95% confidence interval [CI], 15.3-56.5 m; P < .001) compared with the control group, whereas those in the resistance training group increased their distance walked by 12.4 m (95% CI, -8.42 to 33.3 m; P = .24) compared with the control group. Neither exercise group improved its short physical performance battery scores. For brachial artery flow-mediated dilation, those in the treadmill group had a mean improvement of 1.53% (95% CI, 0.35%-2.70%; P = .02) compared with the control group. The treadmill group had greater increases in maximal treadmill walking time (3.44 minutes; 95% CI, 2.05-4.84 minutes; P < .001); walking impairment distance score (10.7; 95% CI, 1.56-19.9; P = .02); and SF-36 PF score (7.5; 95% CI, 0.00-15.0; P = .02) than the control group. The resistance training group had greater increases in maximal treadmill walking time (1.90 minutes; 95% CI, 0.49-3.31 minutes; P = .009); walking impairment scores for distance (6.92; 95% CI, 1.07-12.8; P = .02) and stair climbing (10.4; 95% CI, 0.00-20.8; P = .03); and SF-36 PF score (7.5; 95% CI, 0.0-15.0; P = .04) than the control group. CONCLUSIONS Supervised treadmill training improved 6-minute walk performance, treadmill walking performance, brachial artery flow-mediated dilation, and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication. Lower extremity resistance training improved functional performance measured by treadmill walking, quality of life, and stair climbing ability. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00106327.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Inzitari M, Naydeck BL, Newman AB. Coronary artery calcium and physical function in older adults: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2008; 63:1112-8. [PMID: 18948563 DOI: 10.1093/gerona/63.10.1112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In older adults without clinical cardiovascular disease, coronary artery calcium (CAC) is associated with other subclinical vascular diseases, which, in turn, predict physical dysfunction. However, the association between CAC and physical function is unstudied. METHODS In 387 older community-dwellers from the Cardiovascular Health Study without clinical cardiovascular diseases (mean age +/- standard deviation = 78.7 +/- 3.7, 35% men, 22% African Americans), CAC was measured using electron beam tomography, and physical performance was assessed by usual pace gait speed, chair stand, and tandem stand. Differences in physical performance across CAC quartiles were investigated in the whole cohort and by gender. Associations with gait speed (m/s) were assessed in multivariable models using both the continuous form of CAC score (log(CAC)) and quartiles of CAC, adjusting for demographics and comorbidities. RESULTS No differences in physical performance were observed across CAC quartiles in the whole group. In gender-stratified analyses, a significant association was shown among women, who had progressively lower gait speed across CAC quartiles: Those with CAC > 220 walked more than 0.1 m/s slower than those with CAC < 35 (age-adjusted ptrend =.017). After multivariable adjustment, the association remained statistically significant for women in both linear (log(CAC) and gait speed, p =.025) and logistic models: Each of the top three CAC quartiles (35-220, 221-659, and > or = 660) had a more than twofold odds of walking slower than 1 m/s, compared to the lowest CAC quartile (< 35; p =.021). CONCLUSIONS In this sample of older community-dwellers without overt cardiovascular disease, CAC was inversely related to gait speed in women, but not in men.
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Affiliation(s)
- Marco Inzitari
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, 130 N. Bellefield St., Room 518, Pittsburgh, PA, USA.
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Craft LL, Guralnik JM, Ferrucci L, Liu K, Tian L, Criqui MH, Tan J, McDermott MM. Physical activity during daily life and circulating biomarker levels in patients with peripheral arterial disease. Am J Cardiol 2008; 102:1263-8. [PMID: 18940304 DOI: 10.1016/j.amjcard.2008.06.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 06/30/2008] [Accepted: 06/30/2008] [Indexed: 01/08/2023]
Abstract
Higher levels of inflammation are associated with adverse outcomes in patients with lower extremity peripheral arterial disease (PAD). This study evaluated associations of physical activity during daily life with levels of inflammatory biomarkers, D-dimer, and homocysteine in patients with PAD. Participants were 244 men and women (mean age 74.4 +/- 8.2 years) with PAD (ankle brachial index <0.90). C-reactive protein, interleukin-6, soluble intracellular adhesion molecule-1, soluble vascular cellular adhesion molecule-1, D-dimer, and homocysteine were assessed at study entry. Physical activity was objectively assessed with a vertical accelerometer, which participants wore continuously for 7 days. After adjusting for age, gender, race, body mass index, smoking, co-morbidities, ankle brachial index, and other potential confounders, higher physical activity levels were associated linearly and significantly with lower levels of all measured circulating biomarkers: soluble vascular cellular adhesion molecule-1 (p trend = 0.001), D-dimer (p trend = 0.005), homocysteine (p trend = 0.006), interleukin-6 (p trend = 0.010), C-reactive protein (p trend = 0.028), and soluble intracellular adhesion molecule-1 (p trend = 0.033). In conclusion, higher levels of physical activity were associated independently with lower levels of inflammatory markers, homocysteine, and D-dimer in patients with PAD.
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Affiliation(s)
- Lynette L Craft
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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McDermott MM, Ades PA, Dyer A, Guralnik JM, Kibbe M, Criqui MH. Corridor-based functional performance measures correlate better with physical activity during daily life than treadmill measures in persons with peripheral arterial disease. J Vasc Surg 2008; 48:1231-7, 1237.e1. [PMID: 18829215 DOI: 10.1016/j.jvs.2008.06.050] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 06/17/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare associations of physical activity during daily life with treadmill walking performance and corridor-based functional performance measures in persons with lower extremity peripheral arterial disease (PAD). STUDY DESIGN Cross-sectional. SUBJECTS One hundred fifty-six men and women with PAD who completed baseline measurements and were randomized into the study to improve leg circulation (SILC) exercise clinical trial. MAIN OUTCOME MEASURES Participants completed a Gardner-Skinner treadmill protocol. Corridor-based functional performance measures were the 6-minute walk, walking velocity over four meters at usual and fastest pace, and the short physical performance battery (SPPB) (0-12 scale, 12 = best). Physical activity during daily life was measured continuously over 7 days with a Caltrac (Muscle Dynamics Fitness Network, Inc, Torrence, Calif) accelerometer. RESULTS Adjusting for age, gender, and race, higher levels of physical activity during daily life were associated with greater distance achieved in the 6-minute walk (P trend = .001), faster fast-paced four-meter walking velocity (P trend < .001), faster usual-paced four-meter walking speed (P trend = .027) and a higher SPPB (P trend = .005). The association of physical activity level with maximum treadmill walking distance did not reach statistical significance (P trend = .083). There were no associations of physical activity with treadmill distance to onset of leg symptoms (P trend = .795). CONCLUSION Functional performance measures are more strongly associated with physical activity levels during daily life than treadmill walking measures.
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Affiliation(s)
- Mary M McDermott
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Pereira DAG, Oliveira KLD, Cruz JO, Souza CGD, Cunha Filho IT. Avaliação da reprodutibilidade de testes funcionais na doença arterial periférica. FISIOTERAPIA E PESQUISA 2008. [DOI: 10.1590/s1809-29502008000300003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo visou avaliar a reprodutibilidade de dois testes funcionais de membros inferiores em pacientes com doença arterial periférica. Os testes senta-levanta da cadeira (TSL) e da ponta do pé (TPP) foram aplicados duas vezes em 14 voluntários com doença arterial periférica por três examinadores, com intervalo de 1 minuto entre os testes e de 15 minutos entre teste e reteste. A maioria dos participantes apresentou dificuldades no TPP, sendo realizadas adaptações. Os dados foram analisados estatisticamente; o grau de concordância entre examinadores foi estimado pelo coeficiente de correlação intraclasse (CCI), sendo ±<5% considerado significativo. Todas as correlações foram estatisticamente significativas. O TSL apresentou alta reprodutibilidade tanto inter-examinador (CCI=0,904 no teste e 0,857 no reteste) quanto intra- examinador. O mesmo ocorreu com o TPP (CCI=0,824 no teste e 0,941 no reteste, na avaliação inter-examinador). A correlação de Pearson entre as médias dos três examinadores no TSL e no TPP foi 0,651 no teste e 0,609 no reteste. Ambos os testes são pois reprodutíveis e viáveis na prática clínica, mas é necessário avaliar se são sensíveis a alterações que ocorram durante o processo natural da doença ou se podem ser instrumentos viáveis para acompanhamento desses pacientes.
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McDermott MM, Liu K, Ferrucci L, Tian L, Guralnik JM, Green D, Tan J, Liao Y, Pearce WH, Schneider JR, McCue K, Ridker P, Rifai N, Criqui MH. Circulating blood markers and functional impairment in peripheral arterial disease. J Am Geriatr Soc 2008; 56:1504-10. [PMID: 18662216 DOI: 10.1111/j.1532-5415.2008.01797.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether higher levels of inflammatory blood markers, D-dimer, and homocysteine were associated with greater impairment in lower extremity functioning in persons with peripheral arterial disease (PAD). DESIGN Cross-sectional. SETTING Three Chicago-area medical centers. PARTICIPANTS Four hundred twenty-three persons with PAD (ankle-brachial index (ABI) <0.90). MEASUREMENTS Lower extremity performance was assessed using the 6-minute walk and with usual- and fast-paced 4-m walking speed. Blood markers were D-dimer, C-reactive protein (CRP), interleukin-6 (IL-6), soluble vascular cellular adhesion molecule-1 (sVCAM-1), soluble intracellular adhesion molecule-1 (sICAM-1), and homocysteine. Calf muscle area was measured using computed tomography. RESULTS Adjusting for confounders, higher levels of D-dimer (P<.001), IL-6 (P<.001), sVCAM-1 (P=.006), CRP (P=.01), homocysteine (P=.004), and sICAM-1 (P=.046) were associated with poorer 6-minute walk performance. Higher levels of D-dimer (P<.001), IL-6 (P=.003), sVCAM-1 (P=.001), and homocysteine (P=.005) were associated with slower usual-paced 4-m walking speed. Higher levels of D-dimer, sVCAM-1, sICAM-1, IL-6, and homocysteine were associated with slower fast-paced walking speed. Results were attenuated after additional adjustment for calf muscle area. CONCLUSION Higher levels of inflammation and D-dimer were associated with poorer lower extremity performance in participants with PAD, independent of confounders including ABI.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University Cicago, IL, USA.
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Chen SJ, Pipinos I, Johanning J, Radovic M, Huisinga JM, Myers SA, Stergiou N. Bilateral claudication results in alterations in the gait biomechanics at the hip and ankle joints. J Biomech 2008; 41:2506-14. [PMID: 18586253 DOI: 10.1016/j.jbiomech.2008.05.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 05/06/2008] [Accepted: 05/08/2008] [Indexed: 11/26/2022]
Abstract
Claudication is the most common symptomatic manifestation of peripheral arterial disease (PAD), producing significant ambulatory compromise. The purpose of this study was to use advanced biomechanical gait analysis to determine the gait alterations occurring in claudicating patients both before and after onset of claudication pain in their legs. Hip, knee, and ankle joint moments were measured in claudicating patients (age: 64.46+/-8.47 years; body mass: 80.70+/-12.64kg; body height: 1.72+/-0.08m) and were compared to gender-age-body mass-height-matched healthy controls (age 66.27+/-9.22 years; body mass: 77.89+/-10.65kg; body height: 1.74+/-0.08m). The claudicating patients were evaluated both before (pain-free (PF) condition) and after (pain condition) onset of claudication pain in their legs. Thirteen symptomatic PAD patients (26 claudicating limbs) with bilateral intermittent claudication (IC) and 11 healthy controls (22 control limbs) were tested during level walking at their self-selected speed. Compared to controls, PAD hip and ankle joints demonstrated significant angular kinematics and net internal moment changes. Alterations were present both in PF and pain conditions with several of them becoming worse in the pain condition. Both PF and pain conditions resulted in significantly reduced peak hip extensor moment (5.62+/-1.40 and 5.63+/-1.33% BWxBH, respectively) during early stance as compared to controls (7.53+/-1.16% BWxBH). In the pain condition, PAD patients had a significantly reduced ankle plantar flexor moment (7.56+/-1.41% BWxBH) during late stance as compared to controls (8.65+/-1.27% BWxBH). Furthermore, when comparing PF to pain conditions, there was a decreased peak plantar flexor moment (PF condition: 8.23+/-1.37 vs. pain condition: 7.56+/-1.41% BWxBH) during late stance. The findings point to a weakness in the posterior compartment muscles of the hip and calf as being the key factor underlying the PAD gait adaptations. Our findings establish a detailed baseline description of the changes present in PAD patient's joint angles and moments during walking. Since IC is primarily a gait disability, better understanding of the abnormalities in joint and muscle function will enhance our understanding of the gait impairment and may lead to novel, gait-specific treatments.
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Affiliation(s)
- Shing-Jye Chen
- HPER Biomechanics Laboratory, School of Health, Physical Education & Recreation, University of Nebraska at Omaha, 6001 Dodge Street, Omaha, NE 68182-0216, USA.
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McDermott MM, Guralnik JM, Ferrucci L, Tian L, Liu K, Liao Y, Green D, Sufit R, Hoff F, Nishida T, Sharma L, Pearce WH, Schneider JR, Criqui MH. Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication. Circulation 2008; 117:2484-91. [PMID: 18458172 PMCID: PMC5077147 DOI: 10.1161/circulationaha.107.736108] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study assessed functional performance, calf muscle characteristics, peripheral nerve function, and quality of life in asymptomatic persons with peripheral arterial disease (PAD). METHODS AND RESULTS PAD participants (n=465) had an ankle brachial index <0.90. Non-PAD participants (n=292) had an ankle brachial index of 0.90 to 1.30. PAD participants were categorized into leg symptom groups including intermittent claudication (n=215) and always asymptomatic (participants who never experienced exertional leg pain, even during the 6-minute walk; n=72). Calf muscle was measured with computed tomography. Analyses were adjusted for age, sex, race, ankle brachial index, comorbidities, and other confounders. Compared with participants with intermittent claudication, always asymptomatic PAD participants had smaller calf muscle area (4935 versus 5592 mm(2); P<0.001), higher calf muscle percent fat (16.10% versus 9.45%; P<0.001), poorer 6-minute walk performance (966 versus 1129 ft; P=0.0002), slower usual-paced walking speed (P=0.0019), slower fast-paced walking speed (P<0.001), and a poorer Short-Form 36 Physical Functioning score (P=0.016). Compared with an age-matched, sedentary, non-PAD cohort, always asymptomatic PAD participants had smaller calf muscle area (5061 versus 5895 mm(2); P=0.009), poorer 6-minute walk performance (1126 versus 1452 ft; P<0.001), and poorer Walking Impairment Questionnaire speed scores (40.87 versus 57.78; P=0.001). CONCLUSIONS Persons with PAD who never experience exertional leg symptoms have poorer functional performance, poorer quality of life, and more adverse calf muscle characteristics compared with persons with intermittent claudication and a sedentary, asymptomatic, age-matched group of non-PAD persons.
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Affiliation(s)
- Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, Ill, USA.
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Abstract
Peripheral arterial disease (PAD) is currently a major health problem affecting 8-12 million Americans, 15-40% of whom will have intermittent claudication that can lead to substantial impairment in their ability to carry out normal daily activities as well as perform the recommended cardiovascular exercise. Supervised exercise training is an effective tool in the treatment of claudication and is currently a recommended first-line therapy for patients with this condition. In addition to improving pain-free walking distance and quality of life, supervised exercise training can improve many cardiovascular risk factors, possibly reducing the risk for subsequent myocardial infarction, stroke, and death. This paper will review the benefits of supervised exercise training in patients with PAD.
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Affiliation(s)
- Richard V Milani
- Department of Cardiovascular Disease, Ochsner Clinic Foundation, New Orleans, LA, USA.
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