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de Müllenheim PY, Rouvière L, Emily M, Chaudru S, Kaladji A, Mahé G, Le Faucheur A. "Should I stay or should I go now?" Recovery time effect on walking capacity in symptomatic peripheral artery disease. J Appl Physiol (1985) 2021; 131:207-219. [PMID: 33982591 DOI: 10.1152/japplphysiol.00441.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of the study was to investigate the effect of recovery time on walking capacity (WC) throughout repeated maximal walking bouts in symptomatic lower-extremity peripheral artery disease (PAD). The effect of recovery time on WC (maximal walking time) was determined in 21 participants with PAD in three experimental conditions [recovery time from 0.5 to 9.5 min + a self-selected recovery time (SSRT)]: 1) 11 repeated sequences of two treadmill walking bouts (TW-ISO); 2) a single sequence of seven treadmill walking bouts (TW-CONS); 3) a single sequence of seven outdoor walking bouts (OW-CONS). Exercise transcutaneous oxygen pressure changes were continuously recorded as an indirect measure of ischemia. An individual recovery time (IRT) beyond which WC did not substantially increased was determined in participants with a logarithmic fit. At the group level, mixed models showed a significant effect (P < 0.001) of recovery time on WC restoration. At the participant level, strong logarithmic relationships were found (median significant R2 ≥ 0.78). The median SSRT corresponded to a median work-to-rest ratio >1:1 (i.e., a lower recovery time in view of the corresponding previous walking time) and was related to unrecovered ischemia and a WC restoration level of <80%. A median work-to-rest ratio of ≤1:2 allowed full recovery of ischemia and full restoration of WC. The IRT ratio was between 1:1 and 1:2 and corresponded to the start of recovery from ischemia. Recovery time affects the restoration level of WC during repeated maximal walking bouts in symptomatic PAD. Meaningful variations in WC restoration were related to specific levels of work-to-rest ratios.NEW & NOTEWORTHY This study demonstrated that there is a significant and mostly logarithmic effect of recovery time on walking capacity in people with symptomatic PAD. This study revealed that a median work-to-rest ratio >1:1 leads to the resumption of walking with unrecovered ischemia and precludes the restoration of full walking capacity, whereas a work-to-rest ratio ≤1:2 allowed walking capacity to fully be restored.
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Affiliation(s)
- Pierre-Yves de Müllenheim
- Institute of Physical Education and Sports Sciences (IFEPSA), West Catholic University (UCO), Les Ponts-de-Cé, France
| | | | - Mathieu Emily
- Institut Agro, CNRS, University of Rennes, IRMAR-UMR CNRS 6625, Rennes, France
| | - Ségolène Chaudru
- Clinical Investigation Center, INSERM CIC, Rennes, France.,University of Rennes, Rennes, France
| | - Adrien Kaladji
- Department of Cardiothoracic and Vascular Surgery, University Hospital Rennes, Rennes, France
| | - Guillaume Mahé
- Clinical Investigation Center, INSERM CIC, Rennes, France.,University of Rennes, Rennes, France.,Vascular Medicine Unit, University Hospital Rennes, Rennes, France
| | - Alexis Le Faucheur
- Clinical Investigation Center, INSERM CIC, Rennes, France.,Univ Rennes, M2S-EA 7470, Rennes, France
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Hersant J, Ramondou P, Picquet J, Feuilloy M, Abraham P, Henni S. Calf and non-calf hemodynamic recovery in patients with arterial claudication: Implication for exercise training. Microvasc Res 2021; 135:104143. [PMID: 33515566 DOI: 10.1016/j.mvr.2021.104143] [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: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies in patients with arterial claudication have focused on calf hemodynamic recovery. We hypothesized that the duration of hemodynamic recovery with TcpO2 at calf and non-calf levels would be shorter than 10 min. We analyzed the factors that influence the recovery time. METHODS We monitored limb changes minus chest changes from rest (DROP) of transcutaneous oximetry on buttocks, thighs and calves, during and following a treadmill test (3.2 km/h; 10% grade). We calculated the time required to reach 50% (50%RT) and 10% (90%RT) of minimal DROP value (DROPm) from walking cessation. Regression analyses were used to determine the factors associated to 50%RT and 90%RT. RESULTS Of the 132 patients studied, 18.2% reported isolated non-calf pain by history. Of the 792 recovery time values, only 3 (0.4%) and 23 (2.9%) were in excess of 10 min for 50%RT and for 90%RT, respectively. A weak correlation was found between each of the 792 DROPm and 50%RT (r = -0.270, p < 0.001) as well as for 90%RT (r = -0.311 p < 0.001). Lowest DROPm and BMI (but not age, sex, the use of beta-blockers, the duration of the walking period) were associated to both 50%RT and 90%RT. CONCLUSION Although recovery duration correlates significantly with the severity of ischemia of the same location, a wide discrepancy exists and the longest recovery time does not always correlate to the localization of the most severe ischemia. Non-calf ischemia should be measured when one aims at objectifying the biological effects of exercise or the effects of treatments on recovery from exercise.
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Affiliation(s)
| | | | - Jean Picquet
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Thoracic and Vascular Surgery, University Hospital, Angers, France
| | | | - Pierre Abraham
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Sports Medicine, University Hospital Center, Angers, France.
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France; MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France
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Berli MC, Jundt-Ecker M, Meier MR, Hofer M, Schöni M, Götschi T, Uçkay I, Böni T, Waibel FWA. Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation. PLoS One 2020; 15:e0239930. [PMID: 32986780 PMCID: PMC7521692 DOI: 10.1371/journal.pone.0239930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background In our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2). Methods Persons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS. Results Twenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47–86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3–119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history. Conclusion Resting TcPO2 levels decreased significantly while wearing a liner alone, without a prosthetic socket. Further studies are required to investigate the effect of liner wear on exercise TcPO2 levels.
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Affiliation(s)
- Martin C. Berli
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Michèle Jundt-Ecker
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | | | | | - Madlaina Schöni
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedic Surgery, Institute for Biomechanics, University of Zurich, ETH Zurich, Balgrist Campus, Zurich, Switzerland
| | - Ilker Uçkay
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Thomas Böni
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Felix W. A. Waibel
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
- * E-mail:
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Bouwens E, Klaphake S, Weststrate KJ, Teijink JA, Verhagen HJ, Hoeks SE, Rouwet EV. Supervised exercise therapy and revascularization: Single-center experience of intermittent claudication management. Vasc Med 2019; 24:208-215. [PMID: 30795714 PMCID: PMC6535809 DOI: 10.1177/1358863x18821175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Guidelines recommend supervised exercise therapy (SET) as first-line treatment for intermittent claudication. However, the use of revascularization is widespread. We addressed the effectiveness of preventing (additional) invasive revascularization after primary SET or revascularization based on lesion and patient characteristics. In this single-center, retrospective, cohort study, 474 patients with intermittent claudication were included. Patients with occlusive disease of the aortoiliac tract and/or common femoral artery (inflow) were primarily considered for revascularization, while patients with more distal disease (outflow) were primarily considered for SET. In total, 232 patients were referred for SET and 242 patients received revascularization. The primary outcome was freedom from (additional) intervention, analyzed by Kaplan–Meier estimates. Secondary outcomes were survival, critical ischemia, freedom from target lesion revascularization (TLR), and an increase in maximum walking distance. In the SET-first strategy, 71% of patients had significant outflow lesions. Freedom from intervention was 0.90 ± 0.02 at 1-year and 0.82 ± 0.03 at 2-year follow-up. In the primary revascularization group, 90% of patients had inflow lesions. Freedom from additional intervention was 0.78 ± 0.03 at 1-year and only 0.65 ± 0.04 at 2-year follow-up, despite freedom from TLR of 0.91 ± 0.02 and 0.85 ± 0.03 at 1- and 2-year follow-up, respectively. In conclusion, SET was effective in preventing invasive treatment for patients with mainly outflow lesions. In contrast, secondary intervention rates following our strategy of primary revascularization for inflow lesions were unexpectedly high. These findings further support the guideline recommendations of SET as first-line treatment for all patients with intermittent claudication irrespective of level of disease.
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Affiliation(s)
- Elke Bouwens
- 1 Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanne Klaphake
- 2 Department of Vascular Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karin J Weststrate
- 2 Department of Vascular Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joep Aw Teijink
- 3 Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.,4 Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Hence Jm Verhagen
- 2 Department of Vascular Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanne E Hoeks
- 5 Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ellen V Rouwet
- 2 Department of Vascular Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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