1
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Košuta D, Hvala U, Fras Z, Jug B. Prognostic impact of optimal lifestyle advice and medical therapy in patients with peripheral arterial disease. VASA 2024; 53:39-44. [PMID: 38079164 DOI: 10.1024/0301-1526/a001106] [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] [Indexed: 01/09/2024]
Abstract
Background: Secondary prevention remains under-implemented in patients with peripheral arterial disease (PAD). In the present study, we sought to assess the extent, the predictors and the prognostic impact of optimal lifestyle advice (OLA) and optimal medical therapy (OMT) given at discharge to patients with PAD undergoing invasive peripheral procedures. Patients and methods: We included consecutive patients with PAD undergoing invasive peripheral procedures, between 2012 and 2013. Data were obtained from a mandatory fill-in clinical pathway. The primary outcome was all-cause mortality, verified using the National Mortality Registry. Results: A total of 2014 participants were included (mean age 70±11 years, 38.1% women). OLA was given to 279 (14%), OMT to 1186 (59%) participants. Male gender and absence of chronic limb-threatening ischaemia were significant predictors of OLA and OMT. During the median follow-up of 729 days (interquartile range 645) 392 (19.5%) participants died giving an overall mortality rate of 97/1000 patient years. On multivariate analysis both OLA and OMT emerged as independent predictors of survival (HR for all-cause mortality: 0.59; 95% CI: 0.42-0.82, p 0.005 and HR: 0.41; 95% CI: 0.22-0.76, p 0.002). Conclusions: OLA and OMT are associated with better long-term prognosis in patients with PAD, however they are still under-implemented, suggesting a considerable potential for improvement, especially in women.
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Affiliation(s)
- Daniel Košuta
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Urška Hvala
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zlatko Fras
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Borut Jug
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
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2
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Maeshige Ph N, Hayashi PhD H, Terashi PhD Md H, Fujii PhD Md M, Iwamoto PhD T, Watanabe MSc Y, Imaoka MSc S, Matsumoto MSc J, Nishikawa BSc M, Takeda BSc N, Mikawa BSc R, Tsuji PhD Md Y, Higashita PhD Md R, Ayabe Md S, Terabe Md Y, Furukawa Md M, Tanaka PhD Md J, Ohura PhD Md T, Kawabe PhD N. Effect of Early Rehabilitation on Gait, Wound and Home Discharge in Lower Extremity Chronic Wound Patients: A Japanese Multicenter Retrospective Study. INT J LOW EXTR WOUND 2023; 22:713-721. [PMID: 34459670 DOI: 10.1177/15347346211039588] [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] [Indexed: 11/15/2022]
Abstract
This study investigated the effect of early rehabilitation on gait restoration, wound healing, and home discharge in patients with lower extremity (LE) chronic wounds. This multicenter, retrospective cohort study included 233 Japanese inpatients who received treatment for LE chronic wounds from April 2012 to March 2015. A multivariate analysis was conducted using outcomes of gait restoration, wound healing, and home discharge as dependent variables. Other survey items were used as independent variables. Early rehabilitation was extracted as an independent factor with gait restoration (hazard ratio [HR] 1.82, P < .01) and home discharge (HR 1.77, P < .001) as dependent factors by the stepwise method in Cox proportional-hazards regression analysis, but it was not extracted as an independent factor with wound healing as the dependent factor by the stepwise method as well as the forced entry method (P = .44). A significant relationship between the presence of gait restoration and home discharge was observed in the chi-square test (P<.001), and the duration from admission to gait restoration was significantly correlated to the duration from admission to home discharge (Pearson's product-moment correlation coefficient; r=.89, P<.0001). Early rehabilitation was a positive factor for gait restoration and home discharge in chronic LE wound patients.
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Affiliation(s)
| | | | | | - Miki Fujii PhD Md
- Critical Limb Ischemia Center, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Tetsuya Iwamoto PhD
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Yu Watanabe MSc
- Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | | | | | | | | | | | | | | | - Shinobu Ayabe Md
- Wound Care Center, Yao Tokushukai General Hospital, Yao, Osaka, Japan
| | - Yuta Terabe Md
- Limb Salvage Center, Kasukabe Chuo General Hospital, Kasukabe, Saitama, Japan
| | | | - Junko Tanaka PhD Md
- Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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3
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Novaković M, Prokšelj K, Jug B. Exercise capacity, cardiac and endothelial function in adults with repaired tetralogy of Fallot. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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4
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Tršan J, Košuta D, Rajkovič U, Fras Z, Jug B, Novaković M. Vascular Function in Patients After Myocardial Infarction: The Importance of Physical Activity. Front Physiol 2022; 12:763043. [PMID: 35002758 PMCID: PMC8741173 DOI: 10.3389/fphys.2021.763043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients after myocardial infarction have impaired vascular function. However, effects of lifestyle, e.g., physical activity level, on endothelial function and arterial stiffness remain scarce. The aim of our study was to investigate effects of physical activity level and risk factors on endothelial function and arterial stiffness. Methods: In this cross-sectional study, we ultrasonographically assessed parameters of vascular function, namely flow mediated dilation (FMD) of the brachial artery and carotid artery stiffness in patients after myocardial infarction referred to the cardiac rehabilitation. The International Physical Activity Questionnaire (IPAQ) was obtained from all participants. Based on the IPAQ, patients were classified into three groups: vigorous, moderate, and low physical activity engagement. ANOVA was used for comparison among three groups using Bonferroni correction to determine differences between two sub-groups. Results: One hundred and eight patients after myocardial infarction (mean age 53 ± 10 years) were included. There were significant differences in terms of FMD (8.2 vs. 4.2 vs. 1.9%, p < 0.001) and pulse wave velocity (PWV), a measure of arterial stiffness (6.1 vs. 6.4 vs. 6.9 m/s, p = 0.004) among groups of vigorous, moderate, and low physical activity engagement, respectively. However, in younger patients only FMD remained associated with physical activity level, while arterial stiffness was not. Low physical activity engagement was a significant predictor of both FMD and PWV in univariate and multivariate models, adjusted for age, sex, and other risk factors. Conclusion: Low physical activity level is associated with impaired endothelial function and increased arterial stiffness in patients after myocardial infarction. Future studies are warranted to address this issue in a context of cardiac rehabilitation protocols optimization in order to improve vascular function in these patients.
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Affiliation(s)
- Jure Tršan
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Daniel Košuta
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Uroš Rajkovič
- Faculty of Organizational Sciences, University of Maribor, Kranj, Slovenia
| | - Zlatko Fras
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marko Novaković
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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5
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Paldán K, Steinmetz M, Simanovski J, Rammos C, Ullrich G, Jánosi RA, Moebus S, Rassaf T, Lortz J. Supervised Exercise Therapy Using Mobile Health Technology in Patients With Peripheral Arterial Disease: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e24214. [PMID: 34398800 PMCID: PMC8406106 DOI: 10.2196/24214] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/16/2020] [Accepted: 02/24/2021] [Indexed: 01/18/2023] Open
Abstract
Background Mobile health interventions are intended to support complex health care needs in chronic diseases digitally, but they are mainly targeted at general health improvement and neglect disease-specific requirements. Therefore, we designed TrackPAD, a smartphone app to support supervised exercise training in patients with peripheral arterial disease. Objective This pilot study aimed to evaluate changes in the 6-minute walking distance (meters) as a primary outcome measure. The secondary outcome measures included changes in physical activity and assessing the patients’ peripheral arterial disease–related quality of life. Methods This was a pilot two-arm, single-blinded, randomized controlled trial. Patients with symptomatic PAD (Fontaine stage IIa/b) and access to smartphones were eligible. Eligible participants were randomly assigned to the study, with the control group stratified by the distance covered in the 6-minute walking test using the TENALEA software. Participants randomized to the intervention group received usual care and the mobile intervention (TrackPAD) for the follow-up period of 3 months, whereas participants randomized to the control group received routine care only. TrackPAD records the frequency and duration of training sessions and pain levels using manual user input. Clinical outcome data were collected at the baseline and after 3 months via validated tools (the 6-minute walk test and self-reported quality of life). The usability and quality of the app were determined using the Mobile Application Rating Scale user version. Results The intervention group (n=19) increased their mean 6-minute walking distance (83 meters, SD 72.2), while the control group (n=20) decreased their mean distance after 3 months of follow-up (–38.8 meters, SD 53.7; P=.01). The peripheral arterial disease–related quality of life increased significantly in terms of “symptom perception” and “limitations in physical functioning.” Users’ feedback showed increased motivation and a changed attitude toward performing supervised exercise training. Conclusions Besides the rating providing a valuable support tool for the user group, the mobile intervention TrackPAD was linked to a change in prognosis-relevant outcome measures combined with enhanced coping with the disease. The influence of mobile interventions on long-term prognosis must be evaluated in the future. Trial Registration ClinicalTrials.gov NCT04947228; https://clinicaltrials.gov/ct2/show/NCT04947228
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Affiliation(s)
- Katrin Paldán
- Institute for Urban Public Health, University Clinic of Essen, University of Duisburg-Essen, Germany, Essen, Germany.,Personal Analytics Centre of Competence, Department of Engineering Sciences, University of Duisburg-Essen, Essen, Germany
| | - Martin Steinmetz
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Simanovski
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Greta Ullrich
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Institute for Urban Public Health, University Clinic of Essen, University of Duisburg-Essen, Germany, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Julia Lortz
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
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6
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Hap K, Biernat K, Konieczny G. Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions. J Diabetes Res 2021; 2021:5122494. [PMID: 34056006 PMCID: PMC8131145 DOI: 10.1155/2021/5122494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes mellitus (DM) is one of the major public health problems that account for morbidity, mortality, and disability worldwide. The presence of DM increases the risk of peripheral artery disease (PAD), as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status. Unfortunately, alternative treatments for vascular complications in diabetes are poorly researched. Physiotherapy (kinesitherapy combined with different physical therapy agents) in individuals with DM and coexisting PAD may offer an important complementary therapy alternative. Early therapeutic measures can significantly improve patient outcomes, reduce cardiovascular risk, and improve daily life quality. The article provides an update on the current state of knowledge on physiotherapy interventions in the course of DM in patients with coexisting PAD.
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Affiliation(s)
- Katarzyna Hap
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Biernat
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Konieczny
- Faculty of Health Sciences and Physical Education, Witelon State University of Applied Sciences in Legnica, Poland
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7
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Harwood AE, Pugh CJ, Steward CJ, Menzies C, Thake CD, Cullen T. A systematic review of the role of heat therapy for patients with intermittent claudication due to peripheral artery disease. Vasc Med 2021; 26:440-447. [PMID: 33587690 PMCID: PMC8358540 DOI: 10.1177/1358863x20983475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intermittent claudication (IC) is associated with impairments in quality of life and walking ability. Heat therapy is an emerging cardiovascular therapy, which may improve walking in patients with IC. We undertook a systematic review to establish current evidence for heat therapy for patients with IC. We searched five databases (Ovid Medline / PubMed, Embase, Scopus / Web of Science, Cochrane Library and Health Technology Assessment Databases). A total of 6751 records were screened with 76 full-text articles assessed for eligibility. We included three randomised control trials and three acute interventions. For chronic interventions, three different heat therapy interventions were used. The 6-minute walk distance significantly improved following whole-body immersion (p = 0.03; ES 0.94, 95% CI: 0.06-1.82), but not after Waon therapy or a water-perfused garment. Ankle-brachial pressure indices were significantly improved following whole-body immersion (p = 0.01; ES 1.10, 95% CI: 0.20-1.99) but not after other therapies. No form of heat therapy demonstrated statistical improvements in quality of life or brachial blood pressure. Acute interventions were characterised by large increases in limb blood flow and core temperature, and transient reductions in blood pressure post-heating. At present there are only three randomised controlled trials assessing heat therapy for patients with IC. Moreover, each of those randomised controlled trials utilised different heat therapies. There is also very limited study of the acute physiological responses to different heat therapy interventions in these populations. Future research should establish appropriate heat therapy protocols and implement more randomised trials to understand its effectiveness. PROSPERO: CRD42020187941.
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Affiliation(s)
- Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Christopher Ja Pugh
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Charles J Steward
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Campbell Menzies
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - C Doug Thake
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Tom Cullen
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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8
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Tolani AS, Wurdeman SR, Billing B, O'Brien E, England DL, Stevens PM, Flores A. Understanding Changes in Physical Activity among Lower Limb Prosthesis Users: A COVID-19 Case Series. PM R 2020; 13:97-99. [PMID: 33090671 PMCID: PMC7675514 DOI: 10.1002/pmrj.12508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/14/2020] [Accepted: 09/28/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Akshay S Tolani
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
| | - Shane R Wurdeman
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
| | - Bryce Billing
- Department of Information Technology, Hanger Clinic, Austin, TX, USA
| | - Erin O'Brien
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
| | - Dwiesha L England
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
| | - Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
| | - Aaron Flores
- Hanger Fabrication Network, Hanger Clinic, Austin, TX, USA
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9
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Machado I, Sousa N, Paredes H, Ferreira J, Abrantes C. Combined Aerobic and Resistance Exercise in Walking Performance of Patients With Intermittent Claudication: Systematic Review. Front Physiol 2020; 10:1538. [PMID: 31969830 PMCID: PMC6960137 DOI: 10.3389/fphys.2019.01538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/05/2019] [Indexed: 01/19/2023] Open
Abstract
Background: The short-term benefits of aerobic and resistance exercise in subjects affected by Peripheral Arterial Disease (PAD) are scarcely examined in interaction. This study aimed to identify the effects of combined aerobic and resistance exercise programs on walking performance compared with isolated aerobic exercise or with the usual care in patients with intermittent claudication. Methods: A systematic review was conducted following the PRISMA statement. A total of five electronic databases were searched (until October 2019) for randomized and non-randomized controlled trials. The focus comprised PAD patients with intermittent claudication who performed a combined aerobic and resistance exercise program that assessed the walking performance. Results: Seven studies include combined aerobic and resistance exercise vs. isolated aerobic or vs. usual care. The studies represented a sample size of 337 participants. The follow-up ranged from 4 to 12 weeks, 2 to 5 times-per-week. The risk of bias in the trials was a deemed moderate-to-high risk. After the interventions, the percent change in walking performance outcomes had a large variation. In the combined and isolated aerobic programs, the walking performance always improved, while in the usual care group oscillates between the deterioration and the improvement in all outcomes. Combined exercise and isolated aerobic exercise improved the claudication onset distance from 11 to 396%, and 30 to 422%, the absolute claudication distance from 81 to 197%, and 53 to 121%, and the maximal walking distance around 23 and 10%, respectively. Conclusions: Currently, there is insufficient evidence about the effects of combined aerobic and resistance exercise compared to isolated aerobic exercise or usual care on walking performance. However, despite the low quality of evidence, the combined aerobic and resistance exercise seems to be an effective strategy to improve walking performance in patients with intermittent claudication. These combined exercise modes or isolated aerobic exercise produce positive and significant results on walking performance. The usual care approach has a trend to deteriorate the walking performance. Thus, given the scarcity of data, new randomized controlled trial studies that include assessments of cardiovascular risk factors are urgently required to better determine the effect of this exercise combination.
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Affiliation(s)
- Isabel Machado
- Department of Sports Science, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
| | - Nelson Sousa
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal.,Public Health Unit of Santo Tirso, ACES Grande Porto I-Santo Tirso/Trofa, Santo Tirso, Portugal
| | - Hugo Paredes
- Department of Engineering, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal.,Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
| | - Joana Ferreira
- Hospital of Senhora da Oliveira/EPE, Angiology and Vascular Surgery, Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Catarina Abrantes
- Department of Sports Science, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
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10
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Abaraogu UO, Abaraogu OD, Dall PM, Tew G, Stuart W, Brittenden J, Seenan CA. Exercise therapy in routine management of peripheral arterial disease and intermittent claudication: a scoping review. Ther Adv Cardiovasc Dis 2020; 14:1753944720924270. [PMID: 32459138 PMCID: PMC7273548 DOI: 10.1177/1753944720924270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/15/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. METHODS A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. RESULTS Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients' engagement and adherence as well as resource constraints. CONCLUSION There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.
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Affiliation(s)
- Ukachukwu O. Abaraogu
- Department of Physiotherapy and Paramedicine,
School of Health and Life Sciences, Glasgow Caledonian University, Room 226
Govan Mbeki Building, Cowcaddens Road, Glasgow, Scotland G4 0BA, UK
| | | | - Philippa M. Dall
- Department of Physiotherapy and Paramedicine,
Glasgow Caledonian University, Glasgow, UK
| | - Garry Tew
- Department of Sport, Exercise and
Rehabilitation, Northumbria University, Newcastle, UK
| | - Wesley Stuart
- Vascular Surgery, Queen Elizabeth University
Hospital, Glasgow, UK
| | - Julie Brittenden
- Institute of Cardiovascular and Medical
Sciences, University of Glasgow, Glasgow, UK
| | - Chris A. Seenan
- Department of Physiotherapy and Paramedicine,
Glasgow Caledonian University, Glasgow, UK
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11
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Effects of Long-Versus Short-Term Exposure to the Mediterranean Diet on Skin Microvascular Function and Quality of Life of Healthy Adults in Greece and the UK. Nutrients 2019; 11:nu11102487. [PMID: 31623223 PMCID: PMC6835788 DOI: 10.3390/nu11102487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023] Open
Abstract
The beneficial effects of the Mediterranean diet (MD) adherence in reducing cardiovascular disease (CVD) risk and improving CVD-related physiological indices have been well-documented. However, the exact MD adherence duration needed for these effects to occur is under-researched. The aim of the present, two-arm, two-site study clinical trial was to assess the effects of long- vs. short-term MD adherence on the skin microvascular circulation, and quality of life. Two groups were recruited, one being long-term MD adherers (>5 years; from Greece; control group), and one of the non-adherers (from the UK), with the latter participating in a four-week MD intervention (intervention group). Our main outcome was skin microvascular function assessed by cutaneous vascular conductance (CVC). Secondary outcomes included quality of life, dietary intake, blood pressure and lipidemic profile. At the end of the intervention, both groups had high MD adherence. For the intervention group, significantly improved post-intervention CVC values were noted concerning the initial peak phase (2.0 ± 0.6 vs. 2.8 ± 0.8; p < 0.05). CVC values of the control group, were however higher at the plateau phase in comparison to the intervention group (intervention end; 3.8 ± 0.8 vs. 3.1 ± 1.2; p < 0.05). As per QoL, the physical domain was improved post-intervention (13.7 ± 1.2 vs. 15.9 ± 1.2; p < 0.05). No differences were observed in the lipidemic profile between groups, or between the baseline and final intervention phases. The findings indicate that although short-term MD adherence is effective in improving certain microvascular physiological properties and QoL domains, there is room for additional improvement, observed in long-term adherers. Our findings are important in the design of future, MD-based, lifestyle interventions, with the advisable durations differing between target groups.
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12
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Novaković M, Krevel B, Rajkovič U, Vižintin Cuderman T, Janša Trontelj K, Fras Z, Jug B. Moderate-pain versus pain-free exercise, walking capacity, and cardiovascular health in patients with peripheral artery disease. J Vasc Surg 2019; 70:148-156. [PMID: 30922760 DOI: 10.1016/j.jvs.2018.10.109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/22/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Supervised exercise training (walking) is recommended in patients with intermittent claudication, both as a means to improve symptoms (walking distance and quality of life [QoL]) and as a means to improve general cardiovascular health (including vascular function and heart rate variability [HRV]). Our aim was to compare two types of supervised training (moderate-pain and pain-free walking) with comparable intensity based on heart rate, in terms of walking capacity, QoL, vascular function, biomarkers, and HRV in patients with intermittent claudication. METHODS Thirty-six adults with intermittent claudication were randomized to either moderate-pain or pain-free exercise training (36 sessions, two or three times a week) or usual care (no supervised exercise). Initial walking distance and absolute walking distance using treadmill testing, flow-mediated vasodilation and pulse wave velocity using ultrasound, N-terminal pro-B-type natriuretic peptide and fibrinogen levels, HRV, and QoL (36-Item Short Form Health Survey questionnaire) were determined at baseline and after the intervention period. RESULTS Twenty-nine patients (mean age, 64 ± 9 years; 72% male) completed the study. Both training programs similarly improved walking capacity. Initial walking distance and absolute walking distance significantly increased with either moderate-pain walking (median, 50 m to 107 m [P = .005] and 85 m to 194 m [P = .005], respectively) or pain-free walking (median, 53 m to 128 m [P = .003] and 92 m to 163 m [P = .003], respectively). QoL also similarly improved with both training modalities, whereas only moderate-pain walking was also associated with a statistically significant improvement in the vascular parameters flow-mediated vasodilation (4.4% to 8.0%; P = .002) and pulse wave velocity (6.6 m/s to 6.1 m/s; P = .013). Neither training program was associated with changes in biomarker levels and HRV. CONCLUSIONS Both moderate-pain and pain-free training modalities were safe and similarly improved walking capacity and health-related QoL. Conversely, vascular function improvements were associated with only moderate-pain walking.
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Affiliation(s)
- Marko Novaković
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Barbara Krevel
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Uroš Rajkovič
- Faculty of Organizational Sciences, University of Maribor, Kranj, Slovenia
| | - Tjaša Vižintin Cuderman
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katja Janša Trontelj
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zlatko Fras
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Division of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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