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Mukli P, Pinto CB, Owens CD, Csipo T, Lipecz A, Szarvas Z, Peterfi A, Langley ACDCP, Hoffmeister J, Racz FS, Perry JW, Tarantini S, Nyúl-Tóth Á, Sorond FA, Yang Y, James JA, Kirkpatrick AC, Prodan CI, Toth P, Galindo J, Gardner AW, Sonntag WE, Csiszar A, Ungvari Z, Yabluchanskiy A. Impaired Neurovascular Coupling and Increased Functional Connectivity in the Frontal Cortex Predict Age-Related Cognitive Dysfunction. Adv Sci (Weinh) 2024; 11:e2303516. [PMID: 38155460 PMCID: PMC10962492 DOI: 10.1002/advs.202303516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/19/2023] [Indexed: 12/30/2023]
Abstract
Impaired cerebrovascular function contributes to the genesis of age-related cognitive decline. In this study, the hypothesis is tested that impairments in neurovascular coupling (NVC) responses and brain network function predict cognitive dysfunction in older adults. Cerebromicrovascular and working memory function of healthy young (n = 21, 33.2±7.0 years) and aged (n = 30, 75.9±6.9 years) participants are assessed. To determine NVC responses and functional connectivity (FC) during a working memory (n-back) paradigm, oxy- and deoxyhemoglobin concentration changes from the frontal cortex using functional near-infrared spectroscopy are recorded. NVC responses are significantly impaired during the 2-back task in aged participants, while the frontal networks are characterized by higher local and global connection strength, and dynamic FC (p < 0.05). Both impaired NVC and increased FC correlate with age-related decline in accuracy during the 2-back task. These findings suggest that task-related brain states in older adults require stronger functional connections to compensate for the attenuated NVC responses associated with working memory load.
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Affiliation(s)
- Peter Mukli
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, H-1094, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Camila B Pinto
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - Cameron D Owens
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - Tamas Csipo
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Agnes Lipecz
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Zsofia Szarvas
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Anna Peterfi
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Ana Clara da Costa Pinaffi Langley
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - Jordan Hoffmeister
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Frigyes Samuel Racz
- Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, H-1094, Hungary
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, 78712, USA
| | - Jonathan W Perry
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
| | - Stefano Tarantini
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Ádám Nyúl-Tóth
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
| | - Farzaneh A Sorond
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Chicago, IL, 60611, USA
| | - Yuan Yang
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Tulsa, OK, 73019, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Rehabilitation Sciences, University of Oklahoma Health Science Center, Oklahoma City, OK, 73117, USA
| | - Judith A James
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK, 73104, USA
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | | | - Calin I Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, 73104, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Peter Toth
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, H-7623, Hungary
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, H-7624, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, H-7624, Hungary
| | - Juliette Galindo
- Department of Cardiology, Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA
| | - William E Sonntag
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
| | - Anna Csiszar
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Zoltan Ungvari
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, H-1085, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Andriy Yabluchanskiy
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK, 73117, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
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Gardner AW, Montgomery PS, Wang M, Liang M. Effects of Long-Term Home Exercise in Participants With Peripheral Artery Disease. J Am Heart Assoc 2023; 12:e029755. [PMID: 37929770 PMCID: PMC10727372 DOI: 10.1161/jaha.122.029755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Background This randomized controlled trial compared long-term changes in peak walking time (PWT) and exercise time-to-minimum calf muscle oxygen saturation (StO2) in symptomatic participants with peripheral artery disease following a long-term home exercise program (HEP), a short-term supervised exercise therapy (SET) program that transitioned to a long-term HEP (SET/HEP), and a control intervention. Methods and Results For the first 3 months, HEP and SET/HEP groups performed intermittent walking to mild-to-moderate claudication pain, whereas the control group performed light resistance training. For the subsequent 15 months, the HEP group continued their exercise program, the SET/HEP group transitioned from SET to the HEP program, and the control group transitioned to only receive walking advice. PWT increased significantly from baseline to month 18 in the HEP group (408±279 meters to 814±393 meters, P<0.001) and in the SET/HEP group (457±288 meters to 818±313 meters, P<0.001). Exercise time-to-minimum calf muscle StO2 increased significantly from baseline to month 18 in the HEP group (238±241 seconds to 497±485 seconds, P<0.05) and in the SET/HEP group (296±289 seconds to 620±450 seconds, P<0.001). These changes in PWT and exercise time-to-minimum calf muscle StO2 were greater than in the control group (P<0.001 and P<0.01, respectively). Additionally, the change in exercise time-to-minimum calf muscle StO2 was correlated with the change in PWT in both exercise groups combined (r=0.601, P=0.0015). Conclusions Long-term HEP and SET/HEP were efficacious in improving PWT and exercise time-to-minimum calf muscle StO2 in symptomatic participants with peripheral artery disease, and these changes were correlated with each other. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00618670.
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Affiliation(s)
| | | | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of MedicineCase Western Reserve UniversityClevelandOHUSA
| | - Menglu Liang
- Department of Epidemiology and Biostatistics, School of Public HealthUniversity of MarylandCollege ParkMDUSA
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Gardner AW, Montgomery PS, Zhang S, Pomilla WA, Wang M, Shen B, Liang M. Diabetes Is Negatively Associated With Meeting Physical Activity Time-Intensity Guidelines in Patients With Claudication. J Cardiopulm Rehabil Prev 2023; 43:135-142. [PMID: 36730590 PMCID: PMC9974539 DOI: 10.1097/hcr.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSES We determined the percentage of patients with peripheral artery disease (PAD) and claudication who meet the 2018 physical activity (PA) time-intensity guidelines, and we identified the clinical characteristics associated with the status of meeting the guidelines. METHODS Five hundred seventy-two patients were assessed on their daily ambulatory activity for 1 wk with a step activity monitor, and were evaluated on whether or not they achieved 150 min/wk of moderate-intensity PA. RESULTS Thirty-one percent (n = 175) of the patients with PAD met the PA time-intensity guidelines and 69% (n = 397) did not. In a final multivariable logistic regression model identifying the independent predictors of meeting the PA time-intensity guidelines from clinical characteristics, diabetes was the only significant variable entered (OR = 0.310: 95% CI, 0.175-0.538; P < .001) and was associated with a 69% lower chance of meeting the guidelines. Patients with diabetes spent less daily time in moderate-intensity ambulatory PA than patients without diabetes (15 ± 13 vs 23 ± 20 min/d; P < .001). CONCLUSIONS Thirty-one percent of patients with PAD and claudication met the PA time-intensity guidelines. Furthermore, patients with diabetes were least likely to meet the PA time-intensity guidelines, as they had a 69% lower chance than patients without diabetes. The clinical significance is that PAD patients who have diabetes are particularly susceptible to being physically sedentary, and are therefore prime patients who should be encouraged to increase their daily PA.
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Affiliation(s)
- Andrew W. Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Polly S. Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Shangming Zhang
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - William A. Pomilla
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Menglu Liang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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Gardner AW, Montgomery PS, Wang M, Liang M, Proctor DN. Maximal calf conductance is associated with 6-minute walk distance in participants with and without peripheral artery disease. Vasc Med 2023; 28:113-121. [PMID: 36847177 DOI: 10.1177/1358863x231155299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The aims were (a) to compare the maximal calf conductance and 6-minute walk distance of participants with and without peripheral artery disease (PAD) and claudication, (b) to determine whether maximal calf conductance was more strongly associated with 6-minute walk distance in participants with PAD than in the controls, and (c) to determine whether this association was significant in participants with PAD after adjusting for ABI, as well as for demographic, anthropometric, and comorbid variables. METHODS Participants with PAD (n = 633) and without PAD (n = 327) were assessed on maximal calf conductance using venous occlusion plethysmography, and on 6-minute walk distance. Participants were further characterized on ABI, and on demographic, anthropometric, and comorbid variables. RESULTS The PAD group had lower maximal calf conductance than the control group (0.136 ± 0.071 vs 0.201 ± 0.113 mL/100 mL/min/mmHg, p < 0.001). Additionally, the PAD group had a lower 6-minute walk distance (375 ± 98 m vs 480 ± 107 m, p < 0.001). Maximal calf conductance was positively associated with 6-minute walk distance in both groups (p < 0.001) and was more strongly associated in the PAD group (p < 0.001). In adjusted analyses, maximal calf conductance remained positively associated with 6-minute walk distance in the PAD group (p < 0.001) and in the control group (p < 0.001). CONCLUSIONS Participants with PAD and claudication had impaired maximal calf conductance and a lower 6-minute walk distance than those without PAD, and maximal calf conductance was positively and independently associated with 6-minute walk distance within each group before and after adjusting for ABI, and for demographic, anthropometric, and comorbid variables.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Polly S Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Menglu Liang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - David N Proctor
- Department of Kinesiology, Penn State University, University Park, PA, USA
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Gosalia J, Montgomery PS, Zhang S, Pomilla WA, Wang M, Liang M, Csiszar A, Ungvari Z, Yabluchanskiy A, Proctor DN, Gardner AW. Increased pulse wave velocity is related to impaired working memory and executive function in older adults with metabolic syndrome. GeroScience 2022; 44:2831-2844. [PMID: 35980564 PMCID: PMC9768088 DOI: 10.1007/s11357-022-00640-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/04/2022] [Indexed: 01/07/2023] Open
Abstract
Age-related vascular alterations promote the pathogenesis of vascular cognitive impairment (VCI). Cardiovascular risk factors that accelerate vascular aging exacerbate VCI. Metabolic syndrome (MetS) constitutes a cluster of critical cardiovascular risk factors (abdominal obesity, hypertension, elevated triglycerides, elevated fasting glucose, reduced HDL cholesterol), which affects nearly 37% of the adult US population. The present study was designed to test the hypotheses that MetS exacerbates cognitive impairment and that arterial stiffening moderates the association between cognitive dysfunction and MetS in older adults. MetS was defined by the NCEP ATP III guidelines. Cognitive function (digit span and trail-making tests) and brachial-ankle pulse wave velocity (baPWV; a non-invasive clinical measurement of arterial stiffness) were assessed in older adults with MetS and age- and sex-matched controls. Multiple linear regression models were applied to test for the main effects of MetS, baPWV, and their interaction on cognitive performance. Fifty-three participants with MetS (age: 68 ± 8 years) and 39 age-matched individuals without MetS (age: 66 ± 9 years) were enrolled into the study. In adjusted multivariable regression analyses of the digit span backward length score, both MetS (ß = 1.97, p = 0.048) and MetS by baPWV interaction (ß = - 0.001, p = 0.026) were significant predictors. In participants with MetS, higher baPWV was associated with poorer performance on digit span backward length score, a test of working memory (R = - 0.44, p = 0.0012), but there was no association in those without MetS (R = 0.035, p = 0.83). MetS was negatively associated with performance on the digit span backward length score, baPWV was negatively associated with multiple neuropsychological outcomes, and baPWV moderated the association between digit span backward length score and MetS, as individuals with both MetS and higher baPWV had the most impaired cognitive function. Our findings add to the growing body of evidence that individuals with MetS and higher baPWV may be prone to VCI.
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Affiliation(s)
- Jigar Gosalia
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Polly S Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Shangming Zhang
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - William A Pomilla
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, 500 University DriveMail Code HP28, P.O. Box 850, Hershey, PA, 17033, USA
| | - Menglu Liang
- Department of Public Health Sciences, Penn State College of Medicine, 500 University DriveMail Code HP28, P.O. Box 850, Hershey, PA, 17033, USA
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Departments of Translational Medicine and Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Departments of Translational Medicine and Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Departments of Translational Medicine and Public Health, Semmelweis University, Budapest, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - David N Proctor
- Department of Kinesiology, Penn State University, University Park, PA, USA
| | - Andrew W Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA, USA.
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Gardner AW, Montgomery PS, Wang M, Shen B, Zhang S, Pomilla WA. Association Between Meeting Physical Activity Time-Intensity Guidelines With Ambulation, Quality of Life, and Inflammation in Claudication. J Cardiopulm Rehabil Prev 2022; 42:E82-E89. [PMID: 35385857 PMCID: PMC9535037 DOI: 10.1097/hcr.0000000000000686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this investigation was to determine if meeting the 2018 physical activity (PA) time-intensity guidelines was associated with better ambulatory function, health-related quality of life (HRQoL), vascular function, and inflammation than failing to meet the guidelines in patients with peripheral artery disease and claudication. Second, we determined the optimal number of total steps/d and steps taken at moderate cadence needed to meet the PA time-intensity guidelines. METHODS Five hundred seventy-two patients were assessed on daily ambulatory activity for 1 wk with a step activity monitor, and were grouped according to whether they achieved <150 min/wk of moderate-intensity PA (group 1 = do not meet guidelines; n = 397) or whether they were above this threshold (group 2 = meet guidelines; n = 175). RESULTS Treadmill peak walking time (mean ± SD) was higher ( P < .001) in group 2 (709 ± 359 sec) than in group 1 (427 ± 281 sec). The physical function HRQoL score was higher ( P < .001) in group 2 (61 ± 22%) than in group 1 (44 ± 21%). High-sensitivity C-reactive protein was lower ( P < .001) in group 2 (3.6 ± 4.5 mg/L) than in group 1 (5.9 ± 6.1 mg/L). Finally, ≥7675 total steps/d and ≥1660 steps/d at moderate cadence were optimal thresholds associated with meeting PA guidelines. CONCLUSIONS Patients with claudication who meet the 2018 PA time-intensity guidelines for US adults had better ambulation, HRQoL, and vascular outcomes than those who failed to meet the PA guidelines. Patients with claudication best achieved the PA time-intensity guidelines by taking ≥7675 total steps/d, and ≥1660 steps/d at a moderate cadence.
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Affiliation(s)
- Andrew W. Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Polly S. Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Shangming Zhang
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - William A. Pomilla
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
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Owens CD, Mukli P, Csipo T, Lipecz A, Silva-Palacios F, Dasari TW, Tarantini S, Gardner AW, Montgomery PS, Waldstein SR, Kellawan JM, Nyul-Toth A, Balasubramanian P, Sotonyi P, Csiszar A, Ungvari Z, Yabluchanskiy A. Microvascular dysfunction and neurovascular uncoupling are exacerbated in peripheral artery disease, increasing the risk of cognitive decline in older adults. Am J Physiol Heart Circ Physiol 2022; 322:H924-H935. [PMID: 35333116 PMCID: PMC9037702 DOI: 10.1152/ajpheart.00616.2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Peripheral artery disease (PAD) is a vascular pathology with high prevalence among the aging population. PAD is associated with decreased cognitive performance, but the underlying mechanisms remain obscure. Normal brain function critically depends on an adequate adjustment of cerebral blood supply to match the needs of active brain regions via neurovascular coupling (NVC). NVC responses depend on healthy microvascular endothelial function. PAD is associated with significant endothelial dysfunction in peripheral arteries, but its effect on NVC responses has not been investigated. This study was designed to test the hypothesis that NVC and peripheral microvascular endothelial function are impaired in PAD. We enrolled 11 symptomatic patients with PAD and 11 age- and sex-matched controls. Participants were evaluated for cognitive performance using the Cambridge Neuropsychological Test Automated Battery and functional near-infrared spectroscopy to assess NVC responses during the cognitive n-back task. Peripheral microvascular endothelial function was evaluated using laser speckle contrast imaging. We found that cognitive performance was compromised in patients with PAD, evidenced by reduced visual memory, short-term memory, and sustained attention. We found that NVC responses and peripheral microvascular endothelial function were significantly impaired in patients with PAD. A positive correlation was observed between microvascular endothelial function, NVC responses, and cognitive performance in the study participants. Our findings support the concept that microvascular endothelial dysfunction and neurovascular uncoupling contribute to the genesis of cognitive impairment in older PAD patients with claudication. Longitudinal studies are warranted to test whether the targeted improvement of NVC responses can prevent or delay the onset of PAD-associated cognitive decline.NEW & NOTEWORTHY Peripheral artery disease (PAD) was associated with significantly decreased cognitive performance, impaired neurovascular coupling (NVC) responses in the prefrontal cortex (PFC), left and right dorsolateral prefrontal cortices (LDLPFC and RDLPFC), and impaired peripheral microvascular endothelial function. A positive correlation between microvascular endothelial function, NVC responses, and cognitive performance may suggest that PAD-related cognitive decrement is mechanistically linked, at least in part, to generalized microvascular endothelial dysfunction and subsequent impairment of NVC responses.
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Affiliation(s)
- Cameron D. Owens
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Peter Mukli
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,2International Training Program in Geroscience, Department of Physiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary,3International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Tamas Csipo
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,3International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Agnes Lipecz
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,3International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Federico Silva-Palacios
- 4Vascular Medicine Program, Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Tarun W. Dasari
- 5Cardiovascular Section, Department of Internal Medicine, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Stefano Tarantini
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,3International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary,6The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,7Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrew W. Gardner
- 8Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Polly S. Montgomery
- 8Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Shari R. Waldstein
- 9Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland,10Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
| | - J. Mikhail Kellawan
- 11Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma
| | - Adam Nyul-Toth
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,3International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary,14International Training Program in Geroscience, Institute of Biophysics, Biological Research Centre, Eötvös Loránd Research Network, Szeged, Hungary
| | - Priya Balasubramanian
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,6The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Peter Sotonyi
- 12Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Anna Csiszar
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,6The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,13International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,3International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary,6The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,7Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andriy Yabluchanskiy
- 1Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,6The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,7Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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8
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Gardner AW, Montgomery PS, Wang M, Shen B. Minimal clinically important differences in daily physical activity outcomes following supervised and home-based exercise in peripheral artery disease. Vasc Med 2022; 27:142-149. [PMID: 35164605 DOI: 10.1177/1358863x211072913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: We estimated minimal clinically important differences (MCID) for small, moderate, and large changes in daily step counts and time spent in moderate-to-vigorous physical activity (MVPA) following both supervised and home-based exercise programs in symptomatic patients with peripheral artery disease (PAD). Methods: Patients were randomized to either 12 weeks of a supervised exercise program (n = 60), a home-based exercise program (n = 60), or an attention-control group (n = 60). Results: Using the anchor-based method to determine MCID, the MCID value for a large change in health-related quality of life (HRQoL) was an increase of 1211 total daily steps and an increase in 11 minutes in the time spent in MVPA following 12 weeks of exercise intervention. Using the distribution-based method, the MCID values for small, moderate, and large changes in total daily steps in the home-based exercise group were 558, 1396, and 2233 steps/d, respectively, and the corresponding changes in the time spent in MVPA were 6, 15, and 23 minutes. Similar distribution-based MCID scores were noted for the supervised exercise group. Conclusion: Following 3 months of home-based and supervised exercise programs for patients with PAD and claudication, increases of 11 minutes in time spent in MVPA and 1211 total daily steps were associated with large anchor-based MCID increases in HRQoL. The clinical implication is that patients with PAD and claudication should be encouraged to increase daily steps, particularly by walking an additional 11 minutes each day in MVPA, which is associated with a large meaningful increase in HRQoL.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Polly S Montgomery
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Gardner AW, Montgomery PS, Wang M, Shen B, Afaq A, Khurana A. LIGHT AND MODERATE INTENSITY PHYSICAL ACTIVITY ARE ASSOCIATED WITH BETTER AMBULATION, QUALITY OF LIFE, AND VASCULAR MEASUREMENTS IN PATIENTS WITH CLAUDICATION. J Vasc Surg 2022; 75:1739-1749. [PMID: 34999217 PMCID: PMC9038648 DOI: 10.1016/j.jvs.2021.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine whether patients with claudication who reported performing either light-intensity physical activity (LPA) or moderate-to-vigorous intensity physical activity (MVPA) had higher levels of objectively-determined physical activity, and better physical function, health-related quality of life (HRQoL), and vascular measures, consisting of exercise time to minimum calf muscle oxygen saturation (StO2) and high-sensitivity C-reactive protein, than patients who reported being physically sedentary. METHODS Two hundred sixty-nine patients were assessed on the Johnson Space Center physical activity scale. Patients were grouped according to whether they performed no physical activities (n=75), LPA (n=140), or MVPA (n=54). Primary measurements were total daily steps obtained from a step activity monitor worn for one week, peak walking time obtained from a treadmill test, the physical function score on the Medical Outcomes Study Short-Form 36 survey to assess HRQoL, and high-sensitivity C-reactive protein. RESULTS Total daily steps (mean±SD) was significantly different among groups, as both the LPA group (7878±2808 steps/day) and the MVPA group (8551±3365 steps/day) took more daily steps (p<0.01) than the sedentary group (3323±986 steps/day). Treadmill peak walking time was significantly different among groups, as both the LPA group (433±296 sec) and the MVPA group (548±300 sec) had greater peak walking time (p<0.01) than the sedentary group (302±210 sec). Physical function score was significantly different among groups, as both the LPA group (44±20%) and the MVPA group (58±19%) had higher scores (p<0.01) than the sedentary group (36±20%). Exercise time to the minimum calf muscle StO2 was significantly different among groups, as both the LPA group (215±238 sec) and the MVPA group (377±351 sec) had greater values (p<0.05 and p<0.01, respectively) than the sedentary group (147±172 sec). Finally, high-sensitivity C-reactive protein was significantly different among groups, as both the LPA group (4.8±5.5 mg/L) and the MVPA group (3.5±3.6 mg/L) had lower values (p<0.01) than the sedentary group (8.6±8.4 mg/L). CONCLUSIONS Patients with claudication who reported performing LPA had greater amounts of objectively-determined physical activity levels and better physical function, HRQoL, and vascular measures than those who reported being physically sedentary. Furthermore, these favorable results associated with LPA were even more pronounced in patients who performed MVPA than in patients who were sedentary. The clinical significance is that engaging in any physical activity, even at relatively light intensity, is associated with favorable health and vascular measures in patients with claudication.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA; University of Oklahoma Health Sciences Center, Oklahoma City, OK.
| | - Polly S Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA; University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Azhar Afaq
- Inpatient Physician Associates, Fort Worth, TX
| | - Aman Khurana
- Prairie Cardiovascular Consultants, Springfield, IL
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Abstract
PURPOSE We determined whether patients with peripheral artery disease (PAD) and claudication grouped according to tertiles of community-based daily steps taken at a moderate cadence had differences in vascular function and biomarkers and whether group differences in vascular function and biomarkers persisted after adjusting for demographic variables, comorbid conditions, and severity of PAD. METHODS Two hundred sixty-three patients were evaluated for 1 wk on steps taken at a moderate cadence (exceeding 60 steps/min), and patients were placed into low (group 1), intermediate (group 2), and high (group 3) tertiles. RESULTS Ankle/brachial index (ABI) at 1 min after exercise (mean ± SD) was significantly higher in groups 2 and 3 than in group 1 in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1: 0.34 ± 0.25; group 2: 0.38 ± 0.27; and group 3: 0.44 ± 0.28). Exercise time to reach the minimum calf muscle oxygen saturation (StO2) value during treadmill exercise was significantly longer in groups 2 and 3 than in group 1 in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1: 127 ± 127 sec; group 2: 251 ± 266 sec; and group 3: 310 ± 323 sec). Fibrinogen was significantly lower in group 3 than in group 1 in unadjusted (P = .02) and adjusted (P = .05) analyses (group 1: 3.5 ± 1.2 g/L; group 2: 3.6 ± 1.5 g/L; and group 3: 3.0 ± 1.1 g/L). CONCLUSIONS Compared with patients with claudication in the lowest tertile of community-based daily steps taken at a moderate cadence, patients in the second and third tertiles had better calf muscle StO2 and ABI values during and immediately after exercise. Second, the most active group had lower fibrinogen levels than the least active group.
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Affiliation(s)
- Andrew W. Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center
| | - Polly S. Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
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11
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Gardner AW, Montgomery PS, Wang M, Shen B, Casanegra AI, Silva-Palacios F, Ungvari Z, Yabluchanskiy A, Csiszar A, Waldstein SR. Cognitive decrement in older adults with symptomatic peripheral artery disease. GeroScience 2021; 43:2455-2465. [PMID: 34498199 PMCID: PMC8599571 DOI: 10.1007/s11357-021-00437-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022] Open
Abstract
Peripheral artery disease (PAD) is highly prevalent, affecting up to 20% of people over 70 years of age. To test the hypothesis that PAD promotes the pathogenesis of vascular cognitive impairment (VCI), we compared cognitive function in older adults with symptomatic PAD and in participants without PAD who had a burden of comorbid conditions. Furthermore, we compared the cognitive function of these groups after adjusting for demographic and clinical characteristics, comorbid conditions, and cardiovascular risk factors. Participants with PAD (age: 69 ± 8 years; n = 58) and those without PAD (age: 62 ± 8 years; n = 30) were assessed on a battery of eight neuropsychological tests. The tests assessed attention and working memory, verbal memory, non-verbal memory, perceptuo-motor speed, and executive function. Participants were further characterized on demographic and clinical characteristics, comorbid conditions, cardiovascular risk factors, and ankle-brachial index. The PAD group had significantly lower neuropsychological scores than the non-PAD control group on all eight tests (P < .01). After adjusting for covariates, significantly worse scores in the PAD group persisted for verbal memory, measured by tests on logical memory-immediate recall (P = .022), and logical memory-delayed recall (P < .001), and for attention and working memory, measured by tests on digits forward (P < .001), and digits backward (P = .003). Participants with symptomatic PAD have substantially lower levels of performance on tests of attention, working memory, and verbal memory than participants without PAD independent of demographic characteristics and comorbid health burdens. These findings provide additional evidence in support of the concept that generalized accelerated vascular aging manifesting as symptomatic PAD in the peripheral circulation also affects the brain promoting the pathogenesis of VCI. These cognitive difficulties may also negatively impact symptomatic patient's ability to understand and adhere to behavioral and medical therapies, creating a vicious cycle. We speculate that more intensive follow-up may be needed to promote adherence to therapies and monitor cognitive decline that may affect care.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, 500 University Drive, Mail Code HP28, P.O. Box 850, Hershey, PA, 17033, USA.
| | - Polly S Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, 500 University Drive, Mail Code HP28, P.O. Box 850, Hershey, PA, 17033, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ana I Casanegra
- Vascular Medicine Division, Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Federico Silva-Palacios
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center On Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center On Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center On Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, USA
- Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
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Gardner AW, Addison O, Katzel LI, Montgomery PS, Prior SJ, Serra MC, Sorkin JD. Association between Physical Activity and Mortality in Patients with Claudication. Med Sci Sports Exerc 2021; 53:732-739. [PMID: 32991346 PMCID: PMC7969371 DOI: 10.1249/mss.0000000000002526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the association between light-intensity physical activity and the incidence of all-cause and cardiovascular mortality in patients with peripheral artery disease (PAD) limited by claudication followed for up to 18.7 yr. METHODS A total of 528 patients with PAD and claudication were screened in Baltimore between 1994 and 2002, and 386 were deemed eligible for the study. At baseline, patients were classified into three physical activity groups: 1) physically sedentary, 2) light intensity, and 3) moderate to vigorous intensity based on a questionnaire. All-cause and cardiovascular mortality of patients through December 2014 was determined using the National Death Index and the U.S. Department of Veterans Affairs and the U.S. Department of Defense Suicide Data Repository. RESULTS Median survival time was 9.9 yr (interquartile range, 4.9-15.7 yr; range, 0.38-18.7 yr). During follow-up, 257 patients (66.6%) died, consisting of 40/48 (83.3%) from the sedentary group, 135/210 (64.3%) from the light-intensity group, and 82/128 (64.0%) from the moderate- to vigorous-intensity group. For all-cause mortality, light-intensity activity status (hazard ratio [HR] = 0.523, P = 0.0007) and moderate- to vigorous-intensity status (HR = 0.425, P < 0.0001) were significant predictors. During follow-up, 125 patients died because of cardiovascular causes (32.4%), in which light-intensity activity status (HR = 0.511, P = 0.0113) and moderate- to vigorous-intensity activity status (HR = 0.341, P = 0.0003) were significant predictors. CONCLUSIONS Light-intensity physical activity is associated with nearly 50% lower risk of all-cause and cardiovascular mortality in high-risk patients with PAD and claudication. Furthermore, moderate- to vigorous-intensity physical activity performed regularly is associated with 58% and 66% lower risk of all-cause and cardiovascular mortality, respectively. The survival benefits associated with light-intensity physical activity make it a compelling behavioral intervention that extends beyond improving ambulation.
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Affiliation(s)
- Andrew W. Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
- Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
| | - Leslie I. Katzel
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD
- Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
| | - Polly S. Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - Steven J. Prior
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD
- Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
- Department of Kinesiology, University of Maryland School of Public Health, College Park, MD
| | - Monica C. Serra
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, UT Health San Antonio, TX
- South Texas Veterans Affairs Health Care System, San Antonio, TX
| | - John D. Sorkin
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD
- Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
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Amador JL, DeBar RM, Sidener TM, Gardner AW. Evaluating the Effects of Computer-Based Instruction on Trial-Based Functional Analyses Procedures. Behav Modif 2021; 46:479-505. [PMID: 33729023 DOI: 10.1177/0145445520982552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children who engage in problem behavior are often educated in the public schools. A trial-based functional analysis (TBFA) is an experimental functional analysis whereby conditions are embedded into scheduled activities of the school day to identify environmental variables responsible for problem behavior. To be included in this process, it is important that staff are trained effectively and efficiently. Computer-based instruction (CBI) offers several advantages as a staff training tool including less training time, less required supervision, and permits self-paced and individualized training. The efficacy of CBI on procedures of TBFA to practitioners remains unknown. We evaluated the efficacy of CBI teaching procedures of TBFA with 20 practitioners. Results indicate that CBI is an effective and efficient staff training procedure as post-test scores increased following the CBI training across participants with a mean training duration of less than an hour. Three practitioners successfully implemented four conditions of a TBFA with a confederate following CBI training. Following completion of the study, respondents ranked procedures of the CBI as socially valid.
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Gardner AW, Montgomery PS, Wang M, Shen B. Association between meeting daily step count goals with ambulatory function and quality of life in patients with claudication. J Vasc Surg 2020; 73:2105-2113. [PMID: 33253870 DOI: 10.1016/j.jvs.2020.10.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine (a) whether patients with peripheral artery disease (PAD) who walked at least 7000 and 10,000 steps/day had better ambulatory function and health-related quality of life (HRQoL) than patients who walked less than 7000 steps/day, and (b) whether differences in ambulatory function and HRQoL in patients grouped according to these daily step count criteria persisted after adjusting for covariates. METHODS Two hundred forty-eight patients were assessed on their daily ambulatory activity for 1 week with a step activity monitor, and were grouped according to daily step count targets. Patients who took fewer than 7000 steps/day were included in group 1 (n = 153), those who took 7000 to 9999 steps/day were included in group 2 (n = 57), and patients who took at least 10,000 steps/day were included in group 3 (n = 38). Primary outcomes were the 6-minute walk distance (6MWD) and Walking Impairment Questionnaire (WIQ) distance score, which is a disease-specific measurement of HRQoL. Patients were further characterized on demographic variables, comorbid conditions, and cardiovascular risk factors. RESULTS The groups were significantly different on ankle-brachial index (P = .02), and on the prevalence of hypertension (P = .04), diabetes (P < .01), abdominal obesity (P < .01), arthritis (P = .04), and chronic obstructive pulmonary disease (P < .01). Thus, these variables served as covariates in adjusted analyses, along with age, weight, and sex. The 6MWD (mean ± standard deviation) was significantly different among the groups in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1, 313 ± 90 m; group 2, 378 ± 84 m; and group 3, 414 ± 77 m), with groups 2 and 3 having a higher 6MWD than group 1 (P < .01). The WIQ distance score was significantly different among the groups in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1, 30 ± 30%; group 2, 45 ± 35%; and group 3, 47 ± 34%), with groups 2 and 3 having higher WIQ distance scores than group 1 (P < .01). CONCLUSIONS Patients with PAD who walked more than 7000 and 10,000 steps/day had greater ambulatory function and HRQoL than patients who walked fewer than 7000 steps/day. Second, the greater ambulatory function and HRQoL associated with walking 7000 and 10,000 steps/day persisted after adjusting for covariates. This study provides preliminary evidence that patients with PAD who walk more than 7000 steps/day have better ambulatory function and HRQoL than patients below this threshold.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, Pa; Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Polly S Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, Pa; Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
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Kim DJK, Montgomery PS, Wang M, Shen B, Kuroki M, Gardner AW. Patients With Peripheral Arterial Disease With Exaggerated Pressor Response Have Greater Ambulatory Dysfunction Than Patients With Lower Pressor Response. Angiology 2020; 71:747-753. [PMID: 32425059 DOI: 10.1177/0003319720925970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We determined whether patients with peripheral arterial disease (PAD) who have either an exaggerated or a negative pressor response during treadmill walking have shorter peak walking time (PWT) and claudication onset time (COT) than patients with a normal pressor response, independent of comorbid conditions. A total of 249 patients were categorized to 1 of 3 groups based on systolic blood pressure (SBP) responses at 2 minutes of treadmill walking (speed = 2 mph, grade = 0%): group 1 (negative pressor response, SBP < 0 mm Hg), group 2 (normal pressor response, SBP 18 mm Hg), and group 3 (exaggerated pressor response, SBP > 18 mm Hg). After adjusting for comorbid conditions, group 3 (exaggerated) had significantly reduced COT (P = .011) and PWT (P = .002) compared to group 2 (normal), while group 1 (negative) and group 2 (normal) were not different. Patients with symptomatic PAD with an increase in SBP > 18 mm Hg after 2 minutes of treadmill walking experience claudication earlier and thus have greater ambulatory dysfunction, compared to patients with PAD with a normal pressor response, whereas patients with PAD with negative pressor response had a similar walking performance. The implication is that the magnitude of pressor response to only 2 minutes of treadmill walking can partially explain the degree of ambulatory dysfunction in patients with PAD.
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Affiliation(s)
- Danielle Jin-Kwang Kim
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Polly S Montgomery
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Marcos Kuroki
- Department of Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
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Gardner AW, Montgomery PS, Wang M, Shen B, Casanegra AI, Silva-Palacios F, Knehans AW. Diet is associated with ankle-brachial index, inflammation, and ambulation in patients with intermittent claudication. J Vasc Surg 2020; 72:1375-1384. [PMID: 32122735 DOI: 10.1016/j.jvs.2019.12.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/17/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aims of this investigation were to determine whether the daily dietary intake of nutrients by patients with peripheral artery disease (PAD) and intermittent claudication (IC) met recommended levels for adults older than 50 years and to determine whether meeting recommended levels of nutrients was associated with ankle-brachial index (ABI), inflammation, and ambulation of patients with PAD and IC. METHODS A total of 48 patients were assessed on their dietary intake of 20 nutrients during a 3-day period. Patients were further characterized on demographic variables, comorbid conditions, cardiovascular risk factors, ABI, 6-minute walk distance (6MWD), and high-sensitivity C-reactive protein (hsCRP) concentration. RESULTS Few patients met the daily recommended intakes for calcium (4%), fiber (6%), vitamin E (6%), trans fatty acids (13%), vitamin A (15%), total sugars (19%), potassium (23%), sodium (29%), saturated fat (29%), and vitamin C (31%), and none of the patients met the daily recommended intake of vitamin D (0%). Overall, patients met few of the 20 dietary recommendations as the median score was seven recommendations. Only 17 of 48 patients met more than seven of the recommendations. For the ABI regression model adjusted for age, sex, race, smoking, hypertension, dyslipidemia, body mass index, and percentage body fat, the only significant predictor was total sugars (P < .001); patients who did not meet the recommendation had lower ABI values. For the hsCRP-adjusted regression model, the strongest significant predictor was omega-3 polyunsaturated fatty acids (P = .001), indicating that those who did not meet the recommendation had higher hsCRP values. Finally, for the 6MWD-adjusted regression model, folate (P = .011) and dietary score index (P = .014) were significant predictors; those who did not meet the recommendation for folate and those who met 5 or fewer of the 20 recommendations had shorter 6MWD. CONCLUSIONS Patients with PAD and IC consume a low-nutrient-dense diet that is deficient in many vitamins, calcium, fruits, and vegetables and contains too much added sugar, saturated and trans fats, and processed foods. In addition, more severe PAD, greater inflammation, and ambulatory dysfunction are independently associated with aspects of a low-nutrient-dense diet, such as too much intake of added sugars, low intake of omega-3 polyunsaturated fatty acids and folate, and meeting the recommended intakes of only five or fewer nutrients.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa.
| | - Polly S Montgomery
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Ana I Casanegra
- Vascular Medicine Division, Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Federico Silva-Palacios
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Allen W Knehans
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
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Treat-Jacobson D, McDermott MM, Beckman JA, Burt MA, Creager MA, Ehrman JK, Gardner AW, Mays RJ, Regensteiner JG, Salisbury DL, Schorr EN, Walsh ME. Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association. Circulation 2019; 140:e700-e710. [PMID: 31446770 DOI: 10.1161/cir.0000000000000727] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with lower-extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD. Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD. This advisory provides a practical guide for delivering SET programs to patients with PAD according to Centers for Medicare & Medicaid Services criteria. It summarizes the Centers for Medicare & Medicaid Services process and requirements for referral and coverage of SET and provides guidance on how to implement SET for patients with PAD, including the SET protocol, options for outcome measurement, and transition to home-based exercise. This advisory is based on the guidelines established by the Centers for Medicare & Medicaid Services for Medicare beneficiaries in the United States and is intended to assist clinicians and administrators who are implementing SET programs for patients with PAD.
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Kuroki MT, Montgomery PS, Shen B, Kim DJ, Wang M, Gardner AW. PC088. Greater Exercise Pressor Response at Baseline Is Associated With Improvement in Claudication Outcomes After Exercise Training in Symptomatic Peripheral Artery Disease. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gardner AW, Montgomery PS, Wang M, Chen C, Kuroki M, Kim DJK. Vascular Inflammation, Calf Muscle Oxygen Saturation, and Blood Glucose are Associated With Exercise Pressor Response in Symptomatic Peripheral Artery Disease. Angiology 2019; 70:747-755. [DOI: 10.1177/0003319719838399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We determined whether calf muscle oxygen saturation (StO2) and vascular biomarkers of inflammation and oxidative stress were associated with an exercise pressor response during treadmill walking in 179 patients with symptomatic peripheral artery disease (PAD). The exercise pressor response was measured as the change in blood pressure from rest to the end of the first 2-minute treadmill stage (2 mph, 0% grade). There was a wide range in the change in systolic blood pressure (−46 to 50 mm Hg) and in diastolic blood pressure (−23 to 38 mm Hg), with mean increases of 4.3 and 1.4 mm Hg, respectively. In multiple regression analyses, significant predictors of systolic pressure included glucose ( P < .001) and insulin ( P = .039). Significant predictors of diastolic pressure included cultured endothelial cell apoptosis ( P = .019), the percentage drop in exercise calf muscle (StO2; P = .023), high-sensitivity C-reactive protein ( P = .032), and glucose ( P = .033). Higher levels in pro-inflammatory vascular biomarkers, impaired calf muscle StO2 during exercise, and elevated blood glucose were independently associated with greater exercise pressor response in patients with symptomatic PAD. The clinical implication is that exercise and nutritional interventions designed to improve inflammation, microcirculation, and glucose metabolism may also lower blood pressure during exercise in patients with symptomatic PAD.
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Affiliation(s)
- Andrew W. Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Polly S. Montgomery
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Chixiang Chen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Marcos Kuroki
- Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
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Gardner AW, Parker DE, Montgomery PS. Changes in vascular and inflammatory biomarkers after exercise rehabilitation in patients with symptomatic peripheral artery disease. J Vasc Surg 2019; 70:1280-1290. [PMID: 30922751 DOI: 10.1016/j.jvs.2018.12.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Home-based exercise is an alternative exercise mode to a structured supervised program to improve symptoms in patients with peripheral artery disease (PAD), but little is known about whether the slow-paced and less intense home program also elicits changes in vascular and inflammatory biomarkers. In an exploratory analysis from a randomized controlled trial, we compared changes in vascular and inflammatory biomarkers in patients with symptomatic PAD (typical and atypical of claudication) after home-based exercise and supervised exercise programs and in an attention-control group. METHODS A total of 114 patients were randomized into one of the three groups (n = 38 per group). Two groups performed exercise interventions, consisting of home-based and supervised programs of intermittent walking to mild to moderate claudication pain for 12 weeks; a third group performed light resistance training as a nonwalking attention-control group. Before and after intervention, patients were characterized on treadmill performance and endothelial effects of circulating factors present in sera by a cell culture-based bioassay on primary human arterial endothelial cells, and they were further evaluated on circulating vascular and inflammatory biomarkers. RESULTS Treadmill peak walking time increased (P = .008) in the two exercise groups but not in the control group (P > .05). Cultured endothelial cell apoptosis decreased after home-based exercise (P < .001) and supervised exercise (P = .007), and the change in the exercise groups combined was different from that in the control group (P = .005). For circulating biomarkers, increases were found in hydroxyl radical antioxidant capacity (P = .003) and vascular endothelial growth factor A (P = .037), and decreases were observed in E-selectin (P = .007) and blood glucose concentration (P = .012) after home-based exercise only. The changes in hydroxyl radical antioxidant capacity (P = .005), vascular endothelial growth factor A (P = .008), and E-selectin (P = .034) in the exercise groups combined were different from those in the control group. CONCLUSIONS This exploratory analysis found that both home-based and supervised exercise programs are efficacious to decrease cultured endothelial cell apoptosis in patients with symptomatic PAD. Furthermore, a monitored home-based exercise program elicits additional vascular benefits by improving circulating markers of endogenous antioxidant capacity, angiogenesis, endothelium-derived inflammation, and blood glucose concentration in patients with symptomatic PAD. The novel clinical significance is that important trends were found in this exploratory analysis that a contemporary home-based exercise program and a traditional supervised exercise program may favorably improve vascular and inflammatory biomarkers in addition to the well-described ambulatory improvements in symptomatic patients with PAD.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa.
| | - Donald E Parker
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Polly S Montgomery
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa
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Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, Gardner AW, Hiatt WR, Regensteiner JG, Rich K. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e10-e33. [DOI: 10.1161/cir.0000000000000623] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gardner AW, Montgomery PS, Wang M, Chen C, Kuroki M, Kim DJK. Greater Exercise Pressor Response Is Associated With Impaired Claudication Outcomes in Symptomatic Peripheral Artery Disease. Angiology 2018; 70:220-228. [PMID: 30081644 DOI: 10.1177/0003319718790876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We determined whether a greater exercise pressor response during a constant-load treadmill test was associated with lower peak walking time (PWT) and claudication onset time (COT) measured during a graded maximal treadmill test in 304 patients with symptomatic peripheral artery disease (PAD). The exercise pressor response was assessed by measuring heart rate and blood pressure (BP) at rest and during a constant-load treadmill test (speed = 2 mph, grade = 0%). After only 2 minutes of walking, mean heart rate increased by 26 beats/min from rest and mean systolic BP increased by 16 mm Hg. In adjusted analyses, increases in systolic BP (P = .021), heart rate (P = .002), mean arterial pressure (P = .034), and rate-pressure product (P < .001) from rest to 2 minutes of constant-load exercise were negatively associated with COT. Similarly, increases in heart rate (P = .012) and rate-pressure product (P = .018) from rest to 2 minutes of constant-load exercise were negatively associated with PWT. A greater exercise pressor response observed after only 2 minutes of walking at no incline was independently associated with impaired claudication outcomes in patients with symptomatic PAD. The implication is that the exercise pressor response is an important and easily obtained clinical measurement that partially explains differences in PWT and COT.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Polly S Montgomery
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Chixiang Chen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Marcos Kuroki
- Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
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Addison O, Ryan AS, Prior SJ, Katzel LI, Kundi R, Lal BK, Gardner AW. Changes in Function After a 6-Month Walking Intervention in Patients With Intermittent Claudication Who Are Obese or Nonobese. J Geriatr Phys Ther 2018; 40:190-196. [PMID: 27341324 DOI: 10.1519/jpt.0000000000000096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Both obesity and peripheral artery disease (PAD) limit function and may work additively to reduce mobility. The purpose of this study was to compare the effects of a 6-month, center-based walking program on mobility function between adults who are weight-stable obese and nonobese with PAD. METHODS This is a secondary data analysis of 2 combined studies taken from previous work. Fifty-three adults with PAD and intermittent claudication participated in 6 months of treadmill training or standard of care. Patients were divided into 4 groups for analyses: exercise nonobese (Ex), exercise obese (ExO), standard-of-care nonobese (SC), and standard-of-care obese (SCO). Mobility was assessed by a standardized treadmill test to measure claudication onset time (COT) and peak walking time (PWT) as well as the distance walked during a 6-minute walk distance (6MWD) test. RESULTS There was a significant (P < .001) interaction (intervention × obesity) effect on 6MWD, wherein both exercise groups improved (Ex = 7%, ExO = 16%; P < .02), the SC group did not change (0.9%; P > .05), and the SCO group tended to decline (-18%; P = .06). Both exercise intervention groups significantly improved COT (Ex = 92%, ExO = 102%; P < .01) and PWT (Ex = 54%, ExO = 103%; P < .001). There was no change (P > .05) in either standard-of-care group. CONCLUSIONS Individuals who are obese and nonobese with PAD made similar improvements after a 6-month, center-based walking program. However, patients who are obese with PAD and do not exercise may be susceptible to greater declines in mobility. Exercise may be particularly important in patients who are obese with PAD to avoid declines in mobility.
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Affiliation(s)
- Odessa Addison
- 1Department of Medicine, Division of Gerontology, University of Maryland, Baltimore. 2Department of Veterans Affairs and Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Centers, Baltimore, Maryland. 3Department of Surgery, Division of Vascular Surgery, University of Maryland, Baltimore. 4Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
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Andrade-Lima A, Cucato GG, Domingues WJR, Germano-Soares AH, Cavalcante BR, Correia MA, Saes GF, Wolosker N, Gardner AW, Zerati AE, Ritti-Dias RM. Calf Muscle Oxygen Saturation during 6-Minute Walk Test and Its Relationship with Walking Impairment in Symptomatic Peripheral Artery Disease. Ann Vasc Surg 2018; 52:147-152. [PMID: 29793014 DOI: 10.1016/j.avsg.2018.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/12/2018] [Accepted: 03/25/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Impaired microcirculation is associated with poor walking capacity in symptomatic peripheral artery disease (PAD) patients during treadmill test; however, this test does not simulate the efforts of daily walking of these patients. Thus, the aim of the study was to describe the microcirculation responses during a 6-minute walk test (6MWT) and to analyze the relationship between microcirculation indicators and walking impairment in symptomatic PAD patients. METHODS Thirty-four patients were included (mean age = 67.6 ± 11.2 years). Their clinical characteristics were collected, and they performed a 6MWT, in which the initial claudication distance (ICD) and total walking distance (TWD) were recorded. During and after the 6MWT, calf muscle oxygen saturation (StO2) parameters were monitored continuously to measure microcirculation behavior. The association between calf muscle StO2 parameters and walking impairment were analyzed by Pearson or Spearman correlations. RESULTS Walking impairment was not associated with any StO2 parameters during exercise. In contrast, after 6MWT, recovery time of StO2 (r = -0.472, P = 0.008) and recovery time to maximal StO2 (r = -0.402, P = 0.019) were negatively correlated with ICD. Furthermore, the distance walked under claudication symptoms (ΔTWD-ICD) was positively correlated with recovery time to maximal StO2 (r = 0.347, P = 0.048). CONCLUSIONS In symptomatic PAD patients, shorter ICD values during a 6MWT are associated with a delayed recovery in calf muscle StO2 after exercise. Calf muscle StO2 parameters decrease subtly during 6MWT, suggesting that the degree of ischemia in the calf muscle during ground walking, simulating efforts of the daily walking, is relatively low.
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Affiliation(s)
- Aluísio Andrade-Lima
- Department of Physical Education, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
| | - Gabriel G Cucato
- Albert Einstein Israelite Hospital, São Paulo, São Paulo, Brazil
| | - Wagner J R Domingues
- Associated Graduate Program in Physical Education UEL/UEM, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Bruno R Cavalcante
- School of Physical Education, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Marilia A Correia
- School of Physical Education, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Glauco F Saes
- Division of Vascular and Endovascular Surgery, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Albert Einstein Israelite Hospital, São Paulo, São Paulo, Brazil
| | - Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - Antônio E Zerati
- Division of Vascular and Endovascular Surgery, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Raphael M Ritti-Dias
- Postgraduate Program in Rehabilitation Sciences, University Nine of July, São Paulo, São Paulo, Brazil
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Chen X, Stoner JA, Gardner AW. Reply. J Vasc Surg 2018; 67:1634-1635. [PMID: 29685255 DOI: 10.1016/j.jvs.2018.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/13/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Xi Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Andrew W Gardner
- Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla; Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa
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Gardner AW, Montgomery PS, Wang M. Minimal clinically important differences in treadmill, 6-minute walk, and patient-based outcomes following supervised and home-based exercise in peripheral artery disease. Vasc Med 2018; 23:349-357. [PMID: 29671381 DOI: 10.1177/1358863x18762599] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We estimated minimal clinically important differences (MCIDs) for small, moderate, and large changes in measures obtained from a standardized treadmill test, a 6-minute walk test, and patient-based outcomes following supervised and home-based exercise programs in symptomatic patients with peripheral artery disease (PAD). Patients were randomized to either 12 weeks of a supervised exercise program ( n=60), a home-based exercise program ( n=60), or an attention-control group ( n=60). Using the distribution-based method to determine MCIDs, the MCIDs for small, moderate, and large changes in peak walking time (PWT) in the supervised exercise group were 38, 95, and 152 seconds, respectively, and the changes in claudication onset time (COT) were 35, 87, and 138 seconds. Similar MCID scores were noted for the home-based exercise group. An anchor-based method to determine MCIDs yielded similar patterns of small, moderate, and large change scores in PWT and COT, but values were 1-2 minutes longer than the distribution approach. In conclusion, 3 months of supervised and home-based exercise programs for symptomatic patients with PAD results in distribution-based MCID small, moderate, and large changes ranging from 0.5 and 2.5 minutes for PWT and COT. An anchor-based approach yields higher MCID values, ranging from a minimum of 73 seconds for COT to a maximum of 4 minutes for PWT. The clinical implication is that a goal for eliciting MCIDs in symptomatic PAD patients through a walking exercise intervention is to increase PWT and COT by up to 4 minutes, which corresponds to two work stages during the standardized progressive treadmill test.
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Affiliation(s)
- Andrew W Gardner
- 1 Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Polly S Montgomery
- 1 Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Ming Wang
- 2 Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Gardner AW, Montgomery PS, Wang M, Xu C. Predictors of health-related quality of life in patients with symptomatic peripheral artery disease. J Vasc Surg 2018; 68:1126-1134. [PMID: 29615353 DOI: 10.1016/j.jvs.2017.12.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/22/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to identify predictors of baseline measures of health-related quality of life (HRQoL) in symptomatic patients with peripheral artery disease (PAD) from objective markers of severity of PAD, clinical and demographic characteristics, comorbid conditions, cardiovascular risk factors, objectively measured physical activity, and patient-based measures of physical function. METHODS HRQoL measurements of 216 symptomatic men and women with PAD were assessed with the Medical Outcomes Study 36-Item Short Form Health Survey. Patients were further characterized on demographic variables, comorbid conditions, cardiovascular risk factors, ankle-brachial index, peak walking time during a maximal treadmill test, 6-minute walk distance, gait speed, ambulatory activity monitored during 1 week, activities of daily living (ADLs), Mini-Mental State Examination questionnaire, and Walking Impairment Questionnaire (WIQ). RESULTS For the physical function HRQoL subscale, the significant predictors included WIQ speed score (P < .001), history of stumbling (P < .001), WIQ stair climbing score (P < .001), ADL associated with bathing (P = .001), 6-minute walk distance (P = .004), and daily walking cadence (P = .043). For the role emotional function HRQoL subscale, the significant predictors included a history of stumbling (P < .001), the ADL associated with transferring from a bed to a chair (P < .001), and the WIQ distance score (P = .022). CONCLUSIONS Physical and mental subscales of HRQoL in symptomatic patients with PAD are primarily predicted by patient-based physical function rather than by more specific markers of PAD severity and comorbid conditions. The clinical significance is that interventions designed to improve HRQoL should focus on improving the quality of executing functional tasks, such as walking more steadily without stumbling; completing ADLs that are not specific to walking, such as bathing and transferring; and improving patient-based ability to walk various distances and speeds and to climb stairs.
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Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa.
| | - Polly S Montgomery
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Cong Xu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
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Abstract
Intentional ingestion of a foreign body in adults is a rare clinical presentation. This case is one of a 27-year-old Sudanese man who presented having swallowed a ballpoint pen intentionally. Clinical examination and plain chest radiograph exhibited no signs indicative of perforation with only a raised C reactive protein identified on blood tests. Subsequent gastroscopy revealed that the pen had simultaneously perforated the duodenum at both D1 and D3 requiring removal via a laparotomy. The patient fully recovered and was discharged 2 weeks postoperatively following psychiatric input.
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Affiliation(s)
- Andrew W Gardner
- Department of General Surgery, Aneurin Bevan University Health Board, Newport, UK
| | - Rami W Radwan
- Department of General Surgery, Aneurin Bevan University Health Board, Newport, UK
| | - Miles C Allison
- Department of General Surgery, Aneurin Bevan University Health Board, Newport, UK
| | - Rhodri J Codd
- Department of General Surgery, Aneurin Bevan University Health Board, Newport, UK
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Addison O, Prior SJ, Kundi R, Serra MC, Katzel LI, Gardner AW, Ryan AS. Sarcopenia in Peripheral Arterial Disease: Prevalence and Effect on Functional Status. Arch Phys Med Rehabil 2017; 99:623-628. [PMID: 29138051 DOI: 10.1016/j.apmr.2017.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/28/2017] [Accepted: 10/18/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES (1) To determine the prevalence of sarcopenia in older men with peripheral arterial disease (PAD); (2) to compare a subgroup of the group with age-, race-, sex-, and body mass index (BMI)-matched non-PAD control counterparts, and (3) to compare the functional status of those with PAD with and without sarcopenia. DESIGN Cohort study. SETTING Medical center. PARTICIPANTS Sedentary community-dwelling men (N=108; age, >50y) with a confirmed diagnosis of PAD (44% blacks; BMI, 27.8±0.4kg/m2; ankle-brachial index, .62±.01). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry scans were used to assess appendicular lean mass and determine the prevalence of sarcopenia by/height2. Treadmill tests were used to determine claudication onset time, peak walking time, and claudication recovery time. 6-Minute walk distance was also measured. RESULTS Sarcopenia prevalence in our PAD cohort was 25%. The PAD subgroup (n=42) matched with control counterparts in terms of race, sex, age, and BMI had higher prevalence rates than did their non-PAD counterparts (23.8% vs 2.4%; P<.05). Individuals with sarcopenia (n=28) had a shorter 6-minute walk distance (326±18.8m vs 380±9.7m; P<.05) and higher claudication recovery time (592±98s vs 395±29s; P<.05) than did individuals with PAD but without sarcopenia (n=80). There was no difference in claudication onset time or peak walking time between the PAD groups. CONCLUSIONS Men with PAD demonstrate a high prevalence of sarcopenia. Those with sarcopenia and PAD demonstrate decreased mobility function.
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Affiliation(s)
- Odessa Addison
- Veterans Affairs Medical Center Baltimore, Geriatric Research Education and Clinical Center (GRECC), Baltimore, MD; Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD.
| | - Steven J Prior
- Veterans Affairs Medical Center Baltimore, Geriatric Research Education and Clinical Center (GRECC), Baltimore, MD; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rishi Kundi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD; Department of Surgery, Veterans Affairs Medical Center, Baltimore, MD
| | - Monica C Serra
- Veterans Affairs Medical Center Baltimore, Geriatric Research Education and Clinical Center (GRECC), Baltimore, MD; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Leslie I Katzel
- Veterans Affairs Medical Center Baltimore, Geriatric Research Education and Clinical Center (GRECC), Baltimore, MD; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew W Gardner
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - Alice S Ryan
- Veterans Affairs Medical Center Baltimore, Geriatric Research Education and Clinical Center (GRECC), Baltimore, MD; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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Gardner AW, Montgomery PS, Zhao YD, Ungvari Z, Csiszar A, Sonntag WE. Endothelial Cell Inflammation and Antioxidant Capacity are Associated With 6-Minute Walk Performance in Patients With Symptomatic Peripheral Artery Disease. Angiology 2017; 69:416-423. [PMID: 28835113 DOI: 10.1177/0003319717726934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We determined whether 6-minute walk total distance and pain-free distance were associated with circulating biomarkers of antioxidant capacity and inflammation and with cultured endothelial cell inflammation, oxidative stress, and apoptosis in 251 patients with symptomatic peripheral artery disease (PAD). In multivariate analyses, pain-free distance during the 6-minute walk test was negatively associated with dyslipidemia ( P < .001), chronic kidney disease ( P = .004), and transient transfection, nuclear factor κ-Light-Chain-Enhancer of activated B (NF-κB) cultured endothelial cells ( P = .007) and was positively associated with height ( P = .008). Furthermore, total distance walked during the 6-minute walk test was negatively associated with cultured endothelial cell NF-κB ( P < .001), coronary artery disease ( P = .009), and body mass index ( P = .022) and was positively associated with ankle-brachial index ( P < .001), male sex ( P < .001), and hydroxyl radical antioxidant capacity ( P < .001). The 6-minute walk performance in symptomatic patients with PAD was associated with vascular biomarkers, as walking distances were negatively associated with cultured endothelial cell inflammation and positively associated with circulating antioxidant capacity. The clinical implication is that behavioral interventions designed to alleviate endothelial cell inflammation and increase circulating antioxidant capacity, such as exercise and antioxidant intake, may improve ambulation of patients with PAD during submaximal exercise that is typically performed during daily activities.
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Affiliation(s)
- Andrew W Gardner
- 1 Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA.,2 Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Polly S Montgomery
- 1 Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Yan D Zhao
- 3 Department of Biostatistics and Epidemiology, OUHSC, Oklahoma City, OK, USA
| | - Zoltan Ungvari
- 1 Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Anna Csiszar
- 1 Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - William E Sonntag
- 1 Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
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Chen X, Stoner JA, Montgomery PS, Casanegra AI, Silva-Palacios F, Chen S, Janitz AE, Gardner AW. Prediction of 6-minute walk performance in patients with peripheral artery disease. J Vasc Surg 2017. [PMID: 28647194 DOI: 10.1016/j.jvs.2017.03.438] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a highly prevalent disease that impairs walking ability. Walking tests, such as the 6-minute walk test (6MWT) and 4-meter walk test, are commonly used to assess exercise endurance and ambulatory function over a short distance, respectively. The 6MWT performance is predictive of PAD severity and disease outcomes, but it is not feasible in many clinical settings because it requires a long walkway to serve as the test route and lengthens clinic visits. As an alternative, the 4-meter walk test is convenient, inexpensive, and repeatable, but whether it accurately predicts endurance performance in the long-distance 6MWT is not known. The goal of this study was to develop a statistical model to predict 6MWT gait speed from 4-meter walk test results and clinical characteristics among patients with PAD. METHODS Measures of 6MWT gait speed were derived from 183 patients with symptomatic PAD who were evaluated at the University of Oklahoma Health Sciences Center (2004-2012). The testing procedures and research personnel remained constant throughout the duration of the study. Independent variables included demographic and clinical information and 4-meter walk test gait speed. Fivefold cross validation and manual backward selection were used for model selection. Adjusted R2 and corrected Akaike information criterion were applied to quantify the predictive performance of the regression models. RESULTS A total of 183 people (54% male; mean age, 65 [standard deviation (SD), 10] years) with moderate PAD severity (ankle-brachial index [ABI]; mean, 0.72 [SD, 0.24]) performed the walking tests. Participants covered an average distance of 335 (SD, 97) m distance in the 6MWT. The 4-meter walk gait speed, ABI, and dyspnea were independent predictors of 6MWT speed in the multivariate model (adjusted R2 = 0.55). The model resulted in 95% prediction interval widths of 30 m for mean and 260 m for individual predicted 6MWT distance measures. CONCLUSIONS Slower 4-meter walking speed, lower ABI, and presence of dyspnea all predict slower 6MWT gait speed, which corresponds to shorter 6MWT distance. Prediction of group means is reasonably precise; however, prediction of individual patient 6MWT performance is imprecise relative to between-group differences that are clinically important.
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Affiliation(s)
- Xi Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Polly S Montgomery
- Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Ana I Casanegra
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Federico Silva-Palacios
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Andrew W Gardner
- Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla; Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa
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Gardner AW, Montgomery PS, Zhao YD, Silva-Palacios F, Ungvari Z, Csiszar A, Sonntag WE. Association between daily walking and antioxidant capacity in patients with symptomatic peripheral artery disease. J Vasc Surg 2017; 65:1762-1768. [PMID: 28259579 DOI: 10.1016/j.jvs.2016.12.108] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The primary aim of the study was to assess whether both the amount and pace of daily walking were associated with circulating antioxidant capacity in symptomatic patients with peripheral artery disease (PAD). METHODS Community-based walking was measured in 244 men and women who were limited by symptomatic PAD during a 1-week period in which they wore an ankle-mounted step activity monitor. Patients were further characterized by circulating antioxidant capacity with the OxiSelect (Cell Biolabs Inc, San Diego, Calif) hydroxyl radical antioxidant capacity (HORAC) activity assay. RESULTS To assess the amount of walking, patients were grouped into low (≤2440 strides/d), middle (2441-3835 strides/d), and high (>3835 strides/d) stride tertiles. HORAC was higher in the middle (P = .03) and high (P = .01) stride tertiles than in the low tertile, but there was no difference between middle and high tertiles (P = .44). To assess the pace of walking, patients were grouped into slow (<25.0 strides/min), middle (25.0-31.6 strides/min), and fast (>31.6 strides/min) cadence tertiles. HORAC was higher in the high cadence tertile than in the low (P < .01) and middle (P < .01) tertiles, but there was no difference between low and middle tertiles (P = .48). Similar findings were obtained on group differences in HORAC after adjusting for age, sex, race, and ankle-brachial index for both the amount and pace of daily walking. CONCLUSIONS Walking >2440 strides each day and walking at a cadence faster than 31.6 strides/min for 30 minutes each day are both associated with greater circulating antioxidant capacity in symptomatic patients with PAD. The clinical significance is that a home-based walking program may be one approach to increase endogenous antioxidant capacity.
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Affiliation(s)
- Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Yan D Zhao
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Federico Silva-Palacios
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - William E Sonntag
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
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Farah BQ, Ritti-Dias RM, Cucato GG, Montgomery PS, Gardner AW. Factors Associated with Sedentary Behavior in Patients with Intermittent Claudication. Eur J Vasc Endovasc Surg 2016; 52:809-814. [PMID: 27769867 DOI: 10.1016/j.ejvs.2016.07.082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Time spent in sedentary behavior has been associated with cardio-metabolic risk factors in the general population and in patients with symptomatic peripheral artery disease (PAD). Given the association of sedentary behavior and poor health outcomes, it is important to identify factors associated with sedentary behavior in these patients. The aim of this study was to identify factors associated with the sedentary time in patients with symptomatic PAD. METHODS The sample included 297 patients with symptomatic PAD. Sedentary behavior was assessed using a step activity monitor and the patients were divided into tertiles. Demographic data, body mass index, comorbid conditions, and measures of severity of PAD (ankle brachial index, ischemic window, claudication measurements, peak oxygen uptake and walking economy) were obtained. RESULTS Patients in the highest tertile (i.e. more sedentary) had a higher body mass index and a higher prevalence of diabetes mellitus, metabolic syndrome, and obesity than patients in the lowest tertile, whereas their peak walking time, peak oxygen uptake, and walking economy were lower (p < .05 for all). Using multiple regression procedures, the factors associated with the sedentary time were male sex (b = .217, R2 = .180, p = .001), body mass index (b = .154, R2 = .059, p = .013), peak walking time (b = -.360, R2 = .066, p ≤ .001), and walking economy (b = -.187, R2 = .142, p = .004). CONCLUSION In patients with symptomatic PAD, greater time spent in sedentary behavior was found in men, and in patients with higher body mass index, lower peak walking time, and lower walking economy.
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Affiliation(s)
- B Q Farah
- Graduate Program in Physical Education, University of Pernambuco/Federal University of Paraiba, Recife, PE, Brazil; Group Research in Health and Sport - ASCES College, Caruaru, PE, Brazil
| | - R M Ritti-Dias
- Graduate Program in Physical Education, University of Pernambuco/Federal University of Paraiba, Recife, PE, Brazil; Albert Einstein Hospital, Sao Paulo, SP, Brazil
| | - G G Cucato
- Albert Einstein Hospital, Sao Paulo, SP, Brazil
| | - P S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - A W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA.
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Abstract
The purpose of this study was to compare the gender and age-related differences in vascular reactivity in healthy men and women across a wide age range. Fifty-seven men and 61 women between 20 and 89 years of age, free of cardiovascular disease and risk factors, were categorized into younger (20-39 years), middle-aged (40-59 years), and older (60-89 years) age groups. Subjects were characterized on body weight and height, body mass index (BMI), and calf blood flow under resting, postocclusive reactive hyperemic (PORH), and maximal hyperemic conditions in the lower extremity with use of venous occlusion mercury strain-gauge plethysmography. Similar baseline characteristics were observed among age groups, whereas men had greater body weight (p<0.05), higher BMI values (p<0.05), and a trend toward higher ankle-brachial index (ABI) values (p=0.054) than women. While calf blood flow measurements were similar for men and women at rest and at maximal hyperemic conditions, women had a greater percentage change in calf blood flow from rest to PORH than men (p=0.046). After adjusting for body weight, BMI, and ABI, the percentage change in calf blood flow from rest to PORH was no longer significantly higher in the women (p>0.05). Furthermore, the percentage change in calf blood flow from rest to PORH was negatively related to body weight ( r = -0.30, p<0.01) and to BMI ( r = -0.26, p<0.01) in the men and women. No differences (p>0.05) in the calf blood flow measures were observed among the age groups. In a healthy cohort free of cardiovascular disease, increased BMI accounted for poorer vascular reactivity in men compared to women regardless of age.
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Affiliation(s)
- Bob J Schank
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
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Abstract
The purposes of this study were to (1) determine if peripheral arterial disease (PAD) severity is related to deficits in lower extremity functional strength, (2) identify covariates that might affect the relationship between lower extremity functional strength and severity of PAD, and (3) determine if the relationship between lower extremity functional strength and severity of PAD still persists after statistically controlling for significant covariates. A total of 144 patients were grouped into tertiles according to disease severity. Patients having an ankle-brachial index (ABI) of 0.76 to 0.90 were classified as having mild PAD (high ABI group), 0.51 to 0.75 classified as having moderate PAD (moderate ABI group), and 0.36 to 0.50 as having severe PAD (low ABI group). Lower extremity functional strength was assessed using the chair-stand test where the time to complete 5 consecutive stand-to-sit transfers was recorded. Patients were also characterized on ambulatory function and clinical characteristics. The moderate ABI group took significantly (p<0.05) less time (13.49 ±0.49 s) to complete the chair-stand test than the low ABI group (15.86 ±0.63 s). Both daily physical activity level and total 6-minute walk distance were identified as significant covariates (p<0.05) of lower extremity functional strength. After controlling for daily physical activity level and total 6-minute walk distance, no significant differences (p>0.05) in the time to complete the chair-stand test existed between the ABI groups. These findings indicate that the greater impairment in lower extremity functional strength in patients with severe PAD is explained by their lower physical activity level and poorer overall walking ability.
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Affiliation(s)
- LeighAnn M Atkins
- Department of Health and Sport Sciences, University of Oklahoma, Norman 73019, USA
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Abstract
This study aimed to determine whether peripheral arterial occlusive disease (PAOD) patients with critical limb-threatening ischemia experienced functional benefits following lower extremity revascularization. Twenty ambulatory patients (aged 68 - 7 years) underwent infrainguinal revascularization to alleviate their symptoms. Peripheral hemodynamic and functional measures were obtained on each patient 1 week prior to and 3-4 months following revascularization. Critical limb-threatening ischemia was alleviated by surgery in all patients because the ankle/brachial index (ABI) increased 133% (p, 0.001) from 0.33 6 0.06 to 0.77 6 0.09. Despite the marked peripheral hemodynamic improvement following revascularization, little gains were noted in functional measures. The 6-min walking distance was unchanged (p = 0.739) from 85 6 9 m to 101 6 11 m. Additionally, the free-living daily physical activity, measured by an accelerometer worn over a 2-day period, was unchanged (p = 0.996) from 214 6 46 kcal/day to 215 6 83 kcal/day. In contrast, self-perceived ambulatory function improved by 142% to 271% (p, 0.001), and self-perceived physical activity increased 134% to 156% (p, 0.001). In conclusion, limb salvage following infrainguinal bypass does not translate into improvements in measured ambulation or in measured physical activity in PAOD patients, even though the patients perceive these measures to be better.
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Affiliation(s)
- Andrew W Gardner
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Division of Gerontology, University of Maryland, Baltimore, and Geriatric Research, Education and Clinical Center, Maryland Veterans Affairs Health Care System at Baltimore, MD, USA,
| | - Lois A Killewich
- Section of Vascular Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects had impaired temporal and spatial gait characteristics compared to non-PAD controls at preferred and rapid self-selected walking paces. A total of 28 PAD subjects with intermittent claudication (age = 71 -1; mean -SEM) and 15 non-PAD controls with at least one cardiovascular risk factor but no ambulatory leg pain (age = 71 -1) were recruited. Gait parameters consisting of velocity, cadence, stride length, swing time, stance time, single-support time, double-support time, and base of support were recorded at the preferred and rapid walking paces. At the rapid walking pace, velocity was 22% slower (p, 0.001) in the PAD subjects compared with the non-PAD controls (99.9 - 3.3 vs. 117.5 - 5.3 cm/s) due to an 8% (p = 0.019) slower cadence (99.9 - 1.7 vs. 103.3 - 2.4 steps/min) and a 14% (p, 0.001) shorter stride length (119.8 - 2.9 vs. 135.8 - 4.2 cm/stride). The PAD subjects spent 5% less of the gait cycle in the swing phase (p = 0.006) and 3% more in stance (p = 0.006) than their non-PAD counterparts. During the stance phase, the PAD subjects spent 5% less of the gait cycle in single-stance (p = 0.004) and 16% more in double-stance (p = 0.007). Similar results were obtained at the preferred walking pace. In conclusion, compared with the controls, PAD subjects adopted an ambulatory pattern that favored greater gait stability at the expense of greater walking speed at either their preferred or rapid self-selected paces.
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Affiliation(s)
- Andrew W Gardner
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Division of Gerontology, University of Maryland, Baltimore, MD, and Geriatric Research, Education and Clinical Center, Maryland Veterans Affairs Health Care System at Baltimore, MD, USA,
| | - Larry Forrester
- Claude D Pepper Older Americans Independence Center, Department of Physical Therapy, University of Maryland, Baltimore, MD, USA
| | - Gerald V Smith
- Claude D Pepper Older Americans Independence Center, Department of Physical Therapy, University of Maryland, Baltimore, MD, USA
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Afaq A, Montgomery PS, Scott KJ, Blevins SM, Whitsett TL, Gardner AW. The effect of current cigarette smoking on calf muscle hemoglobin oxygen saturation in patients with intermittent claudication. Vasc Med 2016; 12:167-73. [PMID: 17848472 DOI: 10.1177/1358863x07081317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to compare calf muscle hemoglobin oxygen saturation response during exercise between smokers and non-smokers with peripheral arterial disease. Patients limited by intermittent claudication who were smokers (n = 12) were compared with those who had not smoked (n = 28) for at least 1 year prior to investigation. Ankle/brachial index (ABI) measurements were obtained with Doppler ultrasound, and maximal calf blood flow was measured by venous occlusion plethysmography. Hemoglobin oxygen saturation (StO2) of the calf muscle, initial claudication distance (ICD), and absolute claudication distance (ACD) were obtained during a graded treadmill test. Smokers refrained from smoking on the morning of the test. Smokers had similar ABI values compared with non-smokers (0.70 ± 0.26 vs 0.73 ± 0.23 [mean ± SD]; p = 0.808), whereas the smokers had lower values for maximal calf blood flow (8.71 ± 5.76 %/min vs 11.48 ± 4.46 %/min; p = 0.038), ICD (122 ± 123 m vs 243 ± 177 m; p = 0.023), and ACD (284 ± 170 m vs 452 ± 263 m; p = 0.023). Additionally, smokers had lower calf muscle StO2 values at the end of 1 minute (16 ± 15% vs 37 ± 19%; p = 0.002) and 2 minutes of exercise (16 ± 16% vs 35 ± 25%; p = 0.008), and at the occurrence of ICD (17 ± 17% vs 32 ± 23%; p = 0.033) and ACD (16 ± 16% vs 32 ± 24%; p = 0.024). After adjusting for blood flow, calf muscle StO2 values remained lower in the smokers (p < 0.05). Finally, calf muscle StO2 at the end of the first minute of exercise was related to ICD (r = 0.611, p < 0.001) and ACD (r = 0.443, p < 0.01). In conclusion, smokers limited by intermittent claudication have lower calf muscle StO2 during exercise than nonsmokers, and lower StO2 during exercise is associated with shorter ICD and ACD.
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Affiliation(s)
- Azhar Afaq
- Department of Medicine, Section of Cardiology, University of Oklahoma Health Center, Oklahoma City, OK 73117, USA
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Abstract
The objective of this study was to determine whether differences in large and small arterial compliance existed among normal weight, overweight, and obese older men and women, and whether large and small arterial compliance were associated with abdominal, hip, and subcutaneous fat distribution. A total of 134 individuals who were 40 years of age and older (age = 62 ± 11 years; mean ± SD) were grouped into normal weight (BMI: 18.5—24.9 kg/m2; n = 33), overweight (BMI: 25.0—29.9 kg/m2; n = 48), or obese (BMI: ≥30.0 kg/m2; n = 53) categories. The hemodynamic and arterial compliance measurements were obtained using the HDI/PulseWave CR-2000 CardioVascular Profiling System (Hypertension Diagnostics, Inc). Body mass index, nine-site sum of skinfolds, and circumference measures around the hip and waist were used for analysis. Large and small arterial compliance was lower (p < 0.001) in the obese group (12.4 ± 4.8 ml/mmHg × 10 vs 4.6 ± 2.5 ml/mmHg × 100, respectively) than the normal weight (16.2 ± 4.9 ml/mmHg × 10 vs 5.5 ± 2.7 ml/mmHg × 100) and overweight (15.2 ± 4.3 ml/mmHg × 10 vs 5.0 ± 2.2 ml/mmHg × 100) groups. This difference remained (p < 0.001) after adjusting for body surface area, sex, hyperlipidemia, and hypertension. Additionally, large arterial compliance correlated (p < 0.05) with sum of skinfolds (r = — 0.209), while small arterial compliance correlated with hip circumference (r = — 0.189). Arterial compliance measures were not related (p > 0.05) to waist circumference or waist-to-hip ratio. In conclusion, obesity was associated with a decrease in large and small arterial compliance independent of conventional risk factors. Additionally, subcutaneous fat and fat around the hips were inversely related to arterial compliance.
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Affiliation(s)
- Luke S Acree
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
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Gardner AW, Montgomery PS, Casanegra AI, Silva-Palacios F, Ungvari Z, Csiszar A. Association between gait characteristics and endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease. Age (Dordr) 2016; 38:64. [PMID: 27273077 PMCID: PMC5005916 DOI: 10.1007/s11357-016-9925-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 05/18/2016] [Indexed: 05/06/2023]
Abstract
The aim of the study was to determine whether gait characteristics were associated with endothelial cell inflammation, oxidative stress, and apoptosis and with circulating biomarkers of inflammation and antioxidant capacity in older patients with symptomatic peripheral artery disease (PAD). Gait measurements of 231 symptomatic men and women with PAD were assessed during a 4-m walk test. Patients were further characterized on endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells and on circulating inflammatory and vascular biomarkers. In a multivariate regression model for gait speed, the significant independent variables were age (p < 0.001), intercellular cell adhesion molecule-1 (ICAM-1) (p < 0.001), diabetes (p = 0.003), sex (p = 0.003), and history of cerebrovascular accidents (p = 0.021). In multivariate analyses for gait cadence, the significant independent predictors included high-sensitivity C-reactive protein (HsCRP) (p < 0.001), diabetes (p = 0.001), and hypertension (p = 0.001). In a multivariate regression model for gait stride length, the significant independent variables were HsCRP (p < 0.001), age (p < 0.001), ICAM-1 (p < 0.001), hypertension (p = 0.002), cellular reactive oxygen species production (p = 0.007), and sex (p = 0.008). Higher levels of circulating biomarkers of inflammation and endothelial cell oxidative stress were associated with slower gait speed, slower cadence, and shorter stride length in older symptomatic patients with PAD. Additionally, this profile of impaired gait was more evident in older patients, in women, and in those with diabetes, hypertension, and history of cerebrovascular accidents.
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Affiliation(s)
- Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), 1122 N.E. 13th Street, O'Donoghue Research Building, Suite 1200, Oklahoma City, OK, 73117, USA.
- Veterans Affairs Medical Center, Oklahoma City, OK, USA.
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), 1122 N.E. 13th Street, O'Donoghue Research Building, Suite 1200, Oklahoma City, OK, 73117, USA
| | - Ana I Casanegra
- Cardiovascular Section, Department of Medicine, OUHSC, Oklahoma City, OK, USA
| | | | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), 1122 N.E. 13th Street, O'Donoghue Research Building, Suite 1200, Oklahoma City, OK, 73117, USA
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), 1122 N.E. 13th Street, O'Donoghue Research Building, Suite 1200, Oklahoma City, OK, 73117, USA
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Gardner AW, Montgomery PS. Walking Economy is Impaired in Older Men and Women with Type 2 Diabetes. Int J Diabetol Vasc Dis Res 2016; 2016:7-12. [PMID: 28373997 PMCID: PMC5376089 DOI: 10.19070/2328-353x-si03002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We compared the walking economy in older participants with and without type 2 diabetes. METHODS Walking economy was determined in 115 older participants with type 2 diabetes and 130 older control participants without diabetes by continuously measuring oxygen uptake during a treadmill test in which the work rate was at a constant speed of 2 mph and a grade of 0% for a duration of 10 minutes. Participants also completed a Balke treadmill protocol for the determination of peak oxygen uptake, defined as the highest oxygen uptake value attained during the final work stage attained. Fractional utilization was then calculated as the walking economy oxygen uptake divided by peak oxygen uptake, expressed as a percentage. RESULTS Compared to those without diabetes, participants with type 2 diabetes were older (p=0.042), had higher prevalence of men (p=0.034), obesity (p=0.010), chronic kidney disease (p=0.020), peripheral artery disease (p=0.024), and had a higher body mass index (p=0.025), and waist/hip ratio (p=0.006). After adjusting for these variables, the participants with diabetes had higher walking economy (p<0.001), fractional utilization (p<0.001), and lower peak oxygen uptake (p<0.001) than those without diabetes (p<0.001). CONCLUSIONS Older men and women with type 2 diabetes are less economical when they ambulate at a given speed than compared to control participants without diabetes, independent of their greater co-morbid burden. The impaired walking economy in the diabetic participants is further magnified by their lower aerobic fitness, thereby leading to a higher fractional utilization of oxygen consumed during a given walking task.
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Affiliation(s)
- AW Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - PS Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
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Casanegra AI, Stoner JA, Tafur AJ, Pereira HA, Rathbun SW, Gardner AW. Differences in galectin-3, a biomarker of fibrosis, between participants with peripheral artery disease and participants with normal ankle-brachial index. Vasc Med 2016; 21:437-444. [PMID: 27155290 DOI: 10.1177/1358863x16644059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine if galectin-3 levels were different between participants with peripheral artery disease (PAD) and controls, and to describe its relationship with markers of early atherosclerosis. Sixty participants were recruited into two groups: a PAD group (n=31), ankle-brachial index (ABI) ⩽0.90 and a normal ABI group (n=29), ABI 1.0-1.4. PAD participants were older (68.6 vs 61.8 years, p=0.037), more commonly men (68% vs 38%, p=0.02), and with more cardiovascular risk factors (p<0.001). Galectin-3 was 22% higher in PAD participants (mean±SD: 17.6±4.7 vs 14.4±4.1 ng/mL, p<0.01). The odds ratio for galectin-3 in PAD to be 1 ng/mL higher than the participants with normal ABI was 1.19, after adjusting by age and gender (p=0.014). High-sensitivity C-reactive protein (hs-CRP) and homeostatic model assessment (HOMA) were positively associated with galectin-3 in the age- and gender-adjusted model, while arterial elasticity and microalbuminuria were not. In conclusion, galectin-3 levels were higher in participants with PAD.
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Affiliation(s)
- Ana I Casanegra
- Vascular Medicine Program, Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Alfonso J Tafur
- Vascular Medicine, Northshore University Health System, Evanston, IL, USA
| | - H Anne Pereira
- Department of Pharmaceutical Sciences, Department of Cell Biology and Department of Pathology, Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Suman W Rathbun
- Vascular Medicine Program, Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
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Gardner AW, Parker DE, Montgomery PS. Baseline Predictors of Improved Walking During a Supervised Exercise Program in Men and Women With Peripheral Artery Disease. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486973.57648.0c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Casanegra AI, Stoner JA, Tafur AJ, Pereira A, Rathbun S, Gardner AW. Abstract 313: Differences in Galectin-3, a Biomarker of Fibrosis, Between Subjects With Peripheral Artery Disease and Controls. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Galectin-3 (G3) mediates vascular fibrosis. It can be detected in blood but it is unknown whether G3 is a marker of peripheral artery disease (PAD) or correlates with early atherosclerosis markers.
Objectives/Aims:
To determine if G3 plasma levels are different between subjects with PAD and controls without PAD.
Secondary aim:
To describe the relationship between G3 plasma levels and markers of early atherosclerosis (arterial elasticity, high-sensitivity C-reactive protein [HS-CRP], homeostatic model assessment [HOMA], and urinary albumin/creatinine ratio [UACR]) in a sample of subjects with PAD and controls.
Methods:
Consecutive subjects (n=60) were recruited in 2 groups: (1) a PAD group (n=31), with ankle/brachial index (ABI) <0.90, and (2) non-PAD controls (n=29) with ABI 1-1.4. G3 was measured by ELISA. Demographics, cardiovascular risk factors and markers of early atherosclerosis were compared between groups using t-tests, Chi-square tests and logistic regression and the association between G3 and markers of early atherosclerosis was investigated using linear regression analysis.
Results:
Compared to controls, participants with PAD were older (mean 68.6 vs. 61.8 years, p=0.02), had a higher percentage of men (68% vs. 38%, p=0.02), and had more smokers, diabetics, and subjects with hypertension and dyslipidemia (p<0.001 for all). G3 was higher in PAD (mean ± SD: 17.6±4.7 vs. 14.4±4.1 ng/mL, p<0.01). The odds ratio for G3 in the PAD group to be 1 ng/mL higher than the control group was 1.19, after adjusting by age (≥65 years) and gender, (95% CI 1.036-1.37, p=0.014). when HS-CRP was included in the model the association between PAD and G3 was not significant. HS-CRP (p=0.005) and HOMA (p=0.016) were positively associated with G3 in the adjusted model. Arterial elasticity (p=0.4) and UACR (p=0.09) were not associated with G3 in the adjusted model.
Conclusion:
After adjustment for age and gender, mean G3 levels were 22% higher in PAD participants compared to controls and G3 was positively associated with HS-CRP. Future studies are warranted to determine if G3 is an accurate prognostic biomarker or screening tool to detect PAD and atherosclerosis.
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Affiliation(s)
- Ana I Casanegra
- Internal Medicine, Cardiovascular section, Univ of Oklahoma, Oklahoma City, OK
| | - Julie A Stoner
- Dept of Biostatistics and Epidemiology, Univ of Oklahoma, Oklahoma City, OK
| | - Alfonso J Tafur
- Vascuar Medicine, Northshore Univ Health System, Evanston, IL
| | - Anne Pereira
- Dept of Pharmaceutical Sciences, Dept of Cell Biology, Dept of Pathology, & Oklah, Univ of Oklahoma, Oklahoma City, OK
| | - Suman Rathbun
- Internal Medicine, Cardiovascular section, Univ of Oklahoma, Oklahoma City, OK
| | - Andrew W Gardner
- Reynolds Oklahoma Cntr on Aging, Donald W. Reynolds Dept of Geriatric Medicine, Univ of Oklahoma, Oklahoma City, OK
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Gardner AW. Exercise rehabilitation for peripheral artery disease: An exercise physiology perspective with special emphasis on the emerging trend of home-based exercise. VASA 2015; 44:405-17. [PMID: 26515218 DOI: 10.1024/0301-1526/a000464] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Peripheral artery disease (PAD) is a significant medical concern that is highly prevalent, costly, and deadly. Additionally, patients with PAD have significant impairments in functional independence and health-related quality of life due to leg symptoms and ambulatory dysfunction. Exercise therapy is a primary treatment for patients with PAD, as ambulatory outcome measures improve following a program of exercise rehabilitation. This review describes the outcomes that improve with exercise, the potential mechanisms for improved leg symptoms, key exercise program considerations for training patients with PAD with walking-based exercise, other exercise modalities that have been utilised, the use of on-site supervised exercise programs, and a major focus on historical and contemporary trials on conducting home-based, minimally supervised exercise program to treat PAD. The review concludes with recommendations for future exercise trials, with particular emphasis on reported greater details of the exercise prescription to more accurately quantify the total exercise dose of the program.
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Affiliation(s)
- Andrew W Gardner
- 1 Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, USA
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Gardner AW, Parker DE, Montgomery PS, Sosnowska D, Casanegra AI, Ungvari Z, Csiszar A, Zhang SX, Wang JJ, Sonntag WE. INFLUENCE OF DIABETES ON AMBULATION AND INFLAMMATION IN MEN AND WOMEN WITH SYMPTOMATIC PERIPHERAL ARTERY DISEASE. J Clin Transl Endocrinol 2015; 2:137-143. [PMID: 26835254 PMCID: PMC4730895 DOI: 10.1016/j.jcte.2015.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Diabetes and sex were correlated with ambulation and inflammation in patients with claudication. Men with diabetes have worse ambulation than men without diabetes. Women with diabetes have greater inflammation than women free of diabetes. Men and women with diabetes have evidence for high levels of angiogenic inhibition.
Objective To determine whether diabetes and sex were factors associated with ambulatory function, endothelial cell inflammation, oxidative stress, and apoptosis, and with circulating biomarkers of inflammation and antioxidant capacity in patients with peripheral artery disease (PAD) and claudication. Materials/Methods Ambulatory function of 180 symptomatic men and women with PAD was assessed during a graded maximal treadmill test, 6-minute walk test, and 4-meter walk test. Patients were further characterized on endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells, and on circulating inflammatory and vascular biomarkers. Results Men and women with diabetes had greater prevalence (p = 0.007 and p = 0.015, respectively) of coronary artery disease (CAD) than patients without diabetes. To assure that this difference did not influence planned comparisons, the data set was stratified on CAD. Diabetic men with CAD had a lower peak walking time (PWT) during the treadmill test and a slower 4-meter gait speed compared to non-diabetic men with CAD (p < 0.05). Diabetic women with CAD had a lower PWT compared to their non-diabetic counterparts (p < 0.01). Additionally, diabetic men with CAD had higher pigment epithelium-derived factor (p < 0.05) than their non-diabetic counterparts, and diabetic women with CAD had higher leptin (p < 0.01) and interleukin-8 levels (p < 0.05). Conclusions In patients with PAD, diabetic men and women with CAD had more severe claudication than their non-diabetic counterparts, as measured by shorter PWT, and the men had further ambulatory impairment manifested by slower 4-meter gait speed. Furthermore, the diabetic patients with CAD had elevations in interleukin-8, leptin, and PEDF.
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Affiliation(s)
- Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Donald E Parker
- Department of Biostatistics and Epidemiology, OUHSC, Oklahoma City, OK
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Danuta Sosnowska
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Ana I Casanegra
- Cardiovascular Section, Department of Medicine, OUHSC, Oklahoma City, OK
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
| | - Sarah X Zhang
- Departments of Ophthalmology and Biochemistry, University at Buffalo & SUNY Eye Institute, the State University of New York, Buffalo, NY
| | - Josh J Wang
- Departments of Ophthalmology and Biochemistry, University at Buffalo & SUNY Eye Institute, the State University of New York, Buffalo, NY
| | - William E Sonntag
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK
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Farah BQ, Ritti-Dias RM, Montgomery PS, Casanegra AI, Silva-Palacios F, Gardner AW. Sedentary behavior is associated with impaired biomarkers in claudicants. J Vasc Surg 2015; 63:657-63. [PMID: 26518099 DOI: 10.1016/j.jvs.2015.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Time spent in sedentary behavior has been associated with worse inflammation and cardiometabolic biomarkers in various populations. However, the association between time spent in sedentary behavior and biomarkers remains unknown in patients with intermittent claudication. The aim of the current study was to analyze the relationship between sedentary behavior and inflammatory and cardiometabolic biomarkers in patients with symptomatic peripheral arterial disease (PAD). METHODS The sample included 297 patients with intermittent claudication. Sedentary behavior was assessed using a step activity monitor. Biomarkers of inflammation, oxidative stress, lipid profile, insulin resistance, and endogenous fibrinolysis were assessed. Demographic data, body mass index, physical activity status, and measures of severity of PAD (ankle-brachial index, peak walking time, and ischemic window) also were obtained. RESULTS Time spent in sedentary behavior was related with high-sensitivity C-reactive protein (b = 0.187; P = .005), glucose (b = 0.238; P < .001), fibrinogen (b = 0.167; P = .017), plasminogen activator inhibitor 1 activity (b = 0.143; P = .036), and high-density lipoprotein cholesterol (b = -0.133; P = .029). After adjustment for sex, age, physical activity status, body mass index, and severity of PAD, sedentary behavior remained related with high-sensitivity C-reactive protein (b = 0.170; P = .015), glucose (b = 0.178; P = .004), fibrinogen (b = 0.189; P = .010), and high-density lipoprotein cholesterol (b = -0.128; P = .032). CONCLUSIONS Time spent in sedentary activities was associated with worse inflammatory and cardiometabolic profile in patients with intermittent claudication.
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Affiliation(s)
- Breno Q Farah
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil
| | - Raphael M Ritti-Dias
- Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil; Albert Einstein Hospital, São Paulo, Brazil
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla
| | - Ana I Casanegra
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla
| | - Federico Silva-Palacios
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla
| | - Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla.
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Gardner AW, Waldstein SR, Montgomery PS, Zhao YD. Effect of cognitive status on exercise performance and quality of life in patients with symptomatic peripheral artery disease. J Vasc Surg 2015; 63:98-104. [PMID: 26474509 DOI: 10.1016/j.jvs.2015.08.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/13/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND We determined whether scores on a cognitive screening measure were associated with the primary outcome measure of peak walking time (PWT) and with secondary outcome measures related to mobility, community-based ambulation, health-related quality of life (QoL), and vascular function in patients with claudication and peripheral artery disease (PAD). METHODS Gross cognitive status of 246 PAD patients was assessed with the Mini-Mental State Examination (MMSE) questionnaire. Patients were grouped according to whether they had a perfect MMSE score of 30 points (n = 123) or whether they missed one or more points (n = 123). Patients were characterized on numerous outcomes, including PWT during a treadmill test and QoL. RESULTS Compared with the group with the higher MMSE scores, there was a trend for lower PWT in the group with the lower MMSE scores (P = .06) after adjusting for age, sex, race, and education level (model 1), which became significant (380 ± 250 seconds vs 460 ± 270 seconds; P < .05) after adjusting for model 1 plus coronary artery disease, chronic obstructive pulmonary disease, and arthritis (model 2). Multiple domains of QoL were lower (P < .05) in the group with the lower MMSE scores after adjusting for model 1, but only mental health remained lower (75 ± 20% vs 80 ± 5%; P = .02) after further adjustment with model 2. CONCLUSIONS In symptomatic patients with PAD, lower cognitive screening scores were associated with greater ambulatory impairment than in patients with higher MMSE scores. Furthermore, worse cognitive status was associated with lower scores in multiple dimensions of health-related QoL, all of which except mental health were explained by the comorbid conditions of coronary artery disease, chronic obstructive pulmonary disease, and arthritis. The clinical significance is that there is a need for enhanced cognitive and mental health screening as potential indicators of poor outcome among symptomatic patients with PAD. Furthermore, patients identified as having worse cognitive status might be in greatest need of intervention to improve ambulation and QoL related to mental health.
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Affiliation(s)
- Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, Oklahoma City, Okla.
| | - Shari R Waldstein
- Department of Psychology, University of Maryland Baltimore County, Baltimore, Md
| | - Polly S Montgomery
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, Oklahoma City, Okla
| | - Yan D Zhao
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla
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Farah BQ, Ritti-Dias RM, Cucato GG, Menêses AL, Gardner AW. Clinical predictors of ventilatory threshold achievement in patients with claudication. Med Sci Sports Exerc 2015; 47:493-7. [PMID: 25003779 DOI: 10.1249/mss.0000000000000434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Ventilatory threshold (VT) is considered a clinically important marker of cardiovascular function in several populations, including patients with claudication, because it is related to walking capacity and hemodynamics. The purpose of this study was to identify clinical predictors for VT achievement in patients with intermittent claudication. METHODS One hundred and seventy-seven (n = 177) patients with intermittent claudication performed a progressive graded cardiopulmonary treadmill test until maximal claudication pain. Oxygen uptake (V˙O2) was continuously measured during the test, and afterwards, VT was visually detected. Clinical characteristics, demographic data, comorbid conditions, and cardiovascular risk factors were obtained. Patients who achieved and did not achieve VT were compared, as well as the workload that VT occurred in the former group. RESULTS VT was achieved in 134 patients (76%), and the mean V˙O2 at VT for these patients was 10.8 ± 2.4 mL·kg(-1)·min(-1). Patients who did not achieve VT presented lower ankle brachial index (ABI), claudication onset time, peak walking time, and V˙O2peak, and the proportion of women was higher compared with patients who achieved VT (P < 0.05). Multiple linear regression analysis identified that sex (b = 0.25, P = 0.002), body mass index (b = -0.18, P = 0.025), peak walking time (b = 0.17, P = 0.044), and ABI (b = 0.23, P = 0.006) were predictors of V˙O2 at VT. CONCLUSIONS Forty-three patients (24%) with intermittent claudication did not achieve VT, and these patients were mostly women and those with greater severity of disease. Moreover, in those who reached VT, the predictors of poor VT were female sex, high body mass index, low peak walking time, and low ABI.
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Affiliation(s)
- Breno Q Farah
- 1Graduate Program in Physical Education, Pernambuco University, Pernambuco, BRAZIL; 2Albert Einstein Hospital, São Paulo, BRAZIL; and 3Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Gardner AW, Parker DE, Montgomery PS. Sex-specific predictors of improved walking with step-monitored, home-based exercise in peripheral artery disease. Vasc Med 2015; 20:424-31. [PMID: 26240075 DOI: 10.1177/1358863x15596237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The aim of this study was to determine whether baseline clinical characteristics and the duration and intensity of ambulation during our step-monitored home-based exercise program were predictive of changes in ambulatory outcomes at completion of the program in symptomatic patients with peripheral artery disease (PAD). Twenty-two men (ankle-brachial index (ABI) = 0.71 ± 0.19) and 24 women (ABI = 0.66 ± 0.23) completed the home exercise program, consisting of intermittent walking to mild-to-moderate claudication pain for 3 months. Ambulatory outcome measures were peak walking time (PWT) and claudication onset time (COT) during a treadmill test, and the distance recorded during a 6-minute walk distance test (6MWD). Men experienced significant increases (p<0.01) in COT, PWT, and 6MWD following the home exercise program, and women had significant increases in 6MWD (p<0.01) and PWT (p<0.05). In women, average exercise cadence during the home exercise sessions was the only predictor that entered the model for change in COT (p=0.082), and was the first predictor in the model for change in PWT (p=0.029) and 6MWD (p=0.006). In men, the ABI was the only predictor that entered the model for change in 6MWD (p=0.002), and ABI was a predictor along with metabolic syndrome in the model for change in COT (p=0.003). No variables entered the model for change in PWT. Faster ambulatory cadence during the step-monitored home-based exercise program may predict greater improvements in ambulatory function in women, whereas having less severe PAD and comorbid burden at baseline may predict greater improvements in ambulatory function in men. ClinicalTrials.gov Identifier: NCT00618670.
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Affiliation(s)
- Andrew W Gardner
- Donald W Reynolds Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Donald E Parker
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Polly S Montgomery
- Donald W Reynolds Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
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