A Systematic Review of the Uptake and Adherence Rates to Supervised Exercise Programs in Patients with Intermittent Claudication

Harwood, Amy; Smith, George E.; Cayton, Thomas; Broadbent, Edward; Chetter, Ian

doi:10.1016/j.avsg.2016.02.009

Cited by 172 publications

(176 citation statements)

References 77 publications

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“…Even when supervised exercise is provided to PAD patients without costs, such as in a research program many PAD patients decline participation. 18 …”

Section: Supervised Treadmill Exercise For Peripheral Artery Diseasementioning

confidence: 99%

“…Of 1,541 potential participants without critical limb ischemia who had sufficient ischemic symptoms to be eligible for inclusion in supervised exercise studies, 769 (50%) reported lack of interest or simply refused participation in supervised exercise and an additional 295 (19%) reported that attending supervised exercise was too inconvenient. 18 Overall, 69% of eligible PAD participants refused participation in supervised exercise. In summary, this systematic review demonstrated that even when supervised exercise was available without cost to the participant with PAD, approximately 2/3 of people with PAD declined participation.…”

Section: Supervised Treadmill Exercise For Peripheral Artery Diseasementioning

confidence: 99%

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Exercise training for intermittent claudication

McDermott

2017

Journal of Vascular Surgery

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Objective To provide an overview of evidence regarding exercise therapies for patients with lower extremity peripheral artery disease. Methods This manuscript summarizes the content of a lecture delivered as part of the 2016 Crawford Critical Issues Symposium. Results Multiple randomized clinical trials demonstrate that supervised treadmill exercise significantly improves treadmill walking performance in people with PAD and intermittent claudication symptoms. A meta-analysis of 25 randomized trials demonstrated a 180 meter increase in treadmill walking distance in response to supervised treadmill exercise interventions, compared to a non-exercising control group. Supervised treadmill exercise has been inaccessible to many patients with PAD because of lack of medical insurance coverage. However, in 2017 the Centers for Medicaid and Medicare Service issued a proposed decision memorandum to support health insurance coverage of 12 weeks of supervised treadmill exercise for patients with walking impairment due to PAD. Recent evidence also supports home-based walking exercise to improve walking performance in people with PAD. Effective home-exercise programs incorporate behavioral change interventions such as a remote coach, goal setting, and self-monitoring. Supervised treadmill exercise programs preferentially improve treadmill walking performance, while home-based walking exercise programs preferentially improve corridor walking, such as the six-minute walk test. Clinical trial evidence also supports arm or leg ergometry exercise to improve walking endurance in people with PAD. Treadmill walking exercise appears superior to resistance training alone for improving walking endurance. Conclusion Supervised treadmill exercise significantly improves treadmill walking performance in people with PAD by approximately 180 meters, compared to no exercise. Recent evidence suggests that home-based exercise is also effective, and preferentially improves over ground walking performance, such as the six-minute walk test.

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“…Even when supervised exercise is provided to PAD patients without costs, such as in a research program many PAD patients decline participation. 18 …”

Section: Supervised Treadmill Exercise For Peripheral Artery Diseasementioning

confidence: 99%

Section: Supervised Treadmill Exercise For Peripheral Artery Diseasementioning

confidence: 99%

Exercise training for intermittent claudication

McDermott

2017

Journal of Vascular Surgery

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“…Supervised exercise programs are recommended to improve functional status and reduce leg symptoms and should be discussed as a treatment option for patients with intermittent claudication before revascularization (Gerhard‐Herman et al ). However, a systematic review from 2016 reported that only 1 in 3 patients with intermittent claudication were suitable for and willing to participate in supervised exercise programs (Harwood et al ). For patients with severe PAD, endovascular or open surgery may be options to achieve revascularization, but the ability to perform endovascular or open surgery depends on the localization and extent of the disease.…”

Section: Introductionmentioning

confidence: 99%

The acute effects of different levels of intermittent negative pressure on peripheral circulation in patients with peripheral artery disease

et al. 2019

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Intermittent negative pressure (INP) applied to the lower leg induces acute increase in arterial and skin blood flow. The aim of this study was to identify the optimal level of INP to increase blood flow in patients with lower extremity peripheral artery disease (PAD). We investigated the acute effects of different levels of INP in 16 subjects (7 women and 9 men, mean (SD) age 71(8) years) diagnosed with PAD. During application of INP in a pressure chamber sealed below the knee, arterial blood flow was continuously recorded in the dorsalis pedis artery or tibialis posterior artery (ultrasound Doppler), and skin blood flow was continuously recorded at the pulp of the first toe (laser Doppler). Different pressure levels (0, −10, −20, −40, and −60 mmHg) were tested in randomized order. Maximal arterial blood flow relative to baseline (median [25th, 75th percentiles]) was: 0 mmHg; 1.08 (1.02, 1.13), −10 mmHg; 1.11 (1.07, 1.17), −20 mmHg; 1.18 (1.11, 1.32), −40 mmHg; 1.39 (1.27, 1.91) and −60 mmHg; 1.48 (1.37, 1.78). Maximal laser Doppler flux (LDF) relative to baseline was: 0 mmHg; 1.06 (1.02, 1.12), −10 mmHg; 1.08 (1.05, 1.16) −20 mmHg; 1.12 (1.06, 1.27), −40 mmHg; 1.24 (1.14, 1.50) and −60 mmHg; 1.35 (1.10, 1.70). There were significantly higher maximal arterial blood flow and maximal LDF at −40 mmHg compared with −10 mmHg (P = 0.001 and P = 0.025, respectively). There were no significant differences in maximal arterial blood flow and maximal LDF between 0 and −10 mmHg (both P = 1.0), or between −40 and −60 mmHg (both P = 1.0). INP of −40 mmHg was the lowest negative pressure level that increased blood flow.

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“…National governing bodies recommend a supervised exercise programme as the first line treatment, along with best medical therapy [25]. If supervised exercise is not feasible, acceptable or accessible for patients [17] then more invasive therapies, such as angioplasty or bypass surgery may be utilised. Quality of life (QoL) is an important outcome measure with the World Health Organization (WHO) defining it as “physical, social and mental well-being and not just an absence of infirmity” [31].…”

Section: Introductionmentioning

confidence: 99%

Quality of life in patients with intermittent claudication

et al. 2017

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BackgroundIntermittent claudication (IC) is a common condition that causes pain in the lower limbs when walking and has been shown to severely impact the quality of life (QoL) of patients. The QoL is therefore often regarded as an important measure in clinical trials investigating intermittent claudication. To date, no consensus exits on the type of life questionnaire to be used. This review aims to examine the QoL questionnaires used in trials investigating peripheral arterial disease (PAD).Material and methodsA systematic review of randomised clinical trials including a primary analysis of QoL via questionnaire was performed. Trials involving patients with diagnosed PAD were included (either clinically or by questionnaire). Any trial which had QoL as the primary outcome data was included with no limit being placed on the type of questionnaire used.ResultsThe search yielded a total of 1845 articles of which 31 were deemed appropriate for inclusion in the review. In total, 14 different QoL questionnaires were used across 31 studies. Of the questionnaires 24.06% were missing at least one domain when reported in the results of the study. Mean standard deviation varied widely based on the domain reported, particularly within the SF36.DiscussionDespite previous recommendations for Europewide standardisation of quality of life assessment, to date no such tool exists. This review demonstrated that a number of different questionnaires remain in use, that their completion is often inadequate and that further evidence-based guidelines on QoL assessment are required to guide future research.

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A Systematic Review of the Uptake and Adherence Rates to Supervised Exercise Programs in Patients with Intermittent Claudication

Cited by 172 publications

References 77 publications

Exercise training for intermittent claudication

Exercise training for intermittent claudication

The acute effects of different levels of intermittent negative pressure on peripheral circulation in patients with peripheral artery disease

Quality of life in patients with intermittent claudication

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