Cardiovascular and musculoskeletal response to supervised exercise in patients with intermittent claudication

Harwood, Amy; Totty, Joshua; Pymer, Sean; Huang, Chao; Hitchman, Louise; Carradice, Daniel; Wallace, Tom; Smith, George E.; Chetter, Ian

doi:10.1016/j.jvs.2018.10.065

Cited by 18 publications

(27 citation statements)

References 38 publications

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“…The eligibility (66%) and recruitment (32%) rates for this HIIT programme were similar to those previously reported for standard SEP 22 . With regards to completion rates, these were lower than reported within a systematic review of exercise training trials for patients with IC 22 , but are comparable to the rates for the usual care SEP provided in our centre and likely reflective of “real-world” exercise programmes that are linked to tertiary care facilities 44 . This suggests that HIIT may be a feasible alternative to traditional SEP for claudication and implementation of it was relatively straightforward.…”

Section: Discussionmentioning

confidence: 43%

A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication

Pymer

Ibeggazene

Palmer

et al. 2020

Preprint

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Background: Uptake and completion rates for supervised exercise programmes (SEP) for patients with intermittent claudication (IC) are low. Current exercise prescription is a one size fits all approach, based on claudication pain thresholds, potentially limiting individual benefits. High-intensity interval training (HIIT) has the potential to overcome these barriers as it is a more time-efficient, objectively prescribed exercise programme. This study aimed to assess a novel HIIT programme for patients with IC in terms of safety, feasibility, tolerability and indicators of efficacy. Design/Methods: Patients referred to a usual-care SEP were invited to undertake an alternative HIIT programme. All recruited patients performed a baseline cardiopulmonary exercise test (CPET), to inform their exercise prescription. HIIT involved ten, one-minute high-intensity intervals on a stationary cycle ergometer interspersed with one-minute recovery intervals, performed three times per week for six-weeks. Outcomes included safety, feasibility, tolerability, walking distance and quality of life (QoL). Results: 144 patients with IC were referred, 95 met initial eligibility criteria (66%) and 30 (32%) were recruited for HIIT, of which 15 (50%) completed. Of the recruited patients, 90% were on optimal medical therapy and 40% had concomitant cardiac, cerebrovascular and/or respiratory disease. One serious adverse event was recorded and patients who completed the programme attended 100% of the sessions. Improvements in walking distances and quality of life were observed. Following recruitment of the first 20 patients, the inclusion criteria was refined on the basis of CPET, leading to improved completion rates. Conclusion: The study provides preliminary findings indicating that patients with IC can complete a short-term HIIT programme. HIIT also appears safe, well-tolerated and although not formally powered, walking distances and QoL appear to improve following HIIT. Further research to evaluate the role of HIIT in patients with IC seems warranted.

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Section: Discussionmentioning

confidence: 43%

A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication

Pymer

Ibeggazene

Palmer

et al. 2020

Preprint

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“…7 Another major issue for many patients is the severe decline in functional capacity (V O 2Peak) which are comparable to patients with heart failure and reduced ejection fraction. 8 The reduction in functional capacity is commonly caused by a decline in walking capacity, which may be up to less than 50% of healthy aged-matched controls. 9 Factors influencing the walking distance or speed at which symptoms occur are multifactorial and include the site and severity of disease, walking pace, terrain, incline and footwear.…”

Section: Introductionmentioning

confidence: 99%

Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners

Harwood

Pymer

Ingle

et al. 2020

BMJ Open Sport Exerc Med

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Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.

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“…Nevertheless, peripheral artery disease (PAD) causes the highest treatment costs for health care providers of all cardiovascular disorders [ 2 ]. The prevalence of PAD increases with age and affects a substantial proportion of the elderly population (>20% in those aged >80 years) [ 1 , 3 ]. Additionally, PAD is linked to higher morbidity and mortality and leads to a significantly reduced quality of life including daily life restrictions [ 4 ], ranging from mild impairment in walking distance to limb amputations [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…One recommendation of the current guidelines is supervised exercise therapy (SET) or a supervised exercise program (SEP) [ 3 , 7 ]. For better readability, we refer to both SET and SEP as SET from here on.…”

Section: Introductionmentioning

confidence: 99%

“…Regularly reaching the pain threshold leads to better leg perfusion and makes SET one of the most effective (both medically and economically) conservative therapies for extending pain-free walking distance [ 7 - 10 ]. The regular performance of SET has already been proven to be associated with decreased mortality and also results in an improvement in functional health and quality of life [ 3 , 10 - 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study

Lortz¹,

Simanovski²,

Kuether³

et al. 2020

JMIR Form Res

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Background The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk. Objective Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET). Methods A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET. Results Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app. Conclusions A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived.

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Cardiovascular and musculoskeletal response to supervised exercise in patients with intermittent claudication

Cited by 18 publications

References 38 publications

A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication

A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication

Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners

Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study

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