Changes in Function After a 6-Month Walking Intervention in Patients With Intermittent Claudication Who Are Obese or Nonobese

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 non-obese with PAD. Methods This is a secondary data analysis of two 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 non-obese (Ex), Exercise obese (ExO), standard of care non-obese (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 six-minute walk (6MWD) test. Results There was a significant (p<0.001) interaction (intervention × obesity) effect on 6MWD, wherein both exercise groups improved (Ex=7%, ExO=16%; p<0.02), the SC group did not change (0.9%; p>0.05), and the SCO group tended to decline (−18%; p=0.06). Both exercise intervention groups significantly improved COT (Ex=92%, ExO=102%; p<0.01) and PWT (Ex=54%, ExO=103%; p<0.001). There was no change (p>0.05) in either standard of care group. Conclusions Individuals who are obese and non-obese with PAD made similar improvements following 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.

Functional Electrical Stimulation (FES) Reduces Intermittent Claudication (IC) and Improves Quality of Life (QOL) Measures: A Cohort Crossover

“…In fact, compared to T2 data, the perceived pain at T3 was 81.7% lower as a result of walking with FES (Table 1). Direct comparison of the crossover data to published studies' effects on IC pain reduction is not possible because of experimental differences in measuring pain intensity [18,21]. However indirect, approximate comparison of success in pain reduction after endovascular intervention reported by Land et al [22] appears at least comparable to the pain reduction after walking with FES for 8 weeks.…”

“…The crossover data (T3) documented outcome measures for the nine patients enrolled in the crossover phase. Five measures included: 1) Walking distance was determined by measuring meters traveled during the 6MW test [18]. If patients were unable to walk the full six minutes, they were allowed to sit and rest until they were ready to continue.…”

Body-weight goals, trends, and weight-loss techniques among patients with peripheral arterial disease

“…The increased leg pain with activity may deter those with PAD from participating in exercise as a means of weight loss. In a 6-month study of older adults with PAD we previously found that individuals with obesity who did not participate in an exercise intervention were susceptible to greater declines in mobility when compared with normal-weight peers (Addison et al, 2017). Others have reported similar findings and individuals with the combination of obesity and PAD claudicate more quickly with activity (Dias et al, 2009), and experience greater declines in calf-muscle area (Raval et al, 2012) and gait speed (McDermott et al, 2006) when compared with normal-weight individuals with PAD.…”

“…Obesity is a known risk factor for PAD and up to 60% of individuals with PAD are overweight or obese (McDermott et al, 2001). Obesity is one of the leading causes of disability in older adults without PAD, and among those with PAD obesity results in a further functional burden (Addison et al, 2017; Dias et al, 2009; McDermott et al, 2006; Raval et al, 2012). Older adults with PAD and obesity experience claudication pain more quickly (Addison et al, 2017; Dias et al, 2009), require longer to recover after exercise (Addison et al, 2017; Dias et al, 2009), and experience greater declines in physical function when compared with normal-weight individuals (Addison et al, 2017; Dias et al, 2009; McDermott et al, 2006; Raval et al, 2012).…”

“…Obesity is one of the leading causes of disability in older adults without PAD, and among those with PAD obesity results in a further functional burden (Addison et al, 2017; Dias et al, 2009; McDermott et al, 2006; Raval et al, 2012). Older adults with PAD and obesity experience claudication pain more quickly (Addison et al, 2017; Dias et al, 2009), require longer to recover after exercise (Addison et al, 2017; Dias et al, 2009), and experience greater declines in physical function when compared with normal-weight individuals (Addison et al, 2017; Dias et al, 2009; McDermott et al, 2006; Raval et al, 2012). Further, individuals with PAD demonstrate lower activity levels (Gardner et al, 2008) further increasing the risk for weight gain and obesity (Bann et al, 2015; Myers et al, 2016).…”