Dynamic muscle quality of the plantar flexors is impaired in claudicant patients with peripheral arterial disease and associated with poorer walking endurance

King, Stephanie; Vanicek, Natalie; O’Brien, Thomas D.

doi:10.1016/j.jvs.2015.03.039

Cited by 15 publications

(21 citation statements)

References 43 publications

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“…In contrast, the claudicants utilised the ankle and knee almost equally to meet the functional demands of the task (both ~ 40% of peak support moment). Given that velocity-dependent weakness in the ankle plantarflexors have previously been identified in this population 19 , the greater reliance on these muscles seems counter-intuitive. This is most notable in the weight-acceptance phase that is characterised by fast, eccentric muscle action of the plantarflexors in particular, to absorb the falling body mass 35 .…”

Section: Discussionmentioning

confidence: 89%

“…The present study indicates that the result of reduced strength in these muscle groups, particularly the knee extensors, has a substantial effect on the strategies employed to descend stairs. We have previously demonstrated that the function of the plantarflexors is impaired, both in comparison to healthy controls and in relation to disease severity 19,38 . However, it is unclear whether hip extensor strength has been maintained in the full cohort, allowing for an alternate, compensatory gait strategy to be adopted.…”

Section: Discussionmentioning

confidence: 99%

“…Recent research has demonstrated that those with PAD-IC have velocity-dependent limitations in plantarflexor strength, that are also correlated to disease severity at high contraction speeds 19 , which likely necessitates compensatory strategies at more proximal muscle groups. Combined with impaired balance [20][21][22] and a greater prevalence for falls 22 it is likely that those with PAD-IC face significant functional challenges and risks when negotiating stairs.…”

Section: Introductionmentioning

confidence: 99%

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Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

2018

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A novel hip extensor strategy was identified in a sub-group of claudicants which acts to reduce the demand on the knee extensors, but not the plantarflexors. Weakness in the knee extensors may prevent redistribution of the task demand, typically seen in older adults in stair descent, away from the functionally limited plantarflexor muscle group. Further investigation into multi-level joint strength and the relationship to functional tasks is warranted to inform targeted intervention programmes.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

2018

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“…Muscle strength. Of the nine studies reporting strength measures (Table II, A-C), 13,26,28,30,33,37,39,41,42 six reported comparisons to a control group, 13,26,28,37,41,42 three reported comparisons between a symptomatic and an asymptomatic limb, 13,30,41 and two investigated the effect of intervention. 32,33 Within these studies, a variety of methodologies were employed to assess strength.…”

Section: Resultsmentioning

confidence: 99%

“…Of the eight studies reporting measures of muscle size and activation, 13,26,31,34,[38][39][40][41] six made comparisons to a control group, 13,26,31,34,38,41 two made comparisons to an asymptomatic limb, 13,41 and one reported the effects of the intervention. 41 Multiple methods were employed to assess muscle size, with consistency between three studies adopting a computed tomography scanning procedure. 31,34,36 The symptomatic limb was significantly smaller than the asymptomatic limb in calf circumference and cross-sectional area 13 ; however, wide 95% CIs indicate a heterogeneous group (Table III, A).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of muscle morphology and function in intermittent claudication

Harwood

King

Totty

et al. 2017

Journal of Vascular Surgery

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Previous literature has found clear evidence that strength (of the calf and thigh musculature) and calf characteristics are related to mortality and functional declines. However, this review has demonstrated the vast array of muscle groups assessed and multiple methods employed to determine strength; therefore, it is unclear exactly what measure of "strength" is impaired. Furthermore, the underlying morphologic causes of potential changes in strength are unclear. This information is essential for designing optimal exercise interventions. The data acquired during this systematic review are heterogeneous, with a substantial lack of high-quality intervention-based studies. Future research should endeavor to establish standardized testing procedures and to implement randomized controlled trials for targeted therapeutic interventions.

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Exercise for intermittent claudication

Lane

Harwood

Watson

et al. 2017

Cochrane Database of Systematic Reviews

341

169

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Background Exercise programmes are a relatively inexpensive, low-risk option compared with other, more invasive therapies for treatment of leg pain on walking (intermittent claudication (IC)). This is the fourth update of a review first published in 1998. Objectives Our goal was to determine whether an exercise programme was effective in alleviating symptoms and increasing walking treadmill distances and walking times in people with intermittent claudication. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events, and improving quality of life. Search methods For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (last searched 15 November 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10) via the Cochrane Register of Studies Online, along with trials registries. Selection criteria Randomised controlled trials of an exercise regimen versus control or versus medical therapy for people with IC due to peripheral arterial disease (PAD). We included any exercise programme or regimen used for treatment of IC, such as walking, skipping, and running. Inclusion of trials was not affected by duration, frequency, or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximum walking distance), ankle brachial index (ABI), quality of life, morbidity, or amputation; if none of these was reported, we did not include the trial in this review. Data collection and analysis For this update (2017), RAL and AH selected trials and extracted data independently. We assessed study quality by using the Cochrane 'Risk of bias' tool. We analysed continuous data by determining mean differences (MDs) and 95% confidence intervals (CIs), and dichotomous data by determining risk ratios (RRs) and 95% CIs. We pooled data using a fixed-effect model unless we identified significant heterogeneity, in which case we used a random-effects model. We used the GRADE approach to assess the overall quality of evidence supporting the outcomes assessed in this review.

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Dynamic muscle quality of the plantar flexors is impaired in claudicant patients with peripheral arterial disease and associated with poorer walking endurance

Cited by 15 publications

References 43 publications

Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

A systematic review of muscle morphology and function in intermittent claudication

Exercise for intermittent claudication

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