Effects of heated water-based versus land-based exercise training on vascular function in individuals with peripheral artery disease

Abstract

Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with poor vascular function, walking impairment, and reduced quality of life. Land-based exercise therapy (LBET) is frequently recommended to improve walking and reduce symptoms. Recently, evidence has suggested that heated-water exercise therapy (HWET) is an effective intervention for PAD. However, the efficacy of LBET versus HWET in PAD patients had not been elucidated. Therefore, we sought to compare effects of LBET with HWET on cardiovascular function, exercise tolerance, physical function, and body composition in PAD patients. PAD patients ( n = 53) were recruited and randomly assigned to a LBET group ( n = 25) or HWET group ( n = 28). The LBET group performed treadmill walking, whereas the HWET group performed walking in heated water for 12 wk. Leg (legPWV) and brachial-to-ankle arterial stiffness (baPWV), blood pressure (BP), ankle-brachial index (ABI), 6-min walking distance (6MWD), claudication onset time (COT), physical function, and body composition were assessed before and after 12 wk. There were significant group-by-time interactions ( P < 0.05) for legPWV, BP, 6MWD, COT, body composition, and resting metabolic rate (RMR). Both groups significantly reduced ( P < 0.05) legPWV, BP, and body fat percentage, and HWET measures were significantly lower than LBET measures. Both groups significantly increased 6MWD, COT, and RMR, and HWET group measures were significantly greater than LBET measures. A time effect was noted for baPWV reduction in both groups ( P < 0.05). These results suggest that both LBET and HWET improve cardiovascular function, exercise tolerance, and body composition, and HWET showed considerably greater improvements compared with LBET in patients with PAD. NEW & NOTEWORTHY The results of this study reveal for the first time that although land-based exercise therapy is effective for reducing arterial stiffness and blood pressure in patients with peripheral artery disease (PAD), heated-water exercise therapy demonstrates greater benefits on vascular function. The greater improvements in muscular strength, time to onset of claudication, and exercise tolerance after heated-water exercise therapy may have clinical implications for improving quality of life in patients with PAD. The heated-water exercise therapy intervention demonstrated relatively higher exercise training adherence (∼88%) compared with the land-based exercise intervention (∼81%).

Microvascular Dysfunction in Peripheral Artery Disease: Is Heat Therapy a Viable Treatment?

“…Several benefits for acute and chronic hemodynamics have been reported for heated-water immersion in PAD [12,13]. In addition, we have previously shown that exercise training in heated water promotes hemodynamic benefits, favorable vascular structural changes, and improved quality of life in PAD [14,15]. In fact, exercise in heated water demonstrated relatively higher adherence to the clinically recommended land-based training [15].…”

“…The combined effects of exercise and full-body heating have also been recently investigated. Park et al (2020) examined the effects of a heated-water exercise (HW) protocol and a dry-land exercise (LB) protocol (treadmill training) in patients with PAD [15]. Subjects allocated to both groups participated in their mode of exercise for 12 weeks [15].…”

“…Park et al (2020) examined the effects of a heated-water exercise (HW) protocol and a dry-land exercise (LB) protocol (treadmill training) in patients with PAD [15]. Subjects allocated to both groups participated in their mode of exercise for 12 weeks [15]. Both the heated-water and dry-land exercise groups experienced significant reductions in blood pressure (HW: −8 mmHg, LB: −6 mmHg), resting heart rate (HW: −4 bpm, LB: −2 bpm), and pulse wave velocity (HW: −1.2 m/s, LB: −1 m/s) (a marker of arterial stiffness) compared to baseline.…”

“…In addition, we have previously shown that exercise training in heated water promotes hemodynamic benefits, favorable vascular structural changes, and improved quality of life in PAD [14,15]. In fact, exercise in heated water demonstrated relatively higher adherence to the clinically recommended land-based training [15]. The hemodynamic and vascular structural changes associated with heat therapy may lead to adaptations beneficial to cutaneous microcirculation and may serve a role in preventing ischemic ulcers.…”

“…Although there are no clinically efficient therapies available, heat therapies have recently emerged as a top-priority area of research in the PAD literature. Therapies utilizing heated-water immersion and heated-water exercise have demonstrated promising success [12][13][14][15]. Several benefits for acute and chronic hemodynamics have been reported for heated-water immersion in PAD [12,13].…”