Exercise training for intermittent claudication

McDermott, Mary M.

doi:10.1016/j.jvs.2017.05.111

Cited by 73 publications

(58 citation statements)

References 36 publications

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“…SET improved walking, haemodynamic, and metabolic outcomes in home or clinical settings using treadmills or other calf‐muscle flexing interventions, but not using stretching exercises . Structured exercise programmes generated more improvement in PAD‐related walking and QOL than non‐structured exercise or exercise advice alone, doubling pain‐free and maximum walking distance for both men and women in 3 months with men experiencing greater gains …”

Section: Resultsmentioning

confidence: 99%

“…For those with severe PAD, significant walking improvements were reported for up to 7 years for those receiving SET (6 studies treating 364 patients) and/or invasive ER . Three studies improved walking outcomes for 48 patients with severe PAD receiving autologous stem cells compared with controls High IPC improved peak walking time ( P < .04) compared with 20 minutes of daily walking after patients with severe PAD received 16 weeks of treatment, with each intervention increasing peak walking time from 4 weeks onwards …”

Section: Resultsmentioning

confidence: 99%

“…67 Clinical, patient-centred, and economic benefits of SET were so consistent 68 that in 2017, the United States Centers for Medicare and Medicaid Services issued a decision memorandum to support health insurance coverage for 12 weeks of supervised treadmill exercise for patients with walking impairment due to PAD. 69 SET improved walking, haemodynamic, and metabolic outcomes in home or clinical settings using treadmills or other calf-muscle flexing interventions, 58,70,71 but not using stretching exercises. 49 Structured exercise programmes F I G U R E 2 Number of controlled clinical trials supporting improved patientcentred outcomes for those treated using the indicated intervention(s) for a PADrelated condition.…”

Section: Improved Walking Distance (44 Studies On 2109 Patients)mentioning

confidence: 99%

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Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

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Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD. Key Messages• Peripheral arterial disease (PAD) progresses in severity from impaired walking and quality of life (QOL) through increasing likelihood of pain, ulceration, gangrene, amputation, or death and magnifies clinical, economic, and patient burdens of venous insufficiency or diabetes • improving PAD-related patient-centred outcomes requires consistent early, effective PAD diagnosis and effective treatment to improve lower limb perfusionAbbreviations: ABI, ankle-to-brachial systolic blood pressure index (ratio), optimally performed using handheld Doppler ultrasound; ALU, arterial leg ulcers; CLI, critical limb ischaemia; DAPT, dual antiplatelet therapy, for example, aspirin plus low molecular weight heparin; DFU, diabetic foot ulcers; ER, endovascular revascularisation; HBO, hyperbaric oxygen; IC, intermittent claudication; IPC, intermittent pneumatic compression of the calf muscle; MLU, mixed aetiology leg ulcers complicated with peripheral arterial disease; NMES, neuromuscular electrical stimulation sufficient to cause contraction of the calf muscle; PAD, peripheral arterial disease; PPG, photoplethysmography a technique for measuring venous emptying; QOL, quality of life; RCT, randomised clinical trial; SET, structured exercise therapy supervised by a professional; SOC, standard of care; TcPO 2 , transcutaneous partial pressure of oxygen; VLU, venous leg ulcer.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Improved Walking Distance (44 Studies On 2109 Patients)mentioning

confidence: 99%

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Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

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“…Evidence shows that home-based exercise improves pain-free walking distance by up to 180 m compared to no exercise [11,12]. This is the reason why current practice guidelines recommend exercise training (supervised or home-based) as the first line of treatment in patients with intermittent claudication, superseding vasodilator drugs [13].…”

Section: Discussionmentioning

confidence: 99%

Gender specific differences in peripheral artery disease and their impact on cardiovascular rehabilitation -the experience of a Romanian Rehabilitation Hospital

Comşa¹,

Pharmacy²,

Gușetu³

et al. 2018

Balneo

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Introduction. As the prevalence of peripheral artery disease (PAD) is increasing in developing countries, so are the healthcare and socio-economic costs it brings about. This particular form of atherosclerotic disease is very much age-dependent, and along with the increase in life-expectancy, the lasts decades have seen a sharp rise in PAD prevalence in women. Knowledge regarding genderspecific aspects of the disease are scarce. This has a negative effect on overall outcomes of female PAD patients. Aim. This research aimed to identify gender peculiarities of PAD and evaluate their impact on cardiovascular rehabilitation. Material and methods. This was a retrospective observational study of 104 PAD patients (73 men and 31 women) admitted in 2016 to the Cardiology department of the Rehabilitation Hospital Cluj-Napoca. Demographic, clinical and biological parameters were recorded, as well as the treatment/rehabilitation regimens prescribed. The subjects were divided into to groups according to gender. Statistical analysis was done using the student t-test for unequal variances, hi-square test and the stepwise method for multivariate analysis. Results. The female group had a higher prevalence of diabetes mellitus (45% vs 33%, p=ns), but men were more likely smokers (74% vs 51%-p=0.017). Women had higher median total cholesterol values (p=0.006) and lower HDL-cholesterol levels (p=0.033). More than half of the female patients were already experiencing symptoms of critical limb ischemia on admission (57%), while intermittent claudication was predominant with men (66%). Multivariate analysis identified identified female gender (p=0.028) and ABI (p<0.0001) as sole independent predictors for the severity of the disease. Revascularization using percutaneous techniques was the preferred option for women (35% vs 27%), while surgery was performed more often in men (38% vs 29%)-p=ns. Home-based exercise training was indicated on discharge for more than half of the male group while only 30% of women had physical rehabilitation as a first line of treatment. Discussion. Our research offered similar findings to older studies regarding the genderspecific profile of PAD women, showing they are less exposed to smoking but more likely to experience metabolic disorders. Women had higher rates of critical limb ischemia on admission, suggesting a more advanced disease. Because of a more stable disease in men, this category benefited to a greater extent from exercise training compared to women. Conclusion. Peripheral artery disease has specific gender-related differences that in women have an important impact on both diagnosis and management, impeding rehabilitation and full social reintegration.

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“…As demonstrated in peripheral artery disease, a pathological condition characterized by a restriction in blood supply to peripheral tissues (McDermott, ; Pilz et al., ), endurance training could potentially be an interesting approach in the context of repeated I/R insults affecting SCD patients. In this context, regular physical activity has been associated with several beneficial effects in SCD mice, especially regarding energetics in exercising muscle (particularly, reducing acidosis; Chatel et al., ), inflammation (Charrin et al., ), haemorheological characteristics (Aufradet et al., ; Faes, Charrin, Connes, Pialoux, & Martin, ) and oxidative stress (Charrin et al., ; Chatel et al., ).…”

Section: Introductionmentioning

confidence: 99%

Ischaemia‐induced muscle metabolic abnormalities are poorly alleviated by endurance training in a mouse model of sickle cell disease

Chatel

Messonnier

Vilmen

et al. 2019

Experimental Physiology

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New Findings What is the central question of this study?The aim of this study was to evaluate the potential beneficial effects of endurance training during an ischaemia–reperfusion protocol in a mouse model of sickle cell disease (SCD). What is the main finding and its importance?Endurance training did not reverse the metabolic defects induced by a simulated vaso‐occlusive crisis in SCD mice, with regard to intramuscular acidosis, mitochondrial dysfunction or anatomical properties. Our results suggest that endurance training would reduce the number of vaso‐occlusive crises rather than the complications related to vaso‐occlusive crises. Abstract The aim of this study was to investigate whether endurance training could limit the abnormalities described in a mouse model of sickle cell disease (SCD) in response to an ischaemia–reperfusion (I/R) protocol. Ten sedentary (HbSS‐SED) and nine endurance‐trained (HbSS‐END) SCD mice were submitted to a standardized protocol of I/R of the leg, during which ATP, phosphocreatine and inorganic phosphate concentrations and intramuscular pH were measured using magnetic resonance spectroscopy. Forty‐eight hours later, skeletal muscles were harvested. Oxidative stress markers were then measured. Although the time course of protons accumulation was slightly different between trained and sedentary mice (P < 0.05), the extent of acidosis was similar at the end of the ischaemic period. The initial rate of phosphocreatine resynthesis measured at blood flow restoration, illustrating mitochondrial function, was not altered in trained mice compared with sedentary mice. Although several oxidative stress markers were not different between groups (P > 0.05), the I/R‐related increase of uric acid concentration observed in sedentary SCD mice (P < 0.05) was not present in the trained group. The spleen weight, generally used as a marker of the severity of the disease, was not different between groups (P > 0.05). In conclusion, endurance training did not limit the metabolic consequences of an I/R protocol in skeletal muscle of SCD mice, suggesting that the reduction in the severity of the disease previously demonstrated in the basal state would be attributable to a reduction of the occurrence of vaso‐occlusive crises rather than a decrease of the deleterious effects of vaso‐occlusive crises.

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Exercise training for intermittent claudication

Cited by 73 publications

References 36 publications

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Gender specific differences in peripheral artery disease and their impact on cardiovascular rehabilitation -the experience of a Romanian Rehabilitation Hospital

Ischaemia‐induced muscle metabolic abnormalities are poorly alleviated by endurance training in a mouse model of sickle cell disease

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