Influence of Changes in Sedentary Time on Outcomes of Supervised Exercise Therapy in Individuals with Comorbid Peripheral Artery Disease and Type 2 Diabetes

Whipple, Mary O.; Schorr, Erica; Talley, Kristine Mc; Wolfson, Julian; Lindquist, Ruth; Treat‐Jacobson, Diane

doi:10.1016/j.avsg.2020.03.040

Cited by 11 publications

(30 citation statements)

References 67 publications

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“…In another medical condition, Whipple (286) reported a high prevalence of nonresponders among individuals with peripheral artery disease with or without type 2 diabetes mellitus completing at least two-thirds of their prescribed exercise sessions. When nonresponse was defined as a negative change or no change in 6-minute walk test distance, the prevalence of non-response was 35%, but when defined as a lack of a clinically meaningful change (20 meters), the prevalence of non-response was as high as 56% (287). All participants improved in at least one study outcome, but only one individual improved in every measured outcome.…”

Section: Inter-individual Variability and Dose-response Heterogeneity To Physical Activity And Exercisementioning

confidence: 99%

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

Izquierdo

Merchant

Morley

et al. 2021

The Journal of nutrition, health and aging

597

377

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The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.

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Section: Inter-individual Variability and Dose-response Heterogeneity To Physical Activity And Exercisementioning

confidence: 99%

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

Izquierdo

Merchant

Morley

et al. 2021

The Journal of nutrition, health and aging

597

377

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show abstract

“…The present paper reports the results of a secondary analysis of a single group pre-test, post-test study of older adults referred to a 12-week SET program for treatment of symptomatic PAD. The parent study was designed to examine the effects of type 2 diabetes and changes in sedentary behavior on changes in peak walking distance and claudication onset distance following 12 weeks of SET (Whipple et al, 2020). Data on demographic and clinical characteristics were collected at baseline (the time of enrollment in SET).…”

Section: Methodsmentioning

confidence: 99%

“…It has been reported that baseline physical function, cardiac comorbidity, obesity, and degree of arteriosclerosis influence potential benefit from SET programs (Dörenkamp et al, 2016; Gardner et al, 2016; Rosfors et al, 1990). We have previously reported that self-efficacy and the burden of complications related to type 2 diabetes were significant predictors of improvement in walking distance, while baseline function, changes in sedentary time, previous revascularization, smoking status, or demographic characteristics were not (Whipple et al, 2020). Although there is a lack of consensus regarding predictors of response, the prevalence of nonresponse remains underappreciated and likely underreported in studies of SET for the treatment of PAD.…”

Section: The Problem Of Nonresponse and Poor Response To Exercise Among Older Adultsmentioning

confidence: 99%

Individual Differences in Response to Supervised Exercise Therapy for Peripheral Artery Disease

et al. 2020

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Nonresponse to exercise has been extensively examined in young athletes but is seldom reported in studies of aerobic exercise interventions in older adults. This study examined the prevalence of nonresponse and poor response to exercise in functional and quality of life outcomes and response patterns between and among older adults undergoing 12-weeks of supervised exercise therapy for the management of peripheral artery disease ( N = 44, mean age 72.3 years, 47.7% female). The prevalence of nonresponse (no change/decline in performance) in walking distance was 31.8%. The prevalence of poor response (lack of a clinically meaningful improvement) was 43.2%. Similar patterns of response were observed in both objective and patient-reported measures of physical function. All participants improved in at least one outcome; only two participants improved in all measured outcomes. Additional research should examine modifiable predictors of response to inform programming and maximize an individual’s potential benefit from exercise therapy.

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“…It has been suggested that diabetes contributes to reduced blood volume expansion and impaired skeletal muscle oxygenation. Because physical activity can correct these above disturbances [ 37 ], patients with DM may benefit from physiotherapy even more than the general population. A systematic review published in 2017 by Hageman et al [ 38 ] summarized the literature dedicated to the impact of diabetes, as a comorbid disease, in patients with intermittent claudication (IC) on the effects of supervised exercise training.…”

Section: Kinesitherapymentioning

confidence: 99%

Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions

Hap

Biernat

Konieczny

2021

Journal of Diabetes Research

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Diabetes mellitus (DM) is one of the major public health problems that account for morbidity, mortality, and disability worldwide. The presence of DM increases the risk of peripheral artery disease (PAD), as well as accelerates its course, making these patients more susceptible to ischemic events and impaired functional status. Unfortunately, alternative treatments for vascular complications in diabetes are poorly researched. Physiotherapy (kinesitherapy combined with different physical therapy agents) in individuals with DM and coexisting PAD may offer an important complementary therapy alternative. Early therapeutic measures can significantly improve patient outcomes, reduce cardiovascular risk, and improve daily life quality. The article provides an update on the current state of knowledge on physiotherapy interventions in the course of DM in patients with coexisting PAD.

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Influence of Changes in Sedentary Time on Outcomes of Supervised Exercise Therapy in Individuals with Comorbid Peripheral Artery Disease and Type 2 Diabetes

Cited by 11 publications

References 67 publications

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

Individual Differences in Response to Supervised Exercise Therapy for Peripheral Artery Disease

Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions

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