Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication

Fokkenrood, H.J.P.; Bendermacher, B.L.; Lauret, G.J.; Willigendael, Edith M.; Prins, Martin H.; Teijink, Joep A.W.

doi:10.1002/14651858.cd005263.pub3

Cited by 220 publications

(170 citation statements)

References 86 publications

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“…82 On muscle biopsy, there is greater muscle cell apoptosis and Limb Symptoms in PAD improvements in functional parameters. 120, 121 Randomized trials show that home-based walking exercise programs that include measures to enhance adherence increase the 6-minute walk distance as well as quality of life measures. 120, 122 As shown in the Table, the updated ACCF/AHA practice guidelines support the use of home-based walking and alternate approaches to exercise to enhance walking ability in patients with claudication.…”

Section: Skeletal Muscle Alterations and Mitochondrial Dysfunctionmentioning

confidence: 99%

Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

Hamburg

Creager

2017

Circ J

157

124

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estimates a more than 30% increase in deaths and disability attributable to PAD between 2005 and 2015, which is largely determined by population aging. 3,12 PAD prevalence escalates with advancing age, affecting 1 in 10 adults older than 70 years. In addition to age, smoking and diabetes are the strongest risk factors for PAD across the world. A comprehensive global evaluation of PAD found that its prevalence and risk factors are similar in high-income countries to low-and middle-income countries. 2,13 Lower socioeconomic status is a newly recognized risk factor for PAD. 14 Importantly, there has been a greater increase in PAD prevalence in low-and middle-income countries, rising by 28.7% from 2000 to 2010 as compared with 13.1% in high-income countries. 2, 15 The changing burden of PAD is also greater in women as compared with men.The health implications of PAD derive from both its limb and cardiovascular manifestations. Consistent with the systemic nature of atherosclerosis, polyvascular disease is common in patients with PAD. 16 In the REACH registry, 61% of PAD patients had concomitant coronary artery disease (CAD) and/or cerebrovascular disease. 16 Thus, the presence of PAD portends a high risk for subsequent cardiovascular events. A meta-analysis of over 48,000 participants in population-based cohort studies demonstrated that a low ankle-brachial index (ABI) predicted a 2-fold risk of death, cardiovascular death, and major coronary events at all ranges of the Framingham Risk Score. 4 Further, the elevated risk of cardiovascular events is present in both symptomatic and asymptomatic patients. 17 Patients with atherosclerotic disease in more than 1 vascular territory have particularly poor outcomes. 6 In the over 5,000 Japanese T here is growing recognition of the effect of peripheral artery disease (PAD) on cardiovascular health. 1 Recent studies indicate that, globally, over 200 million adults have PAD, 2,3 which is an expression of systemic atherosclerosis and well-established as heightening the risk for cardiovascular events. 4-6 The limb manifestations of PAD induce considerable suffering. Patients with PAD experience intermittent claudication, characterized as exertional leg pain that limits walking ability, and often times, disability. 7-9 Current medical therapies to reduce the burden of lower extremity symptoms in patients with PAD are limited. Revascularization by endovascular intervention or surgical reconstruction is used to treat lifestyle-limiting claudication if patients do not respond adequately to medical therapy including exercise training. Indeed, lower extremity revascularization with endovascular approaches has undergone a dramatic increase in use. 10 Though endovascular therapy improves blood flow and function, there are significant associated risks, and durability may be limited, especially in infrainguinal disease. Abundant evidence demonstrates the benefits of exercise therapy in claudication, yet the mechanisms underlying the beneficial effects remain incompletely defined. 11 Thus, ...

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Section: Skeletal Muscle Alterations and Mitochondrial Dysfunctionmentioning

confidence: 99%

Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

Hamburg

Creager

2017

Circ J

157

124

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“…92,93 Individual studies and meta-analyses have found that supervised exercise training increases maximal walking time by 120% to 150% ( Figure 5). 94,95 Based on these data, the current ACC/AHA and the ESC (European Society of Cardiology) guidelines recommended supervised exercise for patients with PAD, with sessions occurring at least 3 times per week with exercise regularly once the program is completed. 16,98 Exercise is also recommended in the ACC/ AHA performance measures for patients with PAD.…”

Section: Exercise Trainingmentioning

confidence: 99%

Pharmacological Treatment and Current Management of Peripheral Artery Disease

Bonaca

Creager

2015

Circulation Research

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Abstract:Patients with peripheral artery disease (PAD) are at heightened risk of both systemic cardiovascular adverse events, as well as limb-related morbidity. The optimal management of patients with PAD requires a comprehensive treatment strategy incorporating both lifestyle changes, including smoking cessation and exercise, as well as optimal medical therapy. Pharmacological therapies for patients with PAD are targeted both at modifying broad risk factors for major adverse cardiovascular events, as well as reducing limb-related morbidity. Observational data suggest that indicated pharmacological treatments are greatly underutilized in PAD, underscoring the need for improvements in patient identification and care delivery. Ongoing trials of novel therapies in patients with PAD will further inform pharmacological strategies to reduce both systemic cardiovascular risk and limb-related morbidity. (Circ Res.

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“…Supervised training leads to the appearance of morphological changes in the femoral artery, increased blood flow as well as the development of collateral circulation [7][8][9][10].…”

Section: Ambulatory Trainingmentioning

confidence: 99%