The Evaluation of Exercise Performance in Patients with Peripheral Vascular Disease

Hiatt, William R.; Nawaz, Dilsher; Regensteiner, Judith G.; Hossack, Kenneth F.

doi:10.1097/00008483-198812200-00005

Cited by 141 publications

(96 citation statements)

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“…Although intermittent claudication has been extensively studied in PAD subjects, 7,8 little information is known about their gait characteristics other than that they walk slower at both 4-m and 20-m distances than non-PAD controls. 9,10 Consequently, PAD subjects may be at greater risk for subsequent mobility loss, 11 disability in performing activities of daily living, 11 being homebound, 12 entering a nursing home, 13 and mortality.…”

Section: Introductionmentioning

confidence: 99%

Altered gait profile in subjects with peripheral arterial disease

2001

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Abstract:The purpose of this study was to determine whether peripheral arterial disease (PAD) subjects had impaired temporal and spatial gait characteristics compared to non-PAD controls at preferred and rapid self-selected walking paces. A total of 28 PAD subjects with intermittent claudication (age = 71 ± 1; mean ± SEM) and 15 non-PAD controls with at least one cardiovascular risk factor but no ambulatory leg pain (age = 71 ± 1) were recruited. Gait parameters consisting of velocity, cadence, stride length, swing time, stance time, single-support time, doublesupport time, and base of support were recorded at the preferred and rapid walking paces. At the rapid walking pace, velocity was 22% slower (p Ͻ 0.001) in the PAD subjects compared with the non-PAD controls (99.9 ± 3.3 vs. 117.5 ± 5.3 cm/s) due to an 8% (p = 0.019) slower cadence (99.9 ± 1.7 vs. 103.3 ± 2.4 steps/min) and a 14% (p Ͻ 0.001) shorter stride length (119.8 ± 2.9 vs. 135.8 ± 4.2 cm/stride). The PAD subjects spent 5% less of the gait cycle in the swing phase (p = 0.006) and 3% more in stance (p = 0.006) than their non-PAD counterparts. During the stance phase, the PAD subjects spent 5% less of the gait cycle in single-stance (p = 0.004) and 16% more in double-stance (p = 0.007). Similar results were obtained at the preferred walking pace.In conclusion, compared with the controls, PAD subjects adopted an ambulatory pattern that favored greater gait stability at the expense of greater walking speed at either their preferred or rapid self-selected paces.

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Section: Introductionmentioning

confidence: 99%

Altered gait profile in subjects with peripheral arterial disease

2001

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“…These peripheral hemodynamic measurements obtained from our laboratory are highly reliable in PAD patients with claudication [7,8,20]. The test-retest intraclass reliability coefficient is R=0.87 for calf TcPO 2 [21].…”

Section: Measurementsmentioning

confidence: 77%

“…The cost associated with PAD is comparable to, if not higher than cardiac dysrhythmias, congestive heart failure and cerebrovascular disease, averaging $3.9 billion for total Medicare paid PAD-related care annually [6]. Many of those with PAD are physically limited by ambulatory leg pain, resulting in ambulatory dysfunction, impaired physical function lower physical activity levels and even worse healthrelated quality of life scores than in individuals with coronary artery disease and congestive heart failure [7][8][9][10][11][12][13]. Furthermore, PAD patients have increased rates of functional decline and mobility loss compared to those without PAD [9,10,14].…”

Section: Introductionmentioning

confidence: 99%

Impaired Peripheral Circulation in Veterans with Claudication is Associated with Smoking

Iwai

Umeda²,

Inoue³

et al. 2014

Angiol

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We compared the peripheral vascular function of veterans and non-veterans with peripheral artery disease (PAD) and claudication. The circulation of the lower extremities was assessed under rest and reactive hyperemia conditions in 413 veterans and in 83 non-veterans. Veterans had more severe PAD as measured by a lower ankle/ brachial index (p<0.001). Following the occlusive test, veterans had a greater relative percentage decrease in ankle systolic blood pressure (p=0.015), a greater percentage decrease in calf transcutaneous oxygen tension (p=0.035), and a blunted percentage increase in calf blood flow (p=0.031). After adjustment for current smoking status, these measures were no longer statistically different between the veterans and non-veterans. We conclude that veterans with PAD and claudication have greater impairments in macrovascular and microvascular function of the lower extremities, and greater severity of PAD than compared to non-veterans, and that these factors were primarily associated with their higher prevalence of smoking. The greater compromise in peripheral vascular measures in veterans is particularly noteworthy given that the prevalence of diabetes, hypertension, and dyslipidemia were not higher.

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“…15 At the end of each stage, heart rate, blood pressure and an electrocardiogram (ECG ) recording were obtained. The baseline tests were considered valid only if claudication V ascular M edicine 2004; 9: 18-25 symptoms caused the patient to stop walking.…”

Section: Speci C Methodsmentioning

confidence: 99%

Randomized trial of AT-1015 for treatment of intermittent claudication. A novel 5-hydroxytryptamine antagonist with no evidence of efficacy

et al. 2004

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AT-1015 is a novel selective 5-HT 2A serotonin receptor antagonist that is known to impair platelet aggregation and vasoconstriction. Serotonin has been hypothesized to contribute to claudication symptoms in individuals with peripheral arterial disease (PAD) via microvascular vasoconstrictor and thrombotic effects. AT-1015 was thus evaluated in 439 patients with claudication who were randomized in a double-blind, placebo-controlled trial comparing 10 mg, 20 mg, and 40 mg BID versus placebo for 24 weeks. Treadmill walking performance was assessed by peak walking time (PWT) and pain-free walking time (PFWT). Quality of life (QoL) was measured by the Walking Impairment Questionnaire (WIQ) and the Health Status Survey SF-36. Limb hemodynamics was assessed with the ankle¡brachial index (ABI). The 40 mg arm was terminated prematurely by recommendation of the Data Safety Monitoring Committee due to an excess number of non-fatal myocardial infarctions. At study conclusion, there were no statistically signi cant differences in the mean change of PWT, PFWT, ABI and QoL between the 10 mg and 20 mg BID treatment groups compared with placebo. The proportion of patients who experienced an adverse event (AE) was similar across all treatment groups. Antimuscarinic and gastrointestinal AEs were more common in the AT-1015 treatment groups. Two deaths occurred: one in the placebo group and the other in the AT-1015 20 mg group. Although a prolongation of the QTc interval was observed in all groups, this was not clinically signi cant (QTc > 500 ms). Mean supine pulse rates were signi cantly increased in all AT-1015 treatment groups, consistent with predicted antimuscarinic effects. Population pharmacokinetic analysis t a one-compartment model with rst-order absorption and elimination. These data indicate that selective serotonin receptor blockade does not improve exercise tolerance or quality of life in individuals with claudication.

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The Evaluation of Exercise Performance in Patients with Peripheral Vascular Disease

Cited by 141 publications

References 0 publications

Altered gait profile in subjects with peripheral arterial disease

Altered gait profile in subjects with peripheral arterial disease

Impaired Peripheral Circulation in Veterans with Claudication is Associated with Smoking

Randomized trial of AT-1015 for treatment of intermittent claudication. A novel 5-hydroxytryptamine antagonist with no evidence of efficacy

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