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Xiao YC, Li WY, Zhang L, Fan JF, Wang WZ, Wang YK. Effect of supervised exercise training on cardiovascular function in patients with intermittent claudication: a systematic review and meta-analysis of randomized controlled trials. Clin Res Cardiol 2024:10.1007/s00392-024-02423-4. [PMID: 38451260 DOI: 10.1007/s00392-024-02423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
This study aimed to determine the effect of supervised exercise training (SET) on cardiovascular function in patients with intermittent claudication (IC). A systematic search in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases was conducted. Primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), rate pressure product (RPP), cardiac output (CO), peak oxygen consumption (VO2peak), and heart rate variability (HRV). Secondary outcomes were maximum walking distance (MWD) and pain-free walking distance (PFWD). Outcomes were reported as weighted mean difference (WMD) between the SET group and the control group and synthesized by using the random-effects model. Seventeen RCTs with a total of 936 patients were included in this review. SET resulted in significant improvements of SBP (WMD = - 7.40, 95% CI - 10.69 ~ - 4.11, p < 0.001, I2 = 15.2%), DBP (WMD = - 1.92, 95% CI - 3.82 ~ - 0.02, p = 0.048, I2 = 0.0%), HR (WMD = - 3.38, 95% CI - 6.30 ~ - 0.46, p = 0.023, I2 = 0.0%), RPP (WMD = - 1072.82, 95% CI - 1977.05 ~ - 168.59, p = 0.020, I2 = 42.7%), and VO2peak with plantar flexion ergometer exercise (WMD = 5.57, 95% CI 1.66 ~ 9.49, p = 0.005, I2 = 62.4%), whereas CO and HRV remained statistically unaltered. SET also improved MWD (WMD = 139.04, 95% CI 48.64 ~ 229.44, p = 0.003, I2 = 79.3%) and PFWD (WMD = 40.02, 95% CI 23.85 ~ 56.18, p < 0.001, I2 = 0.0%). In conclusion, SET is effective in improving cardiovascular function in patients with IC, which was confirmed on outcomes of cardiovascular function associated with exercise ability. The findings hold out that the standard therapy of SET can improve not only walking distance but also cardiovascular function in patients with IC.
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Affiliation(s)
- Yu-Chen Xiao
- Naval Medical Center of PLA, 880 Xiangyin Road, Shanghai, 200433, China
| | - Wan-Yang Li
- School of Basic Medical Sciences, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Jie-Fu Fan
- Department of Vascular Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Wei-Zhong Wang
- Naval Medical Center of PLA, 880 Xiangyin Road, Shanghai, 200433, China.
| | - Yang-Kai Wang
- Naval Medical Center of PLA, 880 Xiangyin Road, Shanghai, 200433, China.
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Waddell A, Seed S, Broom DR, McGregor G, Birkett ST, Harwood AE. Safety of home-based exercise for people with intermittent claudication: A systematic review. Vasc Med 2021; 27:186-192. [PMID: 34930062 PMCID: PMC8996308 DOI: 10.1177/1358863x211060388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intermittent claudication (IC) is a classic symptom of peripheral artery disease,
with first line treatment being supervised exercise therapy (SET). Despite this,
SET is frequently underutilised, and adherence is often poor. An alternative
option are home-based exercise programmes (HBEP). Although HBEPs are well
tolerated, to the authors’ knowledge, no research has assessed their safety. The
aim of this review was to assess the safety of HBEPs in people living with IC.
We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library
databases. The main parameter of interest was complication rate, calculated as
the number of related adverse events per patient-hours. Subanalysis was
undertaken to determine differences in safety for studies that did and did not
include pre-exercise cardiac screening, and for studies with exercise at low,
moderate, and high levels of claudication pain. Our search strategy identified
8693 results, of which 27 studies were included for full review. Studies
included 1642 participants completing 147,810 patient-hours of home-based
exercise. Four related adverse events were reported, three of which were cardiac
in origin, giving an all-cause complication rate of one event per 36,953
patient-hours. Three of these events occurred following exercise to high levels
of claudication pain, and one occurred with pain-free exercise. One event
occured in a study without cardiac screening. Based on the low number of related
adverse events, HBEPs appear to be a safe method of exercise prescription for
people with IC. Our results strengthen the rationale for providing alternative
exercise options for this population. PROSPERO Registration No.:
CRD42021254581
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Affiliation(s)
- Alexander Waddell
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Sally Seed
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - David R Broom
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
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Germano-Soares AH, Cucato GG, Leicht AS, Andrade-Lima A, Peçanha T, de Almeida Correia M, Zerati AE, Wolosker N, Ritti-Dias RM. Cardiac Autonomic Modulation Is Associated with Arterial Stiffness in Patients with Symptomatic Peripheral Artery Disease. Ann Vasc Surg 2019; 61:72-77. [PMID: 31336162 DOI: 10.1016/j.avsg.2019.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The objective of this study was to analyze the association between cardiac autonomic modulation and arterial stiffness in patients with peripheral artery disease (PAD). METHODS This cross-sectional study included one hundred fourteen patients with symptomatic PAD (67.5% men; 65 ± 7 years; body mass index: 26.8 ± 4.5 kg/m2). Heart rate variability (HRV) was measured within time (standard deviation of all RR intervals [beat to beat heart interval] [SDNN], root mean square of the successive differences between adjacent normal RR intervals [RMSSD], and the proportion of successive RR intervals that differed by more than 50 msec [pNN50]) and frequency (low frequency [LF] and high frequency [HF]) domains. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Crude and adjusted linear regression analyses examined the relationship between HRV and cfPWV. RESULTS Nonsignificant crude associations were identified among cfPWV and RMSSD (P = 0.181), SDNN (P = 0.105), pNN50 (P = 0.087), LF (P = 0.376), HF (P = 0.175), and LF/HF ratio (P = 0.426). After adjustments for age, sex, smoking, body mass index, ankle-brachial index, and use of beta-blockers, significant associations were identified among cfPWV and RMSSD (P = 0.037), SDNN (P = 0.049), and pNN50 (P = 0.049). CONCLUSIONS Cardiac autonomic modulation was significantly associated with arterial stiffness in patients with PAD after adjustment for confounding factors. This relationship may contribute to the enhanced cardiovascular disease risk for PAD patients and provides a target for strategies to improve patient clinical outcomes.
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Affiliation(s)
| | | | | | - Aluísio Andrade-Lima
- Department of Physical Education, Federal University of Sergipe, Sergipe, Brazil
| | - Tiago Peçanha
- Department of Physical Education, Federal University of Sergipe, Sergipe, Brazil
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Ritti-Dias RM, Correia MDA, Andrade-Lima A, Cucato GG. Exercise as a therapeutic approach to improve blood pressure in patients with peripheral arterial disease: current literature and future directions. Expert Rev Cardiovasc Ther 2018; 17:65-73. [DOI: 10.1080/14779072.2019.1553676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Aluísio Andrade-Lima
- Department of Physical Education, Federal University of Sergipe, Aracaju, Brazil
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Walking training at the heart rate of pain threshold improves cardiovascular function and autonomic regulation in intermittent claudication: A randomized controlled trial. J Sci Med Sport 2017; 20:886-892. [PMID: 28389218 DOI: 10.1016/j.jsams.2017.02.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/30/2017] [Accepted: 02/13/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study investigated the effects of walking training (WT) on cardiovascular function and autonomic regulation in patents with intermittent claudication (IC). DESIGN Randomized controlled trial. METHODS Forty-two male patients with IC (≥50years) were randomly allocated into two groups: control (CG, n=20, 30min of stretching exercises) and WT (WTG, n=22, 15 bouts of 2min of walking interpolated by 2min of upright rest-walking intensity was set at the heart rate of pain threshold). Both interventions were performed twice/week for 12 weeks. Walking capacity (maximal treadmill test), blood pressure (auscultatory), cardiac output (CO2 rebreathing), heart rate (ECG), stroke volume, systemic vascular resistance, forearm and calf vascular resistance (plethysmography), and low (LF) and high frequency (HF) components of heart rate variability and spontaneous baroreflex sensitivity were measured at baseline and after 12 weeks of the study. RESULTS WT increased total walking distance (+302±85m, p=0.001) and spontaneous baroreflex sensitivity (+2.13±1.07ms/mmHg, p=0.02). Additionally, at rest, WT decreased systolic and mean blood pressures (-10±3 and -5±2mmHg, p=0.001 and p=0.01, respectively), cardiac output (-0.37±0.24l/min, p=0.03), heart rate (-4±2bpm, p=0.001), forearm vascular resistance (-8.5±2.8U, p=0.02) and LF/HF (-1.24±0.99, p=0.001). No change was observed in the CG. CONCLUSIONS In addition to increasing walking capacity, WT improved cardiovascular function and autonomic regulation in patients with IC.
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Sobieszczyk PS, Beckman JA. Intervention or exercise?: the answer is yes! J Am Coll Cardiol 2016; 65:1010-2. [PMID: 25766948 DOI: 10.1016/j.jacc.2015.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Piotr S Sobieszczyk
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joshua A Beckman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
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Training improves walking capacity and cardiovascular function in arteritis. JOURNAL OF VASCULAR NURSING 2015; 32:51-4. [PMID: 24944171 DOI: 10.1016/j.jvn.2013.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
Patients with arteritis have a high risk of mortality from cardiovascular disorders. However, whether these patients benefit from an intervention involving exercise remains unclear. In this study, we assessed the effects of an unsupervised exercise program on walking capacity, quality of life, and cardiovascular parameters of a patient with arteritis. A 33-year-old man reporting symptoms of claudication during walking was studied. Imaging tests revealed severe atherosclerosis and arteritis was diagnosed. Five weekly sessions of walking for 16 weeks increased claudication distance and total walking distance, produced improvements in six out of the eight health-related quality-of-life domains, decreased systolic blood pressure, and changed cardiac autonomic modulation toward parasympathetic modulation. This case report showed that unsupervised exercise training improved walking capacity, quality of life, and cardiovascular parameters in a patient with arteritis.
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Wichnieski C, Kirchhof FNS, Beraldo PC, Bertassoni Neto L, Jara CC. Physiotherapeutic intervention in peripheral arterial disease by functional hyperemia in diabetic patients. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.004.ao10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction : Diabetes Mellitus (DM) is conceptualized as a public health problem with varying degrees of morbidity. The physical and functional alternatives for the treatment of circulatory complications of diabetes, such as intermittent claudication, are poorly explored. This indicates the need to search for ancillary techniques that can be used in the physical therapy treatment of diabetic patients. Objective : To investigate the effects of functional hyperemia on peripheral arterial disease in patients with diabetes. Materials and methods: This study was conducted with a group of five volunteers from the Diabetics Association of Parana (Associação Paranaense do Diabético , APAD ), who suffered from peripheral vascular disorders in the lower limbs. All subjects attended 10 sessions (twice weekly). Functional hyperemia was induced by programmed exercise therapy that consisted of walking on a treadmill. Results : There was a significant increase in mean activity time (F9,36 = 13.710; p < 0.001 ), mean walking distance (F9,36 = 27.689 ; p < 001), and mean speed (F9,36 = 15.638 ; p < .001). No statistically significant differences in the ankle-brachial index were noted. Conclusion : There was a significant increase in walking distance, time, and speed for diabetic subjects. Our findings indicate the importance of physical therapists in the supervised treatment of peripheral vascular disorders in diabetic patients.
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Abstract
Patient-reported outcomes (PROs) after vascular surgery are becoming increasingly important in the current era of health care reform. Although a number of general quality of life instruments exist, vascular disease-specific instruments may provide more targeted data on how patients feel after specific interventions. Here we provide a review of both generic and disease-specific instruments focused on arterial conditions, including peripheral arterial disease, carotid arterial disease, and aortic disease, which have been described in the literature. While many different tools currently exist, there is a paucity of well-validated, specific instruments that accurately reflect functional and objective measures of patients' arterial disease burden. A full understanding of the existing tools available to assess patients' perceived lifestyle impact of their disease and its treatments is essential for both research and clinical purposes, and to highlight the need for additional work on this topic.
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Affiliation(s)
- Caitlin W Hicks
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Ying Wei Lum
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287.
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Spafford C, Oakley C, Beard JD. Randomized clinical trial comparing Nordic pole walking and a standard home exercise programme in patients with intermittent claudication. Br J Surg 2014; 101:760-7. [PMID: 24760745 DOI: 10.1002/bjs.9519] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND This was a randomized clinical trial to determine whether Nordic pole walking (NPW) is more effective in improving walking distance than a standard home exercise programme (HEP) in patients with intermittent claudication. METHODS Fifty-two patients with stable claudication were allocated randomly to a standard HEP or NPW group, and asked to complete three 30-min walks per week for 12 weeks. Claudication distance (CD) and maximum walking distance (MWD) were measured at 0 (baseline), 4, 8 and 12 weeks. Patients in the NPW group were tested with (NPW+) and without (NPW-) poles. RESULTS For NPW+, CD increased immediately from a median (range) of 124 (71-248) m to 148 (116-426) m, and MWD from 248 (149-900) to 389 (194-1099) m (P = 0.004 and P < 0.001 respectively). By 12 weeks, CD had further increased to 199 (118-550) m and MWD had more than doubled to 538 (250-1750) m (P < 0.001 and P = 0.001). For NPW-, CD at 12 weeks had increased significantly to 151 (100-328) m and MWD to 400 (200-900) m (P < 0.001 and P = 0.006 respectively). At 12 weeks the changes in the standard HEP group were not significant, despite excellent compliance: CD from 107 (56-332) to 153 (59-321) m and MWD from 355 (92-600) to 334 (149-874) m (P = 0.030 and P = 0.260 respectively). CONCLUSION A 12-week exercise programme using Nordic poles significantly improved walking distance in claudicants compared with a standard HEP. REGISTRATION NUMBER ISRCTN78168304 (http://www.controlled-trials.com).
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Affiliation(s)
- C Spafford
- Sheffield Nordic Walking Research, Steps Physiotherapy and Circulation Clinics, Sheffield, UK
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12
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Systematic Review of Home-based Exercise Programmes for Individuals with Intermittent Claudication. Eur J Vasc Endovasc Surg 2013; 46:690-706. [DOI: 10.1016/j.ejvs.2013.09.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/03/2013] [Indexed: 11/15/2022]
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Community walking programs for treatment of peripheral artery disease. J Vasc Surg 2013; 58:1678-87. [PMID: 24103409 DOI: 10.1016/j.jvs.2013.08.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/14/2013] [Accepted: 08/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Supervised walking programs offered at medical facilities for patients with peripheral artery disease (PAD) and intermittent claudication (IC), although effective, are often not used due to barriers, including lack of reimbursement and the need to travel to specialized locations for the training intervention. Walking programs for PAD patients that occur in community settings, such as those outside of supervised settings, may be a viable treatment option because they are convenient and potentially bypass the need for supervised walking. This review evaluated the various methods and outcomes of community walking programs for PAD. METHODS A literature review using appropriate search terms was conducted within PubMed/MEDLINE and the Cochrane databases to identify studies in the English language that used community walking programs to treat PAD patients with IC. Search results were reviewed, and relevant articles were identified that form the basis of this review. The primary outcome was peak walking performance on the treadmill. RESULTS Ten randomized controlled trials examining peak walking outcomes in 558 PAD patients demonstrated that supervised exercise programs were more effective than community walking studies that consisted of general recommendations for patients with IC to walk at home. Recent community trials that incorporated more advice and feedback for PAD patients in general resulted in similar outcomes, with no differences in peak walking time compared with supervised walking exercise groups. CONCLUSIONS Unstructured recommendations for patients with symptomatic PAD to exercise in the community are not efficacious. Community walking programs with more feedback and monitoring offer improvements in walking performance for patients with claudication and may bypass some obstacles associated with facility-based exercise programs.
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Makris G, Lattimer C, Lavida A, Geroulakos G. Availability of Supervised Exercise Programs and the Role of Structured Home-based Exercise in Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2012; 44:569-75; discussion 576. [DOI: 10.1016/j.ejvs.2012.09.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 09/12/2012] [Indexed: 11/26/2022]
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Beutner F, Teren A, Gielen S, Schuler G, Wirkner K, Tiller D, Loeffler M, Scholz M. Automated photoplethysmography-based determination of ankle-brachial index: a validation study against Doppler sonography. Clin Res Cardiol 2012; 101:875-83. [PMID: 22584382 DOI: 10.1007/s00392-012-0471-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/26/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Determination of ankle-brachial-index (ABI) by manual Doppler is well established to screen for lower extremity arterial disease (LEAD) and to predict cardiovascular risk. A new generation of digital-controlled devices promises automated ABI determination. The aim of this study was to determine comparability of automated photoplethysmography (PPG)-derived ABI calculation with the Doppler-ABI algorithm commonly used in cohort studies. METHODS Automated PPG-based ABI measurements [Vascular Explorer (VE) and Vicorder (VI)] were recorded from 112 limbs of healthy subjects and 22 limbs of patients with confirmed LEAD. Validity was evaluated on the basis of receiver-operating characteristic (ROC) analysis of clinical status and concordance with Doppler-ABI. Differences between cuff inflation [inf]- and deflation [def]-based method were studied in VE. RESULTS PPG-based ABI values were higher compared to Doppler-ABI (VI +0.06, VEinf +0.15, VEdef +0.09, p < 0.001, respectively). The difference was pronounced in pathological (<0.9), borderline (0.9-0.99) and low normal (1.0-1.09) ABI, but less in ABI ≥1.1. However, ROC analysis revealed excellent diagnostic value for LEAD (sensitivity/specificity) and comparable area under the curve at method-adapted ABI thresholds for all methods: Doppler (95/90 %, 0.95), VI (75/96 %, 0.91), VEinf (85/89 %, 0.93) and VEdef (80/98 %, 0.94). CONCLUSIONS Digital-controlled PPG-based ABI determination is a useful diagnostic application for LEAD. However, the systematic higher ABI in PPG-based measurement compared to Doppler and remarkable differences between the deflationary and inflationary method are critical for the interpretation of borderline and low normal ABI values where precise reading is essential to detect mild LEAD and subclinical disease and to predict cardiovascular risk.
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Affiliation(s)
- Frank Beutner
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.
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16
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Casillas JM, Troisgros O, Hannequin A, Gremeaux V, Ader P, Rapin A, Laurent Y. Rehabilitation in patients with peripheral arterial disease. Ann Phys Rehabil Med 2011; 54:443-61. [DOI: 10.1016/j.rehab.2011.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 06/28/2011] [Accepted: 07/02/2011] [Indexed: 12/27/2022]
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Mays RJ, Casserly IP, Kohrt WM, Ho PM, Hiatt WR, Nehler MR, Regensteiner JG. Assessment of functional status and quality of life in claudication. J Vasc Surg 2011; 53:1410-21. [PMID: 21334172 DOI: 10.1016/j.jvs.2010.11.092] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Treadmill walking is commonly used to evaluate walking impairment and efficacy of treatment for intermittent claudication (IC) in clinical and research settings. Although this is an important measure, it does not provide information about how patients perceive the effects of their treatments on more global measures of health-related quality of life (HRQOL). METHODS PubMed/Medline was searched to find publications about the most commonly used questionnaires to assess functional status and/or general and disease-specific HRQOL in patients with peripheral artery disease (PAD) who experience IC. Inclusion criteria for questionnaires were based on existence of a body of literature in symptomatic PAD. RESULTS Six general questionnaires and seven disease-specific questionnaires are included, with details about the number of domains covered and how each tool is scored. The Medical Outcomes Study Short Form 36-item questionnaire and Walking Impairment Questionnaire are currently the most used general and disease-specific questionnaires at baseline and after treatment for IC, respectively. CONCLUSIONS The use of tools that assess functional status and HRQOL has importance in both the clinical and research areas to assess treatment efficacy from the patient's perspective. Therefore, assessing HRQOL in addition to treadmill-measured walking ability provides insight as to the effects of treatments on patient outcomes and may help guide therapy.
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Affiliation(s)
- Ryan J Mays
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Leicht AS, Crowther RG, Muller R, Golledge J. The effects of including quality of life responses in models to predict walking performance of patients with intermittent claudication. Eur J Vasc Endovasc Surg 2011; 41:511-7. [PMID: 21247784 DOI: 10.1016/j.ejvs.2010.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 12/22/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the accuracy of previously developed prediction models of treadmill walking performance in patients with intermittent claudication (IC) due to peripheral arterial disease (PAD); and to examine the accuracy of new prediction models. DESIGN Analysis of data collected in a previous randomised clinical trial. MATERIALS Ninety-three assessments of 28 patients diagnosed with IC due to PAD. METHODS Patients undertook routine clinical assessments, quality of life (QOL) questionnaires and treadmill walking tests. Walking performance and estimates based on prediction models were compared via paired t-tests or Wilcoxon Rank Sum tests. Stepwise linear regression generated models to predict walking performance from clinical measures and QOL responses. Accuracy was determined as the absolute error between model estimates and patient results. RESULTS Walking performance was significantly underestimated (35-71% error) by previously developed prediction models. Models developed in the current study identified QOL responses as the most significant predictors of current walking performance but these models still resulted in substantial errors (19-84%). CONCLUSIONS Previously published predictors of walking performance significantly underestimated patient's ability in practise. Predictions based upon clinical measurements and QOL responses were developed however, their accuracy was also limited. Further research is needed regarding walking performance prediction to assist clinicians with assessment of PAD severity and treatment effectiveness.
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Affiliation(s)
- A S Leicht
- Institute of Sport and Exercise Science, James Cook University, Townsville, Queensland 4811, Australia.
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Exercise-based interventions and health-related quality of life in intermittent claudication: a 20-year (1989–2008) review. ACTA ACUST UNITED AC 2010; 17:140-54. [DOI: 10.1097/hjr.0b013e3283377f08] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Locatelli EC, Pelizzari S, Scapini KB, Leguisamo CP, Silva ABD. Exercícios físicos na doença arterial obstrutiva periférica. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000300010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A maioria dos pacientes portadores de claudicação intermitente, um aspecto clínico da doença arterial periférica, tem importante limitação nas atividades físicas e redução na qualidade de vida. O objetivo deste estudo foi realizar uma revisão da literatura sobre a intervenção através de exercícios em portadores de doença arterial obstrutiva periférica com claudicação intermitente. Trata-se de uma revisão de artigos científicos consultados nos bancos de dados da BIREME, PubMed e SciELO, através das fontes LILACS e MEDLINE e a partir dos descritores em Ciências da Saúde claudicação intermitente, doenças vasculares periféricas, reabilitação, exercício e terapia por exercício. Concluiu-se que, apesar da variabilidade dos regimes de caminhada identificados na literatura, o treino aeróbio, de uma forma geral, proporciona benefícios a pacientes portadores de doença arterial obstrutiva periférica com claudicação intermitente, principalmente na melhora do desempenho de caminhada, o que pode ter impacto significativo na qualidade de vida desses pacientes.
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Roberts A, Roberts E, Sykes K, deCossart L, Edwards P, Cotterell D. Response to Comments on “Physiological and Functional Impact of an Unsupervised but Supported Exercise Programme for Claudicants”. Eur J Vasc Endovasc Surg 2009. [DOI: 10.1016/j.ejvs.2008.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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