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Herrero-Alonso C, López-Lifante VM, Costa-Garrido A, Pera G, Alzamora M, Forés R, Martínez-Ruíz EJ, López-Palencia J, Moizé-Arcone L, Mateo-Aguilar E, Rodríguez-Sales V, Alventosa M, Heras A, Valverde M, Violán C, Torán-Monserrat P. Adherence to Supervised and Unsupervised Exercise Programmes in Ageing Population with Intermittent Claudication: A Randomized Controlled Trial. J Clin Med 2024; 13:3690. [PMID: 38999256 PMCID: PMC11242028 DOI: 10.3390/jcm13133690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Intermittent Claudication symptomatic peripheral arterial disease (ICSPAD) is associated with reduced mobility, functional capacity, and quality of life. Physical exercise is an effective non-pharmacological intervention for the management of ICSPAD. Adherence to exercise programs is challenging, due to the nature of the disease and the complex comorbidities associated with it. This study aimed to determine adherence to three supervised physical exercise programs (a walking intervention, strength intervention, and concurrent intervention) and an unsupervised exercise program (standard advice) in individuals with ICSPAD. Methods: In this clinical trial, 122 patients were divided into four groups based on the type of exercise program they followed: standard advice, walking intervention, strength intervention, and concurrent intervention. Results: The results revealed that while the demographic characteristics were similar, the strength intervention group had a younger mean age, and the walking group had a higher prevalence of hypertension and increased usage of anti-hypertensive drugs. Adherence to physical exercise and pedometer wearing was highest in the standard advice group. Logistic regression analysis showed lower odds of adherence to exercise and pedometer wearing in the intervention groups compared to the standard advice group. Adherence did not significantly vary across ankle-brachial index categories. Furthermore, there was no significant difference in adherence between the severity levels of intermittent claudication, though mild cases tended to exhibit higher adherence. Conclusions: The results show that the standard advice from healthcare professionals positively influences treatment adherence.
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Affiliation(s)
- Cecilia Herrero-Alonso
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
- Palau-Solità Primary Healthcare Institut Català de la Salut, Centre Palau-Solità Plegamans, 08184 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Victor-Miguel López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
- Palau-Solità Primary Healthcare Institut Català de la Salut, Centre Palau-Solità Plegamans, 08184 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), 08007 Barcelona, Spain
| | - Anna Costa-Garrido
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
| | - Maite Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
| | - Rosa Forés
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
| | | | | | - Luciana Moizé-Arcone
- Research Group in Technology Applied to High Performance and Health, Department of Health Sciences, TecnoCampus, Universitat Pompeu Fabra, Av. d'Ernest Lluch, 32, 08302 Barcelona, Spain
| | - Ester Mateo-Aguilar
- Research Group GRACIS, Department of Health Sciences, TecnoCampus, Universitat Pompeu Fabra, Av. d'Ernest Lluch, 32, 08302 Barcelona, Spain
| | - Vanesa Rodríguez-Sales
- Research Group in Technology Applied to High Performance and Health, Department of Health Sciences, TecnoCampus, Universitat Pompeu Fabra, Av. d'Ernest Lluch, 32, 08302 Barcelona, Spain
| | - Marina Alventosa
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
| | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
| | - Marta Valverde
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
- Emergency Department, Hospital Nostra Senyora de Meritxell, AD700 Escaldes-Engordany, Andorra
| | - Concepció Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Grup de Recerca en Impacte de les Malalties Cròniques i les Seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataro, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), 08007 Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, 17001 Girona, Spain
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2
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Tan LT, McDermott KM, Hicks CW. Overview and comparison of contemporary Society for Vascular Surgery, American Heart Association/American College of Cardiology, and European Society for Vascular Surgery guidelines for the management of patients with intermittent claudication. Semin Vasc Surg 2024; 37:188-209. [PMID: 39151998 DOI: 10.1053/j.semvascsurg.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 08/19/2024]
Abstract
Intermittent claudication (IC) is a phenotype of peripheral artery disease that is characterized by pain in the lower extremity muscles during activity that is relieved by rest. Medical management, risk factor control, smoking cessation, and exercise therapy have historically been the mainstays of treatment for IC, but advances in endovascular technology have led to increasing use of peripheral vascular interventions in this patient population. There are meaningful differences in published society guidelines and appropriate use criteria relevant to the management of IC, especially regarding indications for peripheral vascular interventions. The current review aims to highlight similarities and differences between major society recommendations for the management of IC, and to discuss practice trends, disparities, and evidence gaps in the use of peripheral vascular interventions for IC in the context of existing guidelines.
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Affiliation(s)
- Li Ting Tan
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Katherine M McDermott
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Caitlin W Hicks
- Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Halsted 668, Baltimore, MD 21287.
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3
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Heider D, Rezvani F, Matschinger H, Dirmaier J, Härter M, Herbarth L, Steinisch P, Böbinger H, Schuhmann F, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, König HH. The effect of telephone health coaching and remote exercise monitoring for peripheral artery disease (TeGeCoach) on health care cost and utilization: results of a randomized controlled trial. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:615-629. [PMID: 37428355 PMCID: PMC11136827 DOI: 10.1007/s10198-023-01616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is the third most prevalent atherosclerotic cardiovascular disease. In 2016, costs per patient associated with PAD exceeded even the health-economic burden of coronary heart disease. Although affecting over 200 million people worldwide, a clear consensus on the most beneficial components to be included in home-based exercise programs for patients with peripheral artery disease is lacking. The aim of the study was to examine the health care use and costs caused by the 12-month patient-centered 'Telephone Health Coaching and Remote Exercise Monitoring for Peripheral Artery Disease' (TeGeCoach) program in a randomized controlled trial. METHODS This is a two-arm, parallel-group, open-label, pragmatic, randomized, controlled clinical trial (TeGeCoach) at three German statutory health insurance funds with follow-up assessments after 12 and 24-months. Study outcomes were medication use (daily defined doses), days in hospital, sick pay days and health care costs, from the health insurers' perspective. Claims data from the participating health insurers were used for analyses. The main analytic approach was an intention-to-treat (ITT) analysis. Other approaches (modified ITT, per protocol, and as treated) were executed additionally as sensitivity analysis. Random-effects regression models were calculated to determine difference-in-difference (DD) estimators for the first- and the second year of follow-up. Additionally, existing differences at baseline between both groups were treated with entropy balancing to check for the stability of the calculated estimators. RESULTS One thousand six hundred eighty-five patients (Intervention group (IG) = 806; Control group (CG) = 879) were finally included in ITT analyses. The analyses showed non-significant effects of the intervention on savings (first year: - 352€; second year: - 215€). Sensitivity analyses confirmed primary results and showed even larger savings. CONCLUSION Based on health insurance claims data, a significant reduction due to the home-based TeGeCoach program could not be found for health care use and costs in patients with PAD. Nevertheless, in all sensitivity analysis a tendency became apparent for a non-significant cost reducing effect. TRIAL REGISTRATION NCT03496948 (www. CLINICALTRIALS gov), initial release on 23 March 2018.
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Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Herbarth
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Patrick Steinisch
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Hannes Böbinger
- TK Techniker Krankenkasse Statutory Health Insurance, Hamburg, Germany
| | | | - Gundula Krack
- mhplus Krankenkasse Statutory Health Insurance, Ludwigsburg, Germany
| | | | | | | | | | - Mark-Dominik Alscher
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Benjamin Finger
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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4
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Rezvani F, Heider D, König HH, Herbarth L, Steinisch P, Schuhmann F, Böbinger H, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, Härter M, Dirmaier J. Telephone Health Coaching and Remote Exercise Monitoring (TeGeCoach) in Peripheral Arterial Occlusive Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:323-330. [PMID: 38269534 DOI: 10.3238/arztebl.m2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Supervised exercise programs are used to treat intermittent claudication (IC). Home-based exercise programs have been developed to lower barriers to participation. We studied the effects of one such exercise program (TeGeCoach) on self-reported walking ability in patients with IC. METHODS In a pragmatic multicenter randomized controlled trial (registration number NCT03496948), 1982 patients with symp - tomatic IC insured by one of three German statutory health insurance funds received either telephone health coaching with remote exercise monitoring (TeGeCoach; n = 994) or routine care (n = 988). The primary outcome was the change in Walking Impairment Questionnaire (WIQ) scores after 12 and 24 months in the intention-to-treat population. The secondary outcomes were healthrelated quality of life, symptoms of depression or anxiety, health competence, patient activation, alcohol use, and nicotine depen - dence. RESULTS There was a significant group difference in WIQ score in favor of TeGeCoach (p < 0.0001), amounting to 6.30 points at 12 months (Bonferroni-corrected 95% CI [4.02; 8.59], Cohen's d = 0.26) and 4.55 points at 24 months ([2.20; 6.91], d = 0.19). Some of the secondary outcomes also showed positive results in favor of TeGeCoach at 12 months with small effect sizes (d ≥ 0.20), including physical health-related quality of life and patient activation. The average daily step count was not higher in the TeGeCoach group. CONCLUSION Significant improvements regarding symptom burden demonstrate the benefit of a home-based exercise program and thus expand the opportunities for guideline-oriented treatment of IC. Future studies should additionally address the effect of home-based exercise programs on clinical variables by means of, for example, the 6-minute walk test.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf; KKH Health Insurance Fund, Hanover; TK Technicians' Health Insurance Fund, Hamburg; mhplus Health Insurance Fund, Ludwigsburg; IEM GmbH, Aachen; Philips GmbH Market DACH, Hamburg; Robert Bosch Society for Medical Research, Bosch Health Campus GmbH, Stuttgart
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5
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Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise therapy for chronic symptomatic peripheral artery disease. Eur Heart J 2024; 45:1303-1321. [PMID: 38461405 DOI: 10.1093/eurheartj/ehad734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2024] Open
Abstract
All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research.
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Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Ch. de Mont-Paisible 18, Lausanne 1011, Switzerland
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, France
- EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery-Angiology-Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Center of Cardiology, Department of Cardiology III-Angiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Ch. de Mont-Paisible 18, Lausanne 1011, Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University, Bratislava, Slovakia
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
- INSERM CIC 1414, Université de Rennes, Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
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6
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Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise therapy for chronic symptomatic peripheral artery disease. VASA 2024; 53:87-108. [PMID: 38461401 DOI: 10.1024/0301-1526/a001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.
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Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Centre, Helsinki University Hospital, Finland
- University of Helsinki, Finland
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, France
- EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Centre of Cardiology, Department of Cardiology III-Angiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University, Bratislava, Slovakia
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, France
- INSERM CIC 1414, Université de Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
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7
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Mazzolai L, Belch J, Venermo M, Aboyans V, Brodmann M, Bura-Rivière A, Debus S, Espinola-Klein C, Harwood AE, Hawley JA, Lanzi S, Madarič J, Mahé G, Malatesta D, Schlager O, Schmidt-Trucksäss A, Seenan C, Sillesen H, Tew GA, Visonà A. Exercise Therapy for Chronic Symptomatic Peripheral Artery Disease: A Clinical Consensus Document of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in Collaboration With the European Society of Vascular Medicine and the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 2024; 67:S1078-5884(24)00011-X. [PMID: 38467522 DOI: 10.1016/j.ejvs.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.
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Affiliation(s)
- Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland.
| | - Jill Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Centre, Helsinki University Hospital, Helsinki; Department of Vascular Surgery, University of Helsinki, Helsinki
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital; EpiMaCT, INSERM 1094/IRD270, Limoges University, Limoges, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | | | - Sebastien Debus
- Department of Vascular Medicine, Vascular Surgery - Angiology - Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Espinola-Klein
- Centre of Cardiology, Department of Cardiology III-Angiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Amy E Harwood
- Department for Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - John A Hawley
- Exercise and Nutrition Research Programme, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, Lausanne Switzerland
| | - Juraj Madarič
- Department of Angiology, Comenius University; National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France; INSERM CIC 1414, Université de Rennes, Rennes, France
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Chris Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen
| | - Garry A Tew
- Institute for Health and Care Improvement, York St John University, York, UK
| | - Adriana Visonà
- Angiology Unit, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
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8
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Elfghi M, Dunne D, Jones J, Gibson I, Flaherty G, McEvoy JW, Sultan S, Jordan F, Tawfick W. Mobile health technologies to improve walking distance in people with intermittent claudication. Cochrane Database Syst Rev 2024; 2:CD014717. [PMID: 38353263 PMCID: PMC10865447 DOI: 10.1002/14651858.cd014717.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is the obstruction or narrowing of the large arteries of the lower limbs, which can result in impaired oxygen supply to the muscle and other tissues during exercise, or even at rest in more severe cases. PAD is classified into five categories (Fontaine classification). It may be asymptomatic or various levels of claudication pain may be present; at a later stage, there may be ulceration or gangrene of the limb, with amputation occasionally being required. About 20% of people with PAD suffer from intermittent claudication (IC), which is muscular discomfort in the lower extremities induced by exertion and relieved by rest within 10 minutes; IC causes restriction of movement in daily life. Treatment for people with IC involves addressing lifestyle risk factors. Exercise is an important part of treatment, but supervised exercise programmes for individuals with IC have low engagement levels and high attrition rates. The use of mobile technologies has been suggested as a new way to engage people with IC in walking exercise interventions. The novelty of the intervention, low cost for the user, automation, and ease of access are some of the advantages mobile health (mhealth) technologies provide that give them the potential to be effective in boosting physical activity in adults. OBJECTIVES To assess the benefits and harms of mobile health (mhealth) technologies to improve walking distance in people with intermittent claudication. SEARCH METHODS The Cochrane Vascular Information Specialist conducted systematic searches of the Cochrane Vascular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL, and also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The most recent searches were carried out on 19 December 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people aged 18 years or over with symptomatic PAD and a clinical diagnosis of IC. We included RCTs comparing mhealth interventions to improve walking distance versus usual care (no intervention or non-exercise advice), exercise advice, or supervised exercise programmes. We excluded people with chronic limb-threatening ischaemia (Fontaine III and IV). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were change in absolute walking distance from baseline, change in claudication distance from baseline, amputation-free survival, revascularisation-free survival. Our secondary outcomes were major adverse cardiovascular events, major adverse limb events, above-ankle amputation, quality of life, and adverse events. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included four RCTs involving a total of 614 participants with a clinical diagnosis of IC. The duration of intervention of the four included RCTs ranged from 3 to 12 months. Participants were randomised to either mhealth or control (usual care or supervised exercise programme). All four studies had an unclear or high risk of bias in one or several domains. The most prevalent risk of bias was in the area of performance bias, which was rated high risk as it is not possible to blind participants and personnel in this type of trial. Based on GRADE criteria, we downgraded the certainty of the evidence to low, due to concerns about risk of bias, imprecision, and clinical inconsistency. Comparing mhealth with usual care, there was no clear evidence of an effect on absolute walking distance (mean difference 9.99 metres, 95% confidence interval (CI) -27.96 to 47.93; 2 studies, 503 participants; low-certainty evidence). None of the included studies reported on change in claudication walking distance, amputation-free survival, or revascularisation-free survival. Only one study reported on major adverse cardiovascular events (MACE) and found no clear difference between groups (risk ratio 1.37, 95% CI 0.07 to 28.17; 1 study, 305 participants; low-certainty evidence). None of the included studies reported on major adverse limb events (MALE) or above-ankle amputations. AUTHORS' CONCLUSIONS Mobile health technologies can be used to provide lifestyle interventions for people with chronic conditions, such as IC. We identified a limited number of studies that met our inclusion criteria. We found no clear difference between mhealth and usual care in improving absolute walking distance in people with IC; however, we judged the evidence to be low certainty. Larger, well-designed RCTs are needed to provide adequate statistical power to reliably evaluate the effects of mhealth technologies on walking distance in people with IC.
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Affiliation(s)
- Marah Elfghi
- School of Medicine, University of Galway, Galway, Ireland
| | - Denise Dunne
- National Institute for Prevention and Cardiovascular Health, Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
- Croí Heart and Stroke Centre, Newcastle, Galway, Ireland
| | - Jennifer Jones
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | - Irene Gibson
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | | | | | - Sherif Sultan
- Vascular Surgery, Galway University Hospital, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway, Ireland
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Manfredini F, Traina L, Ficarra V, Gandolfi G, Argentoni A, Straudi S, Gasbarro V, Lamberti N. A "test in-train out" program versus a "go home and walk" intervention for home-based exercise therapy in patients with peripheral artery disease: A randomized controlled trial. Scand J Med Sci Sports 2024; 34:e14584. [PMID: 38349067 DOI: 10.1111/sms.14584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE In this single-blinded randomized controlled trial, we compared the "Test in-Train Out" structured home-based exercise program (TiTo-SHB) with the traditional "go home and walk" exercise intervention in people with peripheral artery disease (PAD). METHODS Peripheral artery disease patients at Leriche-Fontaine's stage II were randomized to receive TiTo-SHB or walking advice (C-WA). The TiTo-SHB group performed two daily 8-min sessions of pain-free interval walking at progressive low-to-moderate speed maintained with a metronome. The C-WA group was recommended to walk for 30 min at least three times per week and to endure claudication pain. Outcomes collected at baseline and at the end of the program (6 months) included: 6-min and pain-free walking distance (6MWD, PFWD), ankle-brachial index (ABI), 5-time sit-to-stand test (5STS), and health-related quality of life (HRQoL) by the VascuQoL-6 questionnaire. RESULTS A total of 68 patients were randomized (males n = 50; aged 73 ± 9; TiTo-SHB n = 34). At the end of the program, patients in the TiTo-SHB group compared with the C-WA group had significantly improved 6MWD (Δ + 60 ± 32 m vs. Δ - 5 ± 37 m; p < 0.001) and PFWD (Δ + 140 ± 92 m vs. Δ - 7 ± 87 m; p < 0.001). A significant between-group difference in favor of the TiTo-SHB group was also recorded for all the secondary outcomes, including 5STS (Δ - 2.6 ± 1.8 s vs. Δ + 0.8 ± 2.6 s; p < 0.001), ABI of the more impaired limb (Δ + 0.10 ± 0.11 vs. Δ + 0.02 ± 0.08; p = 0.003), and VascuQoL-6 score (Δ +2 ± 2 vs. -1 ± 4; p < 0.001). CONCLUSION In PAD patients with claudication, the pain-free in-home TiTo-SHB program was more effective in improving exercise capacity and HRQoL than the traditional walking advice recommendation.
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Program of Vascular Rehabilitation and Exercise Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Valentina Ficarra
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Giorgio Gandolfi
- School of Sports and Exercise Medicine, University of Ferrara, Ferrara, Italy
| | - Antonio Argentoni
- School of Sports and Exercise Medicine, University of Ferrara, Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Program of Vascular Rehabilitation and Exercise Medicine, University Hospital of Ferrara, Ferrara, Italy
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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11
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Geroulakos G, Paraskevas KI. The 2024 ESVS Guidelines on Lower Limb Peripheral Arterial Disease: A Step Forward. Eur J Vasc Endovasc Surg 2024; 67:3-5. [PMID: 37832911 DOI: 10.1016/j.ejvs.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Affiliation(s)
- George Geroulakos
- Department of Vascular Surgery, 'Attikon' University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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12
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Hallak AO, Hallak FZ, Hallak YO, Hallak OO, Hayson AW, Tanami SA, Bennett WL, Lavie CJ. Exercise Therapy in the Management of Peripheral Arterial Disease. Mayo Clin Proc Innov Qual Outcomes 2023; 7:476-489. [PMID: 37823000 PMCID: PMC10562863 DOI: 10.1016/j.mayocpiqo.2023.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
The incidence and prevalence of peripheral artery disease (PAD) are increasing globally and have a marked economic burden in the United States. The American Heart Association/American College of Cardiology guidelines recommend exercise therapy as a Class 1A, but its utilization remains suboptimal. This state-of-the-art review aims to provide a comprehensive review of the most updated information available on PAD, along with its risk factors, management options, outcomes, economic burden, and the role of exercise therapy in managing PAD.
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Affiliation(s)
- Ahmad O. Hallak
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA
| | | | - Yusuf O. Hallak
- School of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | | | - Aaron W. Hayson
- Department of Vascular Surgery, Ochsner Medical Center, New Orleans, LA
| | - Sadia A. Tanami
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo
| | | | - Carl J. Lavie
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA
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13
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Ulfsdottir H, Bäck M, Cider Å, Jivegård L, Sandberg A, Nordanstig J, Svensson M. Cost-Effectiveness of Exercise Therapy in Patients with Intermittent Claudication-A Comparison of Supervised Exercise, Home-Based Structured Exercise, and Walk Advice from the SUNFIT Trial. J Clin Med 2023; 12:5277. [PMID: 37629318 PMCID: PMC10455939 DOI: 10.3390/jcm12165277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Hospital-based supervised exercise (SEP) is a guideline-recommended intervention for patients with intermittent claudication (IC). However, due to the limited availability of SEP, home-based structured exercise programs (HSEP) have become increasingly popular alongside the "go home and walk" advice. We evaluated the cost-effectiveness of walk advice (WA) with Nordic pole walking vs. SEP combined with WA or HSEP combined with WA. We used data from the SUNFIT RCT (NCT02341716) to measure quality-adjusted life-years (QALYs) over a 12-month follow-up, and economic costs were obtained from a hospital cost-per-patient accounting system. Incremental cost-effectiveness ratios (ICERs) were calculated, and uncertainty was assessed using nonparametric bootstrapping. The average health-care-cost per patient was similar in the WA (EUR 1781, n = 51) and HSEP (EUR 1820, n = 48) groups but higher in the SEP group (EUR 4619, n = 50, p-value < 0.01). Mean QALYs per patient during the follow-up were similar with no statistically significant differences. The findings do not support SEP as a cost-effective treatment for IC, as it incurred significantly higher costs without providing additional health improvements over WA with or without HSEP during the one-year observation period. The analysis also suggested that HSEP may be cost-effective compared to WA, but only with a 64% probability.
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Affiliation(s)
- Hildigunnur Ulfsdottir
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Sidekick Health, 413 90 Gothenburg, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; (M.B.); (Å.C.); (A.S.)
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Åsa Cider
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; (M.B.); (Å.C.); (A.S.)
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Lennart Jivegård
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Health Technology Assessment Centre Region Västra Götaland, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Anna Sandberg
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden; (M.B.); (Å.C.); (A.S.)
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Joakim Nordanstig
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Department of Vascular Surgery, Sahlgrenska University Hospital, 416 85 Gothenburg, Sweden
| | - Mikael Svensson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA
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Souza J, Escadas S, Baxevani I, Rodrigues D, Freitas A. Smart Wearable Systems for the Remote Monitoring of Selected Vascular Disorders of the Lower Extremity: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15231. [PMID: 36429951 PMCID: PMC9690814 DOI: 10.3390/ijerph192215231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/03/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
This systematic review aims at providing an overview of the state of the art regarding smart wearable systems (SWS) applications to monitor the status of patients suffering from vascular disorders of the lower extremity. Peer-reviewed literature has been analyzed to identify employed data collection methods, system characteristics, and functionalities, and research challenges and limitations to be addressed. The Medline (PubMed) and SCOPUS databases were considered to search for publications describing SWS for remote or continuous monitoring of patients suffering from intermittent claudication, venous ulcers, and diabetic foot ulcers. Publications were first screened based on whether they describe an SWS applicable to the three selected vascular disorders of the lower extremity, including data processing and output to users. Information extracted from publications included targeted disease, clinical parameters to be measured and wearable devices used; system outputs to the user; system characteristics, including capabilities of remote or continuous monitoring or functionalities resulting from advanced data analyses, such as coaching, recommendations, or alerts; challenges and limitations reported; and research outputs. A total of 128 publications were considered in the full-text analysis, and 54 were finally included after eligibility criteria assessment by four independent reviewers. Our results were structured and discussed according to three main topics consisting of data collection, system functionalities, and limitations and challenges.
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Affiliation(s)
- Julio Souza
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal
| | - Sara Escadas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal
| | - Isidora Baxevani
- Department of Materials Science and Technology, University of Crete, 700 13 Iraklio, Greece
| | - Daniel Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, 4200-450 Porto, Portugal
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15
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Veiga C, Pedras S, Oliveira R, Paredes H, Silva I. A Systematic Review on Smartphone Use for Activity Monitoring During Exercise Therapy in Intermittent Claudication. J Vasc Surg 2022; 76:1734-1741. [PMID: 35709859 DOI: 10.1016/j.jvs.2022.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Supervised exercise therapy (SET) is recommended as first line in the management of intermittent claudication (IC). Its use is often limited by accessibility, compliance and cost. Home-based exercise therapy (HBET) programs emerged as an alternative solution, but have shown inferior results. Employment of structured monitoring with the use of external wearable activity monitors (WAM) has been shown to improve outcomes. Mobile applications can make use of built-in accelerometers of modern smartphones and become an alternative solution for monitoring patients during HBET, potentially providing wider accessibility. This review aims to assess current use of smartphone technology (i.e., mobile apps) for monitoring or tracking patients' activity in exercise therapy for peripheral arterial disease (PAD). METHODS The PubMed database was searched from January 2011 to September 2021. Eligible articles had to include a population of patients with PAD, conduct a mobile-health (m-health) exercise intervention and use smartphone technology for monitoring or tracking patients' activity. Randomized control trials (RCTs), prospective studies, and study protocols were included. RESULTS A total of seven articles met the selection criteria. These described six different studies and five different mobile applications. Three were fitness apps (FitBit, Nike+ FuelBand and Garmin Connect) that synchronized with commercially available WAMs to provide users with feedback. Two were PAD-specific apps (TrackPAD and Movn) developed specifically to assess patients' activity during exercise therapy. PAD-specific apps also incorporated coaching and educational elements such as weekly goal setting, claudication reminders, messaging, gamification, training advice and PAD education. CONCLUSION Current HBET programs use smartphone applications mainly via commercially available fitness apps that synchronize with WAM devices to register and access data. PAD-specific apps are scarce but show promising features that can be used to monitor, train, coach, and educate patients during HBET programs. Larger studies combining these elements into HBET programs should provide future direction.
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Affiliation(s)
- Carlos Veiga
- Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS UP), Porto, Portugal.
| | - Susana Pedras
- Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal
| | - Rafaela Oliveira
- Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal
| | - Hugo Paredes
- Instituto de Engenharia de Sistemas e Computadores, Tecnologia e Ciência (INESC TEC), Porto, Portugal; Universidade de Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Ivone Silva
- Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS UP), Porto, Portugal
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16
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Zhang S, Zheng H, Liu X, Meng X. Eight years follow-up of a patient with triple vessel disease patient complicated with heart failure without invasive intervention for home-based exercise rehabilitation combined traditional Chinese medicine: A case report. Clin Case Rep 2022; 10:e5974. [PMID: 35782211 PMCID: PMC9234058 DOI: 10.1002/ccr3.5974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/10/2022] [Accepted: 06/03/2022] [Indexed: 11/06/2022] Open
Abstract
We report 8-year follow-up of a home-based exercise rehabilitation program combined traditional Chinese medicine for a patient with triple vessel disease patient complicated with heart failure without invasive intervention. Improvements were observed in all outcomes.
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Affiliation(s)
- Sisi Zhang
- Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of science and technologyWuhanChina
| | - Huiyang Zheng
- Affiliated Hospital of Changchun University of traditional Chinese MedicineChangchunChina
| | - Xinyu Liu
- Hong Kong Baptist UniversityHong KongChina
| | - Xiaoping Meng
- Affiliated Hospital of Changchun University of traditional Chinese MedicineChangchunChina
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WalkingPad protocol: a randomized clinical trial of behavioral and motivational intervention added to smartphone-enabled supervised home-based exercise in patients with peripheral arterial disease and intermittent claudication. Trials 2022; 23:326. [PMID: 35436974 PMCID: PMC9014283 DOI: 10.1186/s13063-022-06279-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background Physical exercise is a first-line treatment for peripheral arterial disease (PAD) and intermittent claudication (IC) reducing pain and increasing the distances walked. Home-based exercise therapy (HBET) has the advantage of reaching a higher number of patients and increasing adherence to physical exercise as it is performed in the patient’s residential area and does not have the time, cost, and access restrictions of supervised exercise therapy (SET) implemented in a clinical setting. Even so, rates of adherence to physical exercise are relatively low, and therefore, m-health tools are promising in increasing motivation to behavior change and adherence to physical exercise. A built-in virtual assistant is a patient-focused tool available in a mobile interface, providing a variety of functions including health education, motivation, and implementation of behavior change techniques. Methods This is a single-center, prospective, three-arm, single-blind, randomized, controlled, superior clinical trial with stratified and blocked random allocation. Three hundred participants with PAD and IC will be recruited from an Angiology and Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUPorto), Porto, Portugal. All patients will receive the same medical care recommended by current guidelines. Participants in all three groups will receive a personalized prescription for an HBET program and a behavioral change and motivational intervention. Participants in experimental groups 1 and 2 will receive a smartphone with the WalkingPad app to monitor exercise sessions. Experimental group 2 WalkingPad app will have a built-in virtual assistant that will promote behavioral change and provide motivational support. Participants allocated to the active control group will not receive the m-health tool, but a practice diary to encourage monitoring. The program will last for 6 months with three evaluation moments (baseline, 3, and 6 months). The primary outcome will be the change in distances walked (maximal and pain-free) from baseline to 3 and 6 months. Secondary outcomes will be changes in quality of life, patients’ perception of resistance, and walking speed. Discussion This study will allow measuring the effectiveness of an m-health tool in increasing motivation for behavior change and adherence to an HBET program in patients with PAD. The superiority of experimental group 2 in the primary and secondary outcomes will indicate that the virtual assistant is effective for motivating behavioral change and encouraging the practice and adherence to physical exercise. The use of m-health tools and virtual health assistants can potentially fill a gap in the access and quality of health services and information, reducing the burden on the health system and promoting self-management and self-care in chronic illness. Trial registration ClinicalTrials.govNCT04749732. Registered on 10 February 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06279-9.
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Süss JD, Gawenda M. Primärtherapie der Claudicatio intermittens – Anspruch und Wirklichkeit. Zentralbl Chir 2022; 147:453-459. [DOI: 10.1055/a-1798-0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie narrative Übersichtsarbeit fasst die Studienlage zum Thema Gehtraining bei Patienten mit Claudicatio intermittens (CI) zusammen. Eindringlich wird auf die evidenzbasierten
Leitlinienempfehlungen und die dahinterstehenden Studien eingegangen. Aspekte zum angiomorphologischen Befund, zu Patientenadhärenz, Langzeitwirkung, Studienqualität und ihre
Vergleichbarkeit werden diskutiert. Der Problematik in der Versorgungsrealität mit Abweichungen von den Leitlinien und der oftmals invasiven Erstlinientherapie des PAVK-IIb-Patienten werden
besondere Bedeutung geschenkt. Dabei wird die Rolle des Rehasports und die gesundheitspolititsche Bedeutung von Gehtraining in Deutschland erörtert. Gründe für die fehlende Leitlinientreue
und deren Umsetzung im Gesundheitssystem werden analysiert. Dementsprechend werden Handlungsempfehlungen, in Anlehnung an internationale Erfahrungen (Niederlande, Dänemark), zur Besserung
der Situation in Deutschland formuliert.
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Affiliation(s)
- Jan David Süss
- Gefäßchirurgie, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Michael Gawenda
- Gefäßchirurgie, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
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Bearne LM, Volkmer B, Peacock J, Sekhon M, Fisher G, Galea Holmes MN, Douiri A, Amirova A, Farran D, Quirke-McFarlane S, Modarai B, Sackley C, Weinman J, Bieles J. Effect of a Home-Based, Walking Exercise Behavior Change Intervention vs Usual Care on Walking in Adults With Peripheral Artery Disease: The MOSAIC Randomized Clinical Trial. JAMA 2022; 327:1344-1355. [PMID: 35412564 PMCID: PMC9006109 DOI: 10.1001/jama.2022.3391] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/20/2022] [Indexed: 12/13/2022]
Abstract
Importance Home-based walking exercise interventions are recommended for people with peripheral artery disease (PAD), but evidence of their efficacy has been mixed. Objective To investigate the effect of a home-based, walking exercise behavior change intervention delivered by physical therapists in adults with PAD and intermittent claudication compared with usual care. Design, Setting, and Participants Multicenter randomized clinical trial including 190 adults with PAD and intermittent claudication in 6 hospitals in the United Kingdom between January 2018 and March 2020; final follow-up was September 8, 2020. Interventions Participants were randomized to receive a walking exercise behavior change intervention delivered by physical therapists trained to use a motivational approach (n = 95) or usual care (n = 95). Main Outcomes and Measures The primary outcome was 6-minute walking distance at 3-month follow-up (minimal clinically important difference, 8-20 m). There were 8 secondary outcomes, 3 of which were the Walking Estimated Limitation Calculated by History (WELCH) questionnaire (score range, 0 [best performance] to 100), the Brief Illness Perceptions Questionnaire (score range, 0 to 80 [80 indicates negative perception of illness]), and the Theory of Planned Behavior Questionnaire (score range, 3 to 21 [21 indicates best attitude, subjective norms, perceived behavioral control, or intentions]); a minimal clinically important difference was not defined for these instruments. Results Among 190 randomized participants (mean age 68 years, 30% women, 79% White race, mean baseline 6-minute walking distance, 361.0 m), 148 (78%) completed 3-month follow-up. The 6-minute walking distance changed from 352.9 m at baseline to 380.6 m at 3 months in the intervention group and from 369.8 m to 372.1 m in the usual care group (adjusted mean between-group difference, 16.7 m [95% CI, 4.2 m to 29.2 m]; P = .009). Of the 8 secondary outcomes, 5 were not statistically significant. At 6-month follow-up, baseline WELCH scores changed from 18.0 to 27.8 in the intervention group and from 20.7 to 20.7 in the usual care group (adjusted mean between-group difference, 7.4 [95% CI, 2.5 to 12.3]; P = .003), scores on the Brief Illness Perceptions Questionnaire changed from 45.7 to 38.9 in the intervention group and from 44.0 to 45.8 in the usual care group (adjusted mean between-group difference, -6.6 [95% CI, -9.9 to -3.4]; P < .001), and scores on the attitude component of the Theory of Planned Behavior Questionnaire changed from 14.7 to 15.4 in the intervention group and from 14.6 to 13.9 in the usual care group (adjusted mean between-group difference, 1.4 [95% CI, 0.3 to 2.5]; P = .02). Thirteen serious adverse events occurred in the intervention group, compared with 3 in the usual care group. All were determined to be unrelated or unlikely to be related to the study. Conclusions and Relevance Among adults with PAD and intermittent claudication, a home-based, walking exercise behavior change intervention, compared with usual care, resulted in improved walking distance at 3 months. Further research is needed to determine the durability of these findings. Trial Registrations ISRCTN Identifier: 14501418; ClinicalTrials.gov Identifier: NCT03238222.
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Affiliation(s)
- Lindsay M. Bearne
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, United Kingdom
| | - Brittannia Volkmer
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Janet Peacock
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Mandeep Sekhon
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University and St George’s, University of London, London, United Kingdom
| | - Graham Fisher
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Melissa N. Galea Holmes
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- Department of Applied Health Research, University College London, and National Institute for Health Research (NIHR) Applied Research Collaboration North Thames, London, United Kingdom
| | - Abdel Douiri
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Aliya Amirova
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | - Dina Farran
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | | | - Bijan Modarai
- Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, King’s College London and British Health Foundation Centre of Research Excellence, and NIHR Biomedical Research Centre at King’s Health Partners, London, United Kingdom
| | - Catherine Sackley
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - John Weinman
- Institute of Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Julie Bieles
- Department of Population Health Sciences, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
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20
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Elissa Altin S, Schneider MD, Parise H, Banerjee S, Wu WC, Meadows JL, Pfau S, Keefe H, Armstrong EJ. Implementation of supervised exercise therapy in a veteran population with symptomatic claudication. Vasc Med 2022; 27:136-141. [PMID: 35225695 DOI: 10.1177/1358863x211073622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Real-world implementation of supervised exercise therapy (SET) referral for symptomatic intermittent claudication has been limited by poor provider awareness around reimbursement and low patient adherence owing to factors including limited center availability and long travel distances to sites. Methods: In this study, 76 of 77 consecutive male veteran patients with intermittent claudication managed at a single-center vascular specialty clinic were referred to SET prior to revascularization. Pre- and post-SET submaximal exercise treadmill testing was performed for assessment of exercise capacity in metabolic equivalents (METs). Results: In the 48.7% of subjects who completed 36 sessions of SET ( n = 37), the average improvement in METs was 60.3%, reflecting improvement from baseline average of 3.4 METs to 5.5 METs after SET. Another 14 patients pursued self-guided exercise therapy and 25 patients declined any participation in exercise therapy. Reasons for declining participation in SET included inadequate transportation, cost of copayment, and interference with full-time work schedules. There was a nonsignificant numeric trend toward improved change in ankle–brachial index in the combined SET and self-guided exercise groups compared to those that declined exercise therapy (0.011 ± 0.124 vs –0.040 ± 0.105, p = 0.156). Conclusion: High acceptance of referral to SET is possible, despite the limitations to implementation. Incorporation of novel pre- and post-SET submaximal exercise treadmill testing allows for assessment of change in exercise capacity and aids in risk stratification and management of intermittent claudication symptoms.
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Affiliation(s)
- S Elissa Altin
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- West Haven VA Medical Center, West Haven, CT, USA
| | - Marabel D Schneider
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Helen Parise
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Subhash Banerjee
- Divison of Cardiology, University of Texas Southwestern Medical School, Dallas, TX, USA
- VA North Texas Health Care System, Dallas, TX, USA
| | - Wen-Chih Wu
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI, USA
- VA Providence Healthcare System, Providence, RI, USA
| | - Judith L Meadows
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- West Haven VA Medical Center, West Haven, CT, USA
| | - Steven Pfau
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- West Haven VA Medical Center, West Haven, CT, USA
| | - Heidi Keefe
- West Haven VA Medical Center, West Haven, CT, USA
| | - Ehrin J Armstrong
- Adventist Heart and Vascular Institute at Adventist Health, St Helena, CA, USA
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21
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Ibeggazene S, Pymer S, Birkett ST, Caldow E, Harwood AE. A systematic review of exercise intervention reporting quality and dose in studies of intermittent claudication. Vascular 2022; 31:477-488. [PMID: 35130092 DOI: 10.1177/17085381211070700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Exercise therapy is an important treatment option for people with intermittent claudication (IC). Appropriate reporting of exercise interventions in populations with IC within randomised controlled trials (RCTs) is important to ensure that research can be translated into clinical practice. Therefore, the purpose of our review is to evaluate the reporting of exercise interventions in RCTs of exercise therapy in patients with IC. METHODS A systematic search was performed to identify relevant trials in patients with IC published until May 2020. Studies including only participants with critical limb ischaemia or asymptomatic peripheral artery disease were excluded. Each trial was scored using the recently developed 'Consensus on Exercise Reporting Template' (CERT) which has a maximum obtainable score of 19. RESULTS Of 1489 unique records identified from the search, 73 trials were included, reporting 107 exercise interventions. Overall, the average CERT score was 10/19. The exercise equipment used, the use of supervision and a description of whether the exercise prescription was tailored or generic were the most frequently reported intervention components. The motivational strategies used, intervention adherence and intervention fidelity were the most underreported CERT components. There was no trend indicating that CERT scores were higher in more recent publications. CONCLUSIONS We have identified that important details about exercise interventions are frequently missing from the published literature. These missing data hinder replication of research findings and limit the translation of evidence into clinical practice.
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Affiliation(s)
- Saïd Ibeggazene
- College of Health, Wellbeing and Life Sciences, 7314Sheffield Hallam University, Sheffield, UK
| | - Sean Pymer
- Academic Vascular Surgical Unit, 12195Hull York Medical School, Hull, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, 6723University of Central Lancashire, Preston, UK
| | - Edward Caldow
- School of Health and Society, 7046University of Salford, Salford, UK
| | - Amy E Harwood
- Centre for Sports, Exercise and Life Sciences, 120958Coventry University, Coventry, UK
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22
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Building your Peripheral Artery Disease Tool Kit: Medical Management of PAD in 2022. Can J Cardiol 2022; 38:634-644. [DOI: 10.1016/j.cjca.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 12/24/2022] Open
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23
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Sedgwick CE, Growcott C, Akhtar S, Parker D, Pettersen EM, Hashmi F, Williams AE. Patient and clinician experiences and opinions of the use of a novel home use medical device in the treatment of peripheral vascular disease - a qualitative study. J Foot Ankle Res 2021; 14:61. [PMID: 34861883 PMCID: PMC8642923 DOI: 10.1186/s13047-021-00496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peripheral vascular diseases have a significant impact on functional quality of life. Previous research has demonstrated the complex, limiting and costly economic implications of these conditions such as lower limb ulceration chronicity and ischaemic amputation. These complex, limb and life threatening conditions demand the development of novel interventions with objective research as part of that development. Hence, a novel intermittent negative pressure medical device in the form of a wearable boot (FlowOx™) was developed. As part of the development process, this study aimed to explore patient and clinician opinions of the boot. METHODS A qualitative approach was used to collect patient and clinician experiences in Norway. An advisory group informed the semi-structured questions used in seven patient interviews and one clinician focus group (n = 5). The data were recorded digitally and transcribed verbatim. Patient and clinician data were analysed as distinct groups using a thematic process. RESULTS Data analysis resulted in five themes from the patients which gave insight into; the impact of the disease process; practicalities of using the boot, positive experiences of use; perceived outcomes; reflecting on use. Six themes were created from the clinicians. These gave insight into; ideal outcomes and how to measure them; ways to potentially use the boot; using research in healthcare; positives of the device; observed effects and next steps; potential improvements to the device. CONCLUSION This study provides insight into the experiences and opinions of FlowOx™. Patients and clinicians were positive about the device due to its ease of use. Those patients with peripheral arterial disease experienced significantly more benefit, especially for ischaemic ulceration than those with a chronic venous condition. Clinicians placed value on the patient reported outcomes in the treatment decision-making process. This preliminary study into experiences of FlowOx™ use provides valuable feedback that will inform design modification and ongoing research into implementation points and prospective user groups. FlowOx™ demonstrates potential as a conservative therapy offering users a convenient, home use, self-care management solution for improving symptomatic peripheral arterial disease and quality of life.
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Affiliation(s)
- Charlotte E Sedgwick
- University of Salford, School of Health & Society, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Charlotte Growcott
- University of Salford, School of Health & Society, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Shehnaz Akhtar
- University of Salford, School of Health & Society, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Daniel Parker
- University of Salford, School of Health & Society, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
| | - Erik Mulder Pettersen
- Department of Surgery, Sørlandet Hospital, Kristiansand, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Farina Hashmi
- University of Salford, School of Health & Society, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Anita Ellen Williams
- University of Salford, School of Health & Society, Brian Blatchford Building, Frederick Road Campus, Salford, M6 6PU, UK
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24
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Hoel H, Pettersen EM, Høiseth LØ, Mathiesen I, Seternes A, Seljeflot I, Hisdal J. Effects of intermittent negative pressure treatment on circulating vascular biomarkers in patients with intermittent claudication. Vasc Med 2021; 26:489-496. [PMID: 33985385 PMCID: PMC8493410 DOI: 10.1177/1358863x211007933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of this study was to investigate the effects of lower extremity intermittent negative pressure (INP) treatment for 1 hour twice daily for 12 weeks, on circulating vascular biomarkers in patients with intermittent claudication. Patients were randomized to treatment with -40 mmHg INP (treatment group), or -10 mmHg INP (sham control group). Venous blood samples were collected at baseline and after 12 weeks, and concentrations of vascular adhesion molecule-1 (VCAM-1), intracellular adhesion molecule-1 (ICAM-1), E-selectin, P-selectin, von Willebrand factor (vWF), l-arginine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) were analyzed. A larger proportion of the patients in the treatment group (25/31) had a reduction in vWF levels after 12 weeks, compared to the sham control group (17/30) (p = 0.043). Within the treatment group there was a significant mean (SEM) reduction in the concentration of vWF of -11% (4) (p = 0.019), whereas there was no significant change in the levels of vWF in the sham control group (1% (6); p = 0.85). There were no significant differences in the change of any of the biomarker levels between the groups after 12 weeks of treatment. In conclusion, there were no differences in the change of the circulating levels of the measured biomarkers between the treatment group and the sham control group after 12 weeks of INP treatment. However, the observed changes in vWF might indicate a beneficial effect of INP treatment on endothelial activation and endothelial injury. Clinicaltrials.gov Identifier: NCT03640676.
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Affiliation(s)
- Henrik Hoel
- Institute of Clinical Medicine, Faculty
of Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Oslo
University Hospital, Oslo, Norway
- Otivio AS, Oslo, Norway
| | - Erik Mulder Pettersen
- Department of Surgery, Sørlandet
Hospital, Kristiansand, Norway
- Department of Circulation and Medical
Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science
and Technology, Trondheim, Norway
| | | | | | - Arne Seternes
- Department of Circulation and Medical
Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science
and Technology, Trondheim, Norway
- Department of Surgery, Section for
Vascular Surgery, St Olavs Hospital, Trondheim, Norway
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, Faculty
of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Center for
Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, Faculty
of Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Oslo
University Hospital, Oslo, Norway
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25
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Jacobsen A, Houlind KC, Rai A. Life-style counseling program and supervised exercise improves walking distance and quality of life in patients with intermittent claudication. Physiother Theory Pract 2021; 38:2629-2639. [PMID: 34460344 DOI: 10.1080/09593985.2021.1970866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There are many barriers for patients with intermittent claudication (IC) to complete and maintain the supervised exercise therapy (SET) programs. SET combined with life-style counseling was, therefore, investigated. OBJECTIVE This study aimed to report the experience of a single center where SET and life-style counseling targeting the modification of risk factors to treat IC, improved walking distance and quality of life. METHODS Thirty-five patients out of 62 referred patients with IC completed the full program of 12 weeks SET and 12 weeks self-training combined with counseling focusing in modifying the risk factors. The pain free walking distance (PFWD) and maximum walking distance (MWD) were measured as primary outcomes. Vascular Quality of Life Questionnaire 6 (VascuQoL-6) and 6-min walk test (6-MWT) were measured as secondary outcomes. Analysis of variance and last value carried forward method was used to compare the outcomes. RESULTS Fifteen females and 20 males with mean age of 71.5 years completed the program. PFWD and MWD increased by 116% (P < .001) and 120% (P < .001), respectively, at 24 weeks follow-up. Similarly, there was 14% increase in 6-MWT and VascuQoL-6 overall score increased from 13.1 to 15.9 at 24 week follow-up (P < .001). CONCLUSION SET along with life-style counseling can be considered as a package in the treatment of patients with IC.
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Affiliation(s)
- Asger Jacobsen
- Department of Vascular Surgery, Lillebælt Hospital, Kolding, DK, Denmark.,Rehabilitation Centre, Fredericia Municipality, Fredericia, Dk, Denmark
| | | | - Amrit Rai
- Department of Vascular Surgery, Lillebælt Hospital, Kolding, DK, Denmark
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26
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Elfghi M, Dunne D, Jones J, Gibson I, Flaherty G, McEvoy JW, Sultan S, Jordan F, Tawfick W. Mobile health technologies to improve walking distance in people with intermittent claudication. Hippokratia 2021. [DOI: 10.1002/14651858.cd014717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Marah Elfghi
- College of Medicine; National University of Ireland Galway; Galway Ireland
| | - Denise Dunne
- National Institute for Prevention and Cardiovascular Health; Croí Heart and Stroke Centre; Newcastle, Galway Ireland
- Croí Heart and Stroke Centre; Newcastle, Galway Ireland
| | - Jennifer Jones
- Croí, The West of Ireland Cardiac Foundation; Galway Ireland
| | - Irene Gibson
- Croí, The West of Ireland Cardiac Foundation; Galway Ireland
| | - Gerard Flaherty
- School of Medicine; National University of Ireland; Galway Ireland
| | | | - Sherif Sultan
- Vascular Surgery; Galway University Hospital; Galway Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery; National University of Ireland Galway; Galway Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery; Western Vascular Institute, University College Hospital; Galway Ireland
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27
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Naiem AA, Doonan RJ, Steinmetz OK, MacKenzie KS, Girsowicz E, Bayne JP, Obrand DI, Gill HL. Outcomes of endovascular treatment of patients with intermittent claudication due to femoropopliteal disease. Vascular 2021; 30:882-890. [PMID: 34396865 PMCID: PMC9485338 DOI: 10.1177/17085381211039668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Our objective was to evaluate the outcomes of endovascular treatment in patients with moderate and severe claudication due to femoropopliteal disease, that is, disease of the superficial femoral and popliteal arteries. Methods A retrospective review of all patients with moderate and severe claudication (Rutherford 2 and 3) undergoing endovascular treatment for FP disease between January 2012 and December 2017 at two university-affiliated hospitals was performed. All procedures were performed by vascular surgeons. Primary outcomes were mortality, freedom from reintervention, major adverse limb events defined as major amputations, open surgical revascularization, or progression to chronic limb-threatening ischemia (CLTI) at 30 days, 1 year, 2 years, and last follow-up. Unadjusted odds ratios were calculated to identify variables associated with adverse outcomes, and Kaplan–Meier survival curves were used to determine mortality and freedom from reintervention. Results Eighty-five limbs in 74 patients were identified on review. Mean age was 69.6 ± 9.8 years and 74.3% were males. At a median follow-up of 49.0 ± 25.5 months, all-cause mortality rate was 8.1% (6 patients) with 16.7% being due to cardiovascular causes. Reintervention rates were 1.2%, 16.5%, and 21.2% at 30 days, 1 year, and 2 years, respectively. Major adverse limb events occurred in 3 patients and rates were 0%, 1.2%, and 2.4% at 30 days, 1 year, and 2 years, respectively. Progression to CLTI was 0%, 1.2%, and 1.2% at 30 days, 1 year, and 2 years, respectively. Claudication had improved or resolved in 55.6% (n = 34 patients), stable in 38.9% (n = 21 patients), and worse in 5.6% (n = 3 patients) Age ≥ 70 years (OR = 4.09 (1.14–14.66), p = 0.027), TASCII A lesion (OR = 4.67 (1.14–19.17), p = 0.025), and presence of 3-vessel runoff (OR = 3.70 (1.18–11.59), p = 0.022) predicted symptoms’ improvement. TASCII A lesions were less likely to require reintervention (OR = 0.23 (0.06–0.86), p = 0.020). Reintervention within 1 year (OR = 11.67 (0.98–138.94), p = 0.017), reintervention with a stent (OR = 14.40 (1.19–173.67), p = 0.008) and more than one reintervention (OR = 39.00 (2.89–526.28), p < 0.001) predicted major adverse limb events. Conclusions Careful patient selection is important when planning endovascular treatment in patients with intermittent claudication and FP disease. This could result in symptomatic improvement in more than half of the patients. Adverse outcomes such as major adverse limb events, progression to CLTI, and amputations occur at low rates.
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Affiliation(s)
- Ahmed A Naiem
- Division of Vascular Surgery, 5620McGill University Health Centre, Montreal, QC, Canada
| | - Robert James Doonan
- Division of Vascular Surgery, 5620McGill University Health Centre, Montreal, QC, Canada
| | - Oren K Steinmetz
- Division of Vascular Surgery, 5620McGill University Health Centre, Montreal, QC, Canada
| | - Kent S MacKenzie
- Division of Vascular Surgery, 5620McGill University Health Centre, Montreal, QC, Canada
| | - Elie Girsowicz
- Division of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Jason P Bayne
- Division of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Daniel I Obrand
- Division of Vascular Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Heather L Gill
- Division of Vascular Surgery, 5620McGill University Health Centre, Montreal, QC, Canada
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28
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Fakhry F, Rouwet EV, Spillenaar Bilgen R, van der Laan L, Wever JJ, Teijink JAW, Hoffmann WH, van Petersen A, van Brussel JP, Stultiens GNM, Derom A, den Hoed PT, Ho GH, van Dijk LC, Verhofstad N, Orsini M, Hulst I, van Sambeek MRHM, Rizopoulos D, Moelker A, Hunink MGM. Endovascular Revascularization Plus Supervised Exercise Versus Supervised Exercise Only for Intermittent Claudication: A Cost-Effectiveness Analysis. Circ Cardiovasc Interv 2021; 14:e010703. [PMID: 34253049 DOI: 10.1161/circinterventions.121.010703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Farzin Fakhry
- Department of Epidemiology (F.F., R.S.B., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (F.F., A.M., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ellen V Rouwet
- Department of Public Health (E.V.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Reinier Spillenaar Bilgen
- Department of Epidemiology (F.F., R.S.B., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lijckle van der Laan
- Department of Vascular Surgery, Amphia Hospital, Breda, the Netherlands (L.v.d.L., G.H.H.)
| | - Jan J Wever
- Interventional Radiology, Haga Hospital, The Hague, the Netherlands (J.J.W., L.C.v.D.)
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands (N.V., J.A.W.T., M.R.H.M.v.S.)
| | - Wolter H Hoffmann
- Department of Vascular Surgery, Reinier de Graaf Hospital, Delft, the Netherlands (W.H.H., M.O.)
| | - Andre van Petersen
- Department of Vascular Surgery, Bernhoven Hospital, Uden, the Netherlands (A.v.P.)
| | - Jerome P van Brussel
- Department of Vascular Surgery, Sint Franciscus Hospital, Rotterdam, the Netherlands (J.P.v.B.)
| | | | - Alex Derom
- Department of Vascular Surgery, Zorgsaam Hospital, Terneuzen, the Netherlands (A.D.)
| | - P Ted den Hoed
- Department of Vascular Surgery, Ikazia Hospital, Rotterdam, the Netherlands (P.T.d.H.)
| | - Gwan H Ho
- Department of Vascular Surgery, Amphia Hospital, Breda, the Netherlands (L.v.d.L., G.H.H.)
| | - Lukas C van Dijk
- Interventional Radiology, Haga Hospital, The Hague, the Netherlands (J.J.W., L.C.v.D.)
| | - Nicole Verhofstad
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands (N.V., J.A.W.T., M.R.H.M.v.S.)
| | - Mariella Orsini
- Department of Vascular Surgery, Reinier de Graaf Hospital, Delft, the Netherlands (W.H.H., M.O.)
| | | | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands (N.V., J.A.W.T., M.R.H.M.v.S.)
| | - Dimitris Rizopoulos
- Department of Biostatistics (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Radiology (F.F., A.M., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M G Myriam Hunink
- Department of Epidemiology (F.F., R.S.B., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology (F.F., A.M., M.G.M.H.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (M.G.M.H.)
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Manfredini F, Lamberti N, Traina L, Zenunaj G, Medini C, Piva G, Straudi S, Manfredini R, Gasbarro V. Effectiveness of Home-Based Pain-Free Exercise versus Walking Advice in Patients with Peripheral Artery Disease: A Randomized Controlled Trial. Methods Protoc 2021; 4:29. [PMID: 34068534 PMCID: PMC8163172 DOI: 10.3390/mps4020029] [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] [Received: 04/27/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/24/2022] Open
Abstract
Exercise therapy in the intermediate stages of peripheral artery disease (PAD) represents an effective solution to improve mobility and quality of life (QoL). Home-based programs, although less effective than supervised programs, have been found to be successful when conducted at high intensity by walking near maximal pain. In this randomized trial, we aim to compare a low-intensity, pain-free structured home-based exercise (SHB) program to an active control group that will be advised to walk according to guidelines. Sixty PAD patients aged > 60 years with claudication will be randomized with a 1:1 ratio to SHB or Control. Patients in the training group will be prescribed an interval walking program at controlled speed to be performed at home; the speed will be increased weekly. At baseline and after 6 months, the following outcomes will be collected: pain-free walking distance and 6-min walking distance (primary outcome), ankle-brachial index, QoL by the VascuQoL-6 questionnaire, foot temperature by thermal camera, 5-time sit-to-stand test, and long-term clinical outcomes including revascularization rate and mortality. The home-based pain-free exercise program may represent a sustainable and cost effective option for patients and health services. The trial has been approved by the CE-AVEC Ethics Committee (898/20). Registration details: Clinicaltrials.gov NCT04751890 [Registered: 12 February 2021].
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Affiliation(s)
- Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.L.); (G.P.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.L.); (G.P.)
| | - Luca Traina
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (G.Z.); (C.M.); (V.G.)
| | - Gladiol Zenunaj
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (G.Z.); (C.M.); (V.G.)
| | - Chiara Medini
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (G.Z.); (C.M.); (V.G.)
| | - Giovanni Piva
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (F.M.); (N.L.); (G.P.)
| | - Sofia Straudi
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Roberto Manfredini
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 46, 44121 Ferrara, Italy
| | - Vincenzo Gasbarro
- Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, 44124 Ferrara, Italy; (L.T.); (G.Z.); (C.M.); (V.G.)
- Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 46, 44121 Ferrara, Italy
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Lower Extremity Intermittent Negative Pressure for Intermittent Claudication. Follow-Up after 24 Weeks of Treatment. Ann Vasc Surg 2021; 75:253-258. [PMID: 33823265 DOI: 10.1016/j.avsg.2021.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Treatment with lower extremity intermittent negative pressure (INP) of -40 mm Hg for one hour twice daily for 12 weeks, increases walking capacity in patients with intermittent claudication (IC). However, the effects of INP treatment beyond 12 weeks have not been elucidated. The aim of the present study was to investigate the clinical effects of INP treatment after 24 weeks in patients with IC. METHODS This was a follow-up study after a randomized sham-controlled trial, where patients randomized to the active treatment group were offered to continue treatment for 12 additional weeks (24 weeks in total). Treatment with -40 mm Hg INP was applied in a pressure chamber sealed around the lower leg, and the patients were instructed to treat themselves at home one hour in the morning and one hour in the evening. Pain free walking distance (PWD), maximal walking distance (MWD), resting ankle-brachial index (ABI) and post exercise ABI were measured at baseline, after 12 and 24 weeks. RESULTS Ten out of 32 patients (31%) from the active treatment group in the initial trial were included in this follow-up study. At baseline, PWD was (mean ±SD) 151 ± 91 m and MWD was 362 ±159 m. There was a significant increase in both PWD and MWD after 24 weeks of treatment, compared to baseline (ANOVA; P= 0.006 and P= 0.012, respectively). Post hoc tests revealed that PWD increased significantly from baseline to 12 weeks (mean 81 m; 95% CI [6, 156]; P = 0.032), and that MWD increased significantly from 12 to 24 weeks (mean 145 m; 95% CI [22, 268]; P = 0.018). There were no significant changes in resting ABI or post exercise ABI during the 24-week treatment period (ANOVA; P= 0.157 and P= 0.450, respectively). CONCLUSION Both PWD and MWD improved after treatment with - 40 mm Hg INP for one hour twice daily for 24 weeks, compared to baseline. The main improvement in PWD occurred during the first 12 weeks of treatment, whereas the main improvement in MWD occurred between 12 and 24 weeks of treatment.
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Cornelis N, Buys R, Dewit T, Benoit D, Claes J, Fourneau I, Cornelissen V. Satisfaction and Acceptability of Telemonitored Home-Based Exercise in Patients With Intermittent Claudication: Pragmatic Observational Pilot Study. JMIR Rehabil Assist Technol 2021; 8:e18739. [PMID: 33749616 PMCID: PMC8108570 DOI: 10.2196/18739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/20/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Current guidelines recommend supervised exercise training (SET) as a first-line treatment in patients with intermittent claudication (IC). SET has been shown to be more effective than home-based exercise therapy (HBET). However, the lack of available SET programs hampers broad SET implementation in clinical practice. OBJECTIVE The aim of this study is to assess patient satisfaction and acceptability of a structured HBET program using wearable technology and elastic band resistance exercises. METHODS A total of 20 patients with IC (Rutherford 1-3) with internet access and currently not engaged in structured exercise training were recruited in a pragmatic observational pilot study. Participants were instructed to complete 3 walking sessions and 2 elastic band resistance exercise sessions per week in their home environment during a 4-week period. Patient satisfaction and acceptability were assessed using a 5-point Likert scale questionnaire (1-2=very unsatisfied, 3=neutral, and 4-5=very satisfied) evaluating the materials and intervention content. Secondary outcomes were evaluated at baseline and at completion of the 4-week intervention and included maximal walking distance (MWD) and pain-free walking distance (PFWD), physical fitness, and patient-reported outcomes on quality of life, walking capacity, levels of kinesiophobia, and self-efficacy. Statistically significant changes were tested using paired t tests or Wilcoxon signed-rank tests. RESULTS All patients (15 men, 5 women; mean age 64.6, SD 10.6 years; range 41-81 years) completed the 4-week intervention and were highly satisfied with the program (mean overall score 4.5, SD 0.5). Patients' questionnaire responses documented willingness to recommend the exercise program to other patients (mean 4.5, SD 0.5; median 4.5) and preference for continuing the intervention (mean 4.3, SD 0.5; median 4). Furthermore, participants endorsed the use of the sports watches to track walking sessions (mean 4.25, SD 0.6; median 4), felt safe (mean 4.4, SD 0.6; median 4), and appreciated personal feedback (mean 4.55, SD 0.5; median 5) and flexibility of training (mean 4.1, SD 0.7; median 4). Resistance training was not preferred over walking training (mean 2.65, SD 0.8; median 3). In addition, PFWD (+89 m; P=.001), MWD (+58 m; P=.03), Walking Impairment Questionnaire distance score (+0.18; P=.01), activity-related scores (+0.54; P<.001), and total quality of life (+0.36; P=.009) improved following the intervention. Other patient-related outcomes, physical fitness, and physical activity remained to be statistically unaltered. CONCLUSIONS Patients with IC were satisfied and accepted technology to monitor and guide HBET, with observed short-term effectiveness regarding walking capacity and quality of life. However, elastic band resistance exercises as a part of HBET were not preferred over progressive walking. TRIAL REGISTRATION ClinicalTrials.gov NCT04043546; https://clinicaltrials.gov/ct2/show/NCT04043546.
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Affiliation(s)
- Nils Cornelis
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Tijl Dewit
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Dries Benoit
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Cardiovascular Sciences, Vascular Surgery, KU Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Department of Rehabilitation Sciences, Group Rehabilitation for Internal Disorders, KU Leuven, Leuven, Belgium
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Wearable Activity Monitors in Home Based Exercise Therapy for Patients with Intermittent Claudication: A Systematic Review. Eur J Vasc Endovasc Surg 2021; 61:676-687. [PMID: 33451865 DOI: 10.1016/j.ejvs.2020.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Intermittent claudication (IC) can severely limit functional capacity and quality of life. Supervised exercise therapy is the recommended first line management; however, this is often limited by accessibility, compliance and cost. As such, there has been an increased interest in the use of wearable activity monitors (WAMs) in home based telemonitoring exercise programmes for claudicants. This review aims to evaluate the efficacy of WAM as a feedback and monitoring tool in home based exercise programmes for patients with IC. DATA SOURCES A search strategy was devised. The databases MEDLINE, EMBASE, and Web of Science were searched through to April 2020. REVIEW METHODS Randomised trials and prospective trials were included. Eligible trials had to incorporate WAMs as a feedback tool to target walking/exercise behaviour. The primary outcome was the change in walking ability. Study quality was assessed with risk of bias tool. RESULTS A total of 1148 records were retrieved. Of these, eight randomised controlled trials and one prospective cohort study, all of which compared a WAM intervention against standard care and/or supervised exercise, met the inclusion criteria. Owing to heterogeneity between studies, no meta-analysis was conducted. WAM interventions improved measures of walking ability (heterogeneous outcomes such as maximum walking distance, claudication distance and six minute walk distance), increased daily walking activity (steps/day), cardiovascular metrics (maximum oxygen consumption), and quality of life. CONCLUSION There is some evidence that home based WAM interventions are beneficial for improving walking ability and quality of life in patients with IC. However, existing studies are limited by inadequate sample size, duration, and appropriate power. Achieving consensus on outcome reporting and study methods, as well as maximising device adherence, is needed.
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Harwood AE, Pymer S, Ingle L, Doherty P, Chetter IC, Parmenter B, Askew CD, Tew GA. Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners. BMJ Open Sport Exerc Med 2020; 6:e000897. [PMID: 33262892 PMCID: PMC7673109 DOI: 10.1136/bmjsem-2020-000897] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 12/19/2022] Open
Abstract
Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or 'self-facilitated' exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.
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Affiliation(s)
- Amy E Harwood
- Centre for Sport and Exercise Life Sciences, Coventry University, Coventry, UK
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Sean Pymer
- Academic Vascular Unit, Hull York Medical School, Hull, UK
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | | | - Ian C Chetter
- Academic Vascular Unit, Hull York Medical School, Hull, UK
| | - Belinda Parmenter
- Department of Exercise Physiology, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Christopher D Askew
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore DC, Australia
- Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Gary A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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A randomized controlled trial of treatment with intermittent negative pressure for intermittent claudication. J Vasc Surg 2020; 73:1750-1758.e1. [PMID: 33899743 DOI: 10.1016/j.jvs.2020.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We investigated the effects of lower extremity intermittent negative pressure (INP) treatment for 1 hour two times daily for 12 weeks on the walking distance of patients with intermittent claudication (IC). METHODS Patients with IC were randomized to treatment with -40 mm Hg INP (treatment group) or -10 mm Hg INP (sham control group). Pain-free walking distance (PWD) and maximal walking distance (MWD) on a treadmill, resting and postexercise ankle-brachial index, resting and postischemic blood flow (plethysmography), and quality of life (EQ-5D-5L and Vascuqol-6) were measured at baseline and after 12 weeks of treatment. RESULTS A total of 72 patients were randomized, and 63 had data available for the intention-to-treat analyses. The between-group comparisons showed a significant change in the PWD, favoring the treatment group over the sham control group (estimated treatment effect, 50 m; 95% confidence interval [CI], 11-89; P = .014). The PWD had increased by 68 m (P < .001) in the treatment group and 18 m (P = .064) in the sham control group. No significant difference was found in the change in the MWD between the two groups (estimated treatment effect, 42 m; 95% CI, -14 to 97; P = .139). The MWD had increased by 62 m (P = .006) in the treatment group and 20 m (P = .265) in the sham control group. For patients with a baseline PWD of <200 m (n = 56), significant changes had occurred in both PWD and MWD between the two groups, favoring the treatment group (estimated treatment effect, 42 m; 95% CI, 2-83; P = .042; and estimated treatment effect, 62 m; 95% CI, 5-118; P = .032; respectively). Both overall and for the group of patients with a PWD <200 m, no significant differences were found in the changes in the resting and postexercise ankle-brachial index, resting and postischemic blood flow, or quality of life parameters between the two groups. CONCLUSIONS Treatment with -40 mm Hg INP increased the PWD compared with sham treatment in patients with IC. For the patients with a baseline PWD of <200 m, an increase was found in both PWD and MWD compared with sham treatment.
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Successful Implementation of the Exercise First Approach for Intermittent Claudication in the Netherlands is Associated with Few Lower Limb Revascularisations. Eur J Vasc Endovasc Surg 2020; 60:881-887. [PMID: 32888779 DOI: 10.1016/j.ejvs.2020.07.074] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE A stepped care model, in which patients are primarily treated with supervised exercise therapy (SET), is recommended as the optimal strategy for intermittent claudication (IC). The aim of this study was to determine the primary treatment (SET, endovascular revascularisation [ER], or open surgery) in relation to secondary lower limb revascularisation and survival in patients with IC. METHODS This study was a nationwide retrospective data analysis of health insurance claims of patients newly diagnosed with IC between January 2013 and December 2017. Exclusion criteria were the presence of diagnostic codes for critical limb ischaemia or for a diabetic foot. Study outcomes were distribution of primary treatment modalities, freedom from secondary lower limb revascularisation, and overall five year survival. Analysis included Kaplan-Meier method and Cox proportional hazards regression models with adjustment for multiple confounders (age, gender, socioeconomic status, use of diabetes medication, statins, platelet aggregation inhibitors or anticoagulants, presence of cardiac disease, chronic obstructive pulmonary disease, and pre-dialysis). RESULTS The five year cohort included 54 504 patients with IC (primary SET n = 39 476, primary ER n = 11 769, and primary open surgery n = 3 259). SET as primary treatment increased from 63% in 2013 to 87% in 2017. Patients who underwent ER or open surgery as a primary treatment had a higher risk of secondary revascularisations (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.37-1.51; p < .001 and HR 1.45; 95% CI 1.34-1.57; p < .001, respectively) and a higher mortality risk compared with SET as a primary treatment (HR 1.38; 95% CI 1.29-1.48; p < .001 and HR 1.49; 95% CI 1.34-1.65; p < .001, respectively). CONCLUSION Guideline adherence improved to 87% in Dutch patients with IC. Patients receiving primary SET had fewer lower limb revascularisations and demonstrated better survival than patients undergoing primary ER or open surgery.
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Rümenapf G, Morbach S, Schmidt A, Sigl M. Intermittent Claudication and Asymptomatic Peripheral Arterial Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:188-193. [PMID: 32327031 DOI: 10.3238/arztebl.2020.0188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/10/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The conservative treatment of peripheral arterial disease (PAD), as recommended in current guidelines, encompasses measures such as lifestyle modification and risk-factor management. In addition, in patients with vasogenic intermittent claudication (IC), it is recommended that patients first be given drugs to improve perfusion and undergo supervised gait training. Revascularization is not recommended for asymptomatic persons, but it is considered mandatory for patients with critical ischemia. In this article on conservative and revascularizing treatment strategies for IC, we address the following questions: whether all treatment options are available, how effective they are, and whether the reality of treatment for IC in Germany corresponds to what is recommended in the guidelines. METHODS In 2014, the German Society for Angiology carried out a comprehensive literature search in order to prepare a new version of the S3 guideline on PAD. This literature search was updated up to 2018, with identical methods, for the present review. RESULTS The benefit of lifestyle modification and risk factor treatment is supported by high-level evidence ( evidence level I, recommendation grade A ). The distance patients are able to walk without pain is increased by drug therapy as well (evidence level IIb), but the therapeutic effect is only moderate. Supervised exercise training (SET), though supported by high-level evidence (I, A), is of limited efficacy, availability, and applicability, and patient compliance with it is also limited. In patients with IC, revascularization leads to complete relief of symptoms more rapidly than gait training, and its long-term benefit is steadily improving owing to advances in medical technology. A combination of arterial revascularization and gait training yields the best results. In a clinical trial, patients with IC who underwent combined therapy increased the distance they could walk without pain by 954 m in six months, compared to 407 m in a group that underwent gait training alone. CONCLUSION In the treatment of vasogenic IC, SET and drugs to increase perfusion are now giving way to revascularization, which is more effective. As far as can be determined, SET is not currently implemented at all in the German health care system. It would be desirable for SET to be more available and more widely used, both to sustain the benefit of revascularization over the long term and to lower the general cardiovascular risk.
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Affiliation(s)
- Gerhard Rümenapf
- Department of Angiology, Center of Vascular Medicine "Oberrhein" Speyer, Diakonissen-Stiftungs-Krankenhaus, Speyer; Department of Diabetology and Angiology, Marienkrankenhaus, Soest; Department of Angiology, University Hospital Leipzig; Department of Angiology, Department of Medicine 1, University Hospital Mannheim
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Rezvani F, Heider D, Härter M, König HH, Bienert F, Brinkmann J, Herbarth L, Kramer E, Steinisch P, Freudenstein F, Terhalle R, Grosse Y, Bock S, Posselt J, Beutel C, Reif F, Kirchhoff F, Neuschwander C, Löffler F, Brunner L, Dickmeis P, Heidenthal T, Schmitz L, Chase DP, Seelenmeyer C, Alscher MD, Tegtbur U, Dirmaier J. Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation. BMJ Open 2020; 10:e032146. [PMID: 32503866 PMCID: PMC7279623 DOI: 10.1136/bmjopen-2019-032146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD. METHODS AND ANALYSIS The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Frank Bienert
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Julia Brinkmann
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Lutz Herbarth
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Edith Kramer
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | - René Terhalle
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Yvonne Grosse
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Susanne Bock
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | - Corinna Beutel
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Franziska Reif
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | | | | | | | | | | | | | - Claudia Seelenmeyer
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Mark Dominik Alscher
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Uwe Tegtbur
- Department of Sports Medicine, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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Harzand A, Vakili AA, Alrohaibani A, Abdelhamid SM, Gordon NF, Thiel J, Benarroch‐Gampel J, Teodorescu VJ, Minton K, Wenger NK, Rajani RR, Shah AJ. Rationale and design of a smartphone-enabled, home-based exercise program in patients with symptomatic peripheral arterial disease: The smart step randomized trial. Clin Cardiol 2020; 43:537-545. [PMID: 32324307 PMCID: PMC7298994 DOI: 10.1002/clc.23362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Supervised exercise therapy (SET) is recommended in patients with symptomatic peripheral arterial disease (PAD) as first-line therapy, although patient adoption remains low. Home-based exercise therapy (HBET) delivered through smartphones may expand access. The feasibility of such programs, especially in low-resource settings, remains unknown. METHODS Smart Step is a pilot randomized trial of smartphone-enabled HBET vs walking advice in patients with symptomatic PAD in an inner-city hospital. Participants receive a smartphone app with daily exercise reminders and educational content. A trained coach performs weekly phone-based coaching sessions. All participants receive a Fitbit Charge HR 2 to measure physical activity. The primary outcome changes in 6-minute walking test (6MWT) distance at 12 weeks over baseline. Secondary outcomes are the degree of engagement with the smartphone app and changes in health behaviors and quality of life scores after 12 weeks and 1 year. RESULTS A total of 15 patients are randomized as of December 15, 2019 with a mean (SD) age of 66.1 (5.8) years. The majority are female (60%) and black (87%). At baseline, the mean (SD) ABI and 6MWT were 0.86 (0.29) and 363.5 m, respectively. Enrollment is expected to continue until December 2020 to achieve a target size of 50 participants. CONCLUSIONS The potential significance of this trial will be to provide preliminary evidence of a home-based, "mobile-first" approach for delivering a structured exercise rehabilitation program. Smartphone-enabled HBET can be potentially more accessible than center-based programs, and if proven effective, may have a potential widespread public health benefit.
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Affiliation(s)
- Arash Harzand
- Division of Cardiology, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Atlanta Veterans Affairs Medical CenterDecaturGeorgia
| | | | - Alaaeddin Alrohaibani
- Division of Cardiology, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Atlanta Veterans Affairs Medical CenterDecaturGeorgia
| | - Smah M. Abdelhamid
- Division of Cardiology, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Atlanta Veterans Affairs Medical CenterDecaturGeorgia
| | - Neil F. Gordon
- INTERVENT InternationalSavannahGeorgiaUSA
- Centre for Exercise Science and Sports Medicine, School of Therapeutic SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - John Thiel
- INTERVENT InternationalSavannahGeorgiaUSA
| | - Jaime Benarroch‐Gampel
- Division of Vascular Surgery, Department of SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- Grady Memorial HospitalAtlantaGeorgiaUSA
| | - Victoria J. Teodorescu
- Division of Vascular Surgery, Department of SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- Grady Memorial HospitalAtlantaGeorgiaUSA
| | | | - Nanette K. Wenger
- Division of Cardiology, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Grady Memorial HospitalAtlantaGeorgiaUSA
| | - Ravi R. Rajani
- Division of Vascular Surgery, Department of SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
- Grady Memorial HospitalAtlantaGeorgiaUSA
| | - Amit J. Shah
- Division of Cardiology, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Atlanta Veterans Affairs Medical CenterDecaturGeorgia
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
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Djerf H, Hellman J, Baubeta Fridh E, Andersson M, Nordanstig J, Falkenberg M. Low Risk of Procedure Related Major Amputation Following Revascularisation for Intermittent Claudication: A Population Based Study. Eur J Vasc Endovasc Surg 2020; 59:817-822. [DOI: 10.1016/j.ejvs.2019.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 10/22/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022]
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Bolt LJJ, Jacobs MLYE, Sigterman TA, Krasznai AG, Sikkink CJJM, Schurink GWH, Bouwman LH. Assessment of behavioral determinants influencing success of supervised exercise therapy in patients with intermittent claudication: A cross sectional survey. Physiol Behav 2020; 215:112732. [PMID: 31682890 DOI: 10.1016/j.physbeh.2019.112732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/18/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Supervised exercise therapy is the first step in treatment of intermittent claudication. However, adherence to supervised exercise therapy is low. Limited access and reimbursement issues are known reasons, though lack of motivation is often leading. Behavioral determinants influencing motivation and thus adherence to supervised exercise therapy remain to be investigated. In this study we sought to determine which behavioral determinants would be of influence on the long-term adherence of supervised exercise therapy. METHODS 200 patients, newly diagnosed with peripheral arterial disease Rutherford classification II-III, were sent a questionnaire to assess motivation and behavior with regard to supervised exercise therapy. The questionnaire was constructed using the I-CHANGE model for explaining motivational and behavioral change. Baseline characteristics were acquired from medical records. Alpha Cronbach's was calculated to test reliability of the questionnaire. RESULTS 108 (54%) patients returned their questionnaire. A total of 79% patients followed supervised exercise therapy. Patients who increased their walking distance after supervised exercise therapy have significantly greater knowledge (p = 0.05), positive attitude (p = 0.03) and lower negative attitude (p = 0.01). Patients with a higher self-efficacy remained significantly more active after participating in supervised exercise therapy (p = 0.05). CONCLUSION Increasing the determinants knowledge, attitude and self-efficacy will improve adherence to supervised exercise therapy and result in delayed claudication onset time.
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Affiliation(s)
- L J J Bolt
- Zuyderland Medical Center Parkstad Heerlen, the Netherlands.
| | - M L Y E Jacobs
- Zuyderland Medical Center Parkstad Heerlen, the Netherlands.
| | | | - A G Krasznai
- Zuyderland Medical Center Parkstad Heerlen, the Netherlands.
| | - C J J M Sikkink
- Zuyderland Medical Center Parkstad Heerlen, the Netherlands.
| | - G W H Schurink
- Maastricht University Medical Center, Maastricht, the Netherlands.
| | - L H Bouwman
- Zuyderland Medical Center Parkstad Heerlen, the Netherlands.
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Rodrigues E, Silva I. Supervised exercise therapy in intermittent claudication: a systematic review of clinical impact and limitations. INT ANGIOL 2020; 39:60-75. [DOI: 10.23736/s0392-9590.19.04159-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Saxon JT, Safley DM, Mena-Hurtado C, Heyligers J, Fitridge R, Shishehbor M, Spertus JA, Gosch K, Patel MR, Smolderen KG. Adherence to Guideline-Recommended Therapy-Including Supervised Exercise Therapy Referral-Across Peripheral Artery Disease Specialty Clinics: Insights From the International PORTRAIT Registry. J Am Heart Assoc 2020; 9:e012541. [PMID: 31973609 PMCID: PMC7033887 DOI: 10.1161/jaha.119.012541] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Underuse of guideline‐recommended therapy in peripheral artery disease (PAD) in administrative and procedural databases has been described, but reports on medically managed patients and referral to supervised exercise therapy (SET) in PAD are lacking. We aimed to document the use of PAD guideline‐recommended therapy, including SET in patients with PAD symptoms consulting a specialty clinic across 3 countries. Methods and Results The 16‐center PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry enrolled 1275 patients with new or an exacerbation of PAD symptoms (2011–2015). We prospectively documented antiplatelet medications, statins, smoking cessation counseling and/or therapy, and referral to SET: “2 quality measures” referred to the use of both statin and antiplatelet medications; “4 quality measures” to receiving all 4 measures. Median odds ratios were calculated to quantify treatment variation across sites. A total of 89% patients were on antiplatelets, 83% on statins, and 23% had been referred to SET. Of 455 current smokers, 342 (72%) patients received smoking cessation therapy/counseling. Overall, 77.2% of patients received “2 quality measures” and 19.7% “4 quality measures.” The median odds ratio for 2 quality measures was 2.13 (95% CI, 1.61–3.56; P<0.001) and for 4 quality measures was 5.43 (95% CI, 2.84–17.91; P<0.001). Variability in adherence was not explained by country, except for referral to SET. The odds for SET referral in The Netherlands (70% referral rate) was nearly 100 times greater than in US sites (2% referral rate). Conclusions Not all patients who have undergone a PAD workup at a specialty care facility are treated with evidence‐based care, especially so for SET.
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City Kansas City MO
| | - David M Safley
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City Kansas City MO
| | | | | | | | | | - John A Spertus
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City Kansas City MO
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Kim G Smolderen
- Saint Luke's Mid America Heart Institute Kansas City MO.,University of Missouri-Kansas City Kansas City MO
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Djerf H, Millinger J, Falkenberg M, Jivegård L, Svensson M, Nordanstig J. Absence of Long-Term Benefit of Revascularization in Patients With Intermittent Claudication: Five-Year Results From the IRONIC Randomized Controlled Trial. Circ Cardiovasc Interv 2020; 13:e008450. [PMID: 31937137 DOI: 10.1161/circinterventions.119.008450] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The long-term benefit of revascularization for intermittent claudication is poorly understood. The aim of this study was to investigate the long-term effectiveness and cost-effectiveness compared with a noninvasive approach. METHODS The IRONIC trial (Invasive Revascularization or Not in Intermittent Claudication) randomized patients with mild-to-severe intermittent claudication to either revascularization + best medical therapy + structured exercise therapy (the revascularization group) or best medical therapy + structured exercise therapy (the nonrevascularization group). The health-related quality of life short form 36 questionnaire was primary outcome and disease-specific health-related quality of life (vascular quality of life questionnaire) and treadmill walking distances were secondary end points. Health-related quality of life has previously been reported superior in the revascularization group at 1- and 2-year follow-up. In this study, the 5-year results were determined. The cost-effectiveness of the treatment options was analyzed from a payer/healthcare standpoint. RESULTS Altogether, 158 patients were randomized in a 1:1 ratio. Regarding the primary end point, no intergroup differences were observed for the short form 36 sum or domain scores from baseline to 5 years, except for the short form 36 role emotional domain score, with greater improvement in the nonrevascularization group (n=116, P=0.007). No intergroup differences were observed in the vascular quality of life questionnaire total and domain scores (n=116, NS) or in treadmill walking distances (n=91, NS). A revascularization strategy resulted in almost twice the cost per patient compared with a noninvasive treatment approach ($13 098 versus $6965, P=0.02). CONCLUSIONS After 5 years of follow-up, a revascularization strategy had lost its early benefit and did not result in any long-term improvement in health-related quality of life or walking capacity compared to a noninvasive treatment strategy. Revascularization was not a cost-effective treatment option from a payer/healthcare point of view. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01219842.
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Affiliation(s)
- Henrik Djerf
- Department of Vascular Surgery (H.D., J.M., J.N.), Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiology, Institute of Clinical Science (H.D., M.F.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Millinger
- Department of Vascular Surgery (H.D., J.M., J.N.), Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine (J.M., L.J., J.N.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mårten Falkenberg
- Department of Radiology, Institute of Clinical Science (H.D., M.F.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Lennart Jivegård
- HTA Centrum (Health Technology Assessment Center) Västra Götaland (L.J.), Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine (J.M., L.J., J.N.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mikael Svensson
- Department of Public Health and Community Medicine (M.S.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Joakim Nordanstig
- Department of Vascular Surgery (H.D., J.M., J.N.), Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine (J.M., L.J., J.N.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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Babber A, Ravikumar R, Onida S, Lane TRA, Davies AH. Effect of footplate neuromuscular electrical stimulation on functional and quality-of-life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial. Br J Surg 2020; 107:355-363. [PMID: 31912491 DOI: 10.1002/bjs.11398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/25/2019] [Accepted: 09/18/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Supervised exercise programmes for intermittent claudication have poor access and limited compliance. Neuromuscular electrical stimulation (NMES) may be an effective alternative. A proof-of-concept study and RCT were conducted. METHODS In study 1, eligible patients underwent baseline assessment; treadmill testing for initial (ICD) and maximum (MCD) claudication distance; EuroQoL Five Dimensions five-level instrument (EQ-5D-5L™) and Intermittent Claudication Questionnaire (ICQ) assessment; and measurement of ultrasound haemodynamics of the superficial femoral artery. After familiarization with the NMES device, participants underwent a 30-min session of stimulation with concomitant recording of haemodynamic measures at 15 min, and after device cessation. Measurements were repeated after 6 weeks of daily use of NMES. In study 2, consecutive patients underwent baseline assessment before online randomization to a supervised exercise programme only, or adjunctive NMES treatment for 6 weeks, followed by repeat measurements. RESULTS Study 1 (20 patients) showed a significant improvement in MCD (46 per cent; P < 0·001) and ICD (71 per cent; P < 0·001). The RCT (42 patients) showed a significant adjunctive benefit of NMES in ICD (46 per cent; P = 0·014). Improvements were seen in the ICQ (9 points; P = 0·009) and EQ-5D-5L™ (P = 0·007) in study 1, and there was a significant adjunctive benefit of NMES on the ICQ score in patients who did supervised exercise (11·2 points; P = 0·031). Blood volume flow and time-adjusted mean velocity increased significantly with the device on (P < 0·050). Overall, NMES compliance exceeded 95 per cent. CONCLUSION Footplate NMES significantly improved walking distance in patients with intermittent claudication when used independently and also as an adjunct to supervised exercise. Registration number: trial 1, NCT02436200; trial 2, NCT02429310 (http://www.clinicaltrials.gov).
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Affiliation(s)
- A Babber
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - R Ravikumar
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - T R A Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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Abaraogu UO, Abaraogu OD, Dall PM, Tew G, Stuart W, Brittenden J, Seenan CA. Exercise therapy in routine management of peripheral arterial disease and intermittent claudication: a scoping review. Ther Adv Cardiovasc Dis 2020; 14:1753944720924270. [PMID: 32459138 PMCID: PMC7273548 DOI: 10.1177/1753944720924270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/15/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Little is known about the extent to which routine care management of peripheral arterial disease (PAD) and intermittent claudication (IC) align with best practice recommendations on exercise therapy. We conducted a scoping review to examine the published literature on the availability and workings of exercise therapy in the routine management of patients with PAD and IC, and the attitude and practice of health professionals and patients. METHODS A systematic search was conducted in February 2018. The Cumulative Index of Nursing and Allied Health Literature, Ovid MEDLINE, Allied and Complementary Medicine Database, ScienceDirect, Web of Science and the Directory of Open Access Repositories were searched. Hand searching of reference lists of identified studies was also performed. Inclusion criteria were based on study aim, and included studies that reported on the perceptions, practices, and workings of routine exercise programs for patients with IC, their availability, access, and perceived barriers. RESULTS Eight studies met the eligibility criteria and were included in the review. Studies conducted within Europe were included. Findings indicated that vascular surgeons in parts of Europe generally recognize supervised exercise therapy as a best practice treatment for IC, but do not often refer their patients for supervised exercise therapy due to the unavailability of, or lack of access to supervised exercise therapy programs. Available supervised exercise therapy programs do not implement best practice recommendations, and in the majority, patients only undergo one session per week. Some challenges were cited as the cause of the suboptimal program implementation. These included issues related to patients' engagement and adherence as well as resource constraints. CONCLUSION There is a dearth of published research on exercise therapy in the routine management of PAD and IC. Available data from a few countries within Europe indicated that supervised exercise is underutilized despite health professionals recognizing the benefits. Research is needed to understand how to improve the availability, access, uptake, and adherence to the best exercise recommendations in the routine management of people with PAD and IC.
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Affiliation(s)
- Ukachukwu O. Abaraogu
- Department of Physiotherapy and Paramedicine,
School of Health and Life Sciences, Glasgow Caledonian University, Room 226
Govan Mbeki Building, Cowcaddens Road, Glasgow, Scotland G4 0BA, UK
| | | | - Philippa M. Dall
- Department of Physiotherapy and Paramedicine,
Glasgow Caledonian University, Glasgow, UK
| | - Garry Tew
- Department of Sport, Exercise and
Rehabilitation, Northumbria University, Newcastle, UK
| | - Wesley Stuart
- Vascular Surgery, Queen Elizabeth University
Hospital, Glasgow, UK
| | - Julie Brittenden
- Institute of Cardiovascular and Medical
Sciences, University of Glasgow, Glasgow, UK
| | - Chris A. Seenan
- Department of Physiotherapy and Paramedicine,
Glasgow Caledonian University, Glasgow, UK
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Wearable Sensor Technology Efficacy in Peripheral Vascular Disease (wSTEP): A Randomized Controlled Trial. Ann Surg 2019; 268:1113-1118. [PMID: 28498233 DOI: 10.1097/sla.0000000000002300] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effect of using wearable activity monitors (WAMs) in patients with intermittent claudication (IC) within a single-center randomized controlled trial. BACKGROUND WAMs allow users to set daily activity targets and monitor their progress. They may offer an alternative treatment to supervised exercise programs (SEPs) for patients with IC. METHODS Thirty-seven patients with IC were recruited and randomized into intervention or control group. The intervention consisted of a feedback-enabled, wrist-worn activity monitor (WAM) in addition to access to SEP. The control group was given access to SEP only. The outcome measures were maximum walking distance (MWD), claudication distance (CD), and quality of life as measured by the VascuQol questionnaire. Participants were assessed upon recruitment, and at 3, 6, and 12 months. RESULTS Patients in the WAM group showed significant improvement in MWD at 3 and 6 months (80-112 m, to 178 m; P < 0.001), which was sustained at 12 months. The WAM group also increased CD (40 vs 110 m; P < 0.001) and VascuQol score (4.7 vs 5.8; P = 0.004). The control group saw a temporary increase in VascuQol score at 6 months (4.5 vs 4.7; P = 0.028), but no other improvements in MWD or CD were observed. Significantly higher improvements in MWD were seen in the WAM group compared with that in the control group at 6 months (82 vs -5 m; P = 0.009, r = 0.47) and 12 months (69 vs 7.5 m; P = 0.011, r = 0.52). CONCLUSIONS The study demonstrates the significant, sustained benefit of WAM-led technologies for patients with IC. This potentially resource-sparing intervention is likely to provide a valuable adjunct or alternative to SEP.
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Bearne L, Galea Holmes M, Bieles J, Eddy S, Fisher G, Modarai B, Patel S, Peacock JL, Sackley C, Volkmer B, Weinman J. Motivating Structured walking Activity in people with Intermittent Claudication (MOSAIC): protocol for a randomised controlled trial of a physiotherapist-led, behavioural change intervention versus usual care in adults with intermittent claudication. BMJ Open 2019; 9:e030002. [PMID: 31446416 PMCID: PMC6720323 DOI: 10.1136/bmjopen-2019-030002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Walking exercise is a recommended but underused treatment for intermittent claudication caused by peripheral arterial disease (PAD). Addressing the factors that influence walking exercise may increase patient uptake of and adherence to recommended walking. The primary aim of this randomised controlled trial (RCT) is to evaluate the efficacy of a physiotherapist-led behavioural change intervention on walking ability in adults with intermittent claudication (MOtivating Structured walking Activity in people with Intermittent Claudication (MOSAIC)) in comparison with usual care. METHODS AND ANALYSIS The MOSAIC trial is a two-arm, parallel-group, single-blind RCT. 192 adults will be recruited from six National Health Service Hospital Trusts. Inclusion criteria are: aged ≥50 years, PAD (Ankle Brachial Pressure Index ≤0.90, radiographic evidence or clinician report) and intermittent claudication (San Diego Claudication Questionnaire), being able and willing to participate and provide informed consent. The primary outcome is walking ability (6 min walking distance) at 3 months. Outcomes will be obtained at baseline, 3 and 6 months by an assessor blind to group allocation. Participants will be individually randomised (n=96/group, stratified by centre) to receive either MOSAIC or usual care by an independent randomisation service. Estimates of treatment effects will use an intention-to-treat framework implemented using multiple regression adjusted for baseline values and centre. ETHICS AND DISSEMINATION This trial has full ethical approval (London-Bloomsbury Research Ethics Committee (17/LO/0568)). It will be disseminated via patient forums, peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN14501418.
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Affiliation(s)
- Lindsay Bearne
- Department of Population Health Sciences, King's College London, London, UK
| | - Melissa Galea Holmes
- Department of Population Health Sciences, King's College London, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - Julie Bieles
- Department of Population Health Sciences, King's College London, London, UK
| | - Saskia Eddy
- Department of Population Health Sciences, King's College London, London, UK
| | - Graham Fisher
- Department of Population Health Sciences, King's College London, London, UK
| | - Bijan Modarai
- Academic Department of Vascular Surgery, King's College London, London, UK
| | - Sanjay Patel
- Department of Vascular Surgery, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Janet L Peacock
- Department of Population Health Sciences, King's College London, London, UK
| | - Catherine Sackley
- Department of Population Health Sciences, King's College London, London, UK
| | - Brittannia Volkmer
- Department of Population Health Sciences, King's College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
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National survey of current practice and opinions on rehabilitation for intermittent claudication in the Danish Public Healthcare System. SCAND CARDIOVASC J 2019; 53:361-372. [PMID: 31394936 DOI: 10.1080/14017431.2019.1654614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective. International guidelines recommend rehabilitation including supervised exercise therapy in patients with Intermittent Claudication (IC), but knowledge of the implementation in clinical practice is limited. This study aims to investigate current practice and opinions on rehabilitation for patients with IC among vascular surgeons and rehabilitation departments in the municipalities and hospitals. Design. Three electronic cross-sectional surveys were distributed nationally to the Danish vascular surgeons (n = 131) and to rehabilitation departments in the municipalities (n = 92) and hospitals (n = 33). Results. The response rates were 70% among the vascular surgeons, 98% among the municipalities and 94% among the hospitals. Vascular surgeons utilize oral advice to exercise by self-administered walking, pharmacological treatment, and revascularization to improve walking distance in patients with IC. Currently, only 12% of the vascular surgeons referred to rehabilitation to improve walking distance, while almost all vascular surgeons (96%) would refer their patients to IC rehabilitation, if it was available. Only 14% of municipalities and none of the hospitals, who treat patients with IC, have a rehabilitation program designed specifically for patients with IC. However, 59% of the rehabilitation departments in the municipalities and 26% in the hospitals included patients with IC in rehabilitation program designed for other patient groups - mostly cardiac patients. There was consensus among the groups of respondents that future IC specific rehabilitation should include an initial conversation, supervised exercise therapy, smoking cessation, and patient education according to guidelines. Conclusion. Vascular surgeons support referral and participation in IC rehabilitation to improve walking distance in patients with IC. Despite some hospitals and municipalities included patients with IC in rehabilitation nearly all services fail to meet current guideline as specific services tailored to patient with IC is almost non-existent in Denmark. Our findings call for action for services to comply with current recommendations of structured, systematic rehabilitation for patients with IC.
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van den Houten MML, Hageman D, Gommans LNM, Kleijnen J, Scheltinga MRM, Teijink JAW. The Effect of Supervised Exercise, Home Based Exercise and Endovascular Revascularisation on Physical Activity in Patients With Intermittent Claudication: A Network Meta-analysis. Eur J Vasc Endovasc Surg 2019; 58:383-392. [PMID: 31235306 DOI: 10.1016/j.ejvs.2018.12.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is unclear whether supervised exercise therapy (SET), home based exercise therapy (HBET), and endovascular revascularisation (ER) for intermittent claudication (IC) have a meaningful impact on physical activity, despite extensive research on their effect on walking performance. METHODS Multiple databases were searched systematically up to May 2018 for randomised controlled trials with objective measurements of physical activity in patients with IC. A Bayesian network meta-analysis was performed comparing the change in physical activity between baseline and follow up between treatments (SET, HBET, ER) and control (usual care). The standardised mean difference (SMD) with 95% credible interval (CI) was calculated as a summary statistic and converted into steps per day to aid interpretation. RESULTS Eight trials involving 656 patients with IC investigating the short-term effect of treatment on daily physical activity were included. Both SET (SMD 0.41, 95% CI 0.10-0.72: this corresponds to a difference of + 803 steps/day on a pedometer) and HBET (SMD 0.50, 95% CI 0.18-0.88: + 980 steps/day) displayed a benefit over control, based on evidence of moderate and low quality, respectively. The benefit of ER compared with control was SMD 0.36 (95% CI -0.22 to 0.99: + 705 steps/day), but only one trial supplied direct evidence, resulting in a low rating of the quality of evidence. Comparisons between treatments yielded no statistically significant differences. The results were robust to several sensitivity analyses. CONCLUSION SET improves daily physical activity levels in patients with IC over control. HBET may have a similar benefit, while invasive treatment failed to lead to a statistically significant improvement of physical activity compared with control. However, the underlying quality of evidence for comparisons with ER and HBET is low, impeding definite conclusions.
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Affiliation(s)
- Marijn M L van den Houten
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands; Primary Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - David Hageman
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands; Primary Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | | | - Jos Kleijnen
- Primary Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Kleijnen Systematic Reviews Ltd, York, UK
| | - Marc R M Scheltinga
- Department of Vascular Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands; Primary Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
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Golledge J, Singh TP, Alahakoon C, Pinchbeck J, Yip L, Moxon JV, Morris DR. Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease. Br J Surg 2019; 106:319-331. [DOI: 10.1002/bjs.11101] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/11/2018] [Accepted: 11/30/2018] [Indexed: 01/13/2023]
Abstract
Abstract
Background
Supervised exercise is recommended for the management of peripheral artery disease (PAD); however, the uptake is limited. Structured home exercise programmes may be more feasible, but their effectiveness is unclear. This systematic review and meta-analysis examined the benefit of structured home exercise programmes for treating PAD in comparison to controls not receiving an exercise programme.
Methods
A literature search was conducted to identify RCTs comparing structured home exercise with controls not receiving an exercise programme among patients with PAD. To be included, studies had to report outcomes from treadmill or corridor walking tests, or objective assessment of physical activity. Inverse variance-weighted meta-analysis was performed to compare changes in maximum walking distance and intermittent claudication onset distance in treadmill tests, walking distance during a 6-min walking test, and physical activity measured using a pedometer or accelerometer. Summarized results are presented in terms of standard deviation differences.
Results
Eleven randomized trials involving 807 patients were included. Follow-up ranged from 2 to 24 months; only one trial included follow-up beyond 12 months. Meta-analyses showed that structured home exercise programmes led to significant improvements in maximum walking distance (mean difference (MD) 0·32, 95 per cent c.i. 0·15 to 0·50; P < 0·001), intermittent claudication onset distance (MD 0·45, 0·27 to 0·62; P < 0·001), walking distance in a 6-min walking test (MD 0·28, 0·09 to 0·47; P = 0·004) and physical activity (MD 0·27, 0·11 to 0·43; P = 0·001).
Conclusion
This meta-analysis suggests that structured home exercise programmes are effective at improving walking performance and physical activity in the short term for patients with PAD.
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Affiliation(s)
- J Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia
| | - T P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - C Alahakoon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J Pinchbeck
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - L Yip
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - D R Morris
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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