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Rahman H, Leutzinger T, Hassan M, Schieber M, Koutakis P, Fuglestad MA, DeSpiegelaere H, Longo GM, Malcolm P, Johanning JM, Casale GP, Pipinos II, Myers SA. Peripheral artery disease causes consistent gait irregularities regardless of the location of leg claudication pain. Ann Phys Rehabil Med 2024; 67:101793. [PMID: 38118246 PMCID: PMC11009086 DOI: 10.1016/j.rehab.2023.101793] [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: 08/09/2022] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND The most common symptom of peripheral artery disease (PAD) is intermittent claudication that involves the calf, thigh, and/or buttock muscles. How the specific location of this leg pain is related to altered gait, however, is unknown. OBJECTIVES We hypothesized that because the location of claudication symptoms uniquely affects different leg muscle groups in people with PAD, this would produce distinctive walking patterns. METHODS A total of 105 participants with PAD and 35 age-matched older volunteers without PAD (CTRL) were recruited. Participants completed walking impairment questionnaires (WIQ), Gardner-Skinner progressive treadmill tests, the six-minute walk test, and we performed an advanced evaluation of the biomechanics of their overground walking. Participants with PAD were categorized into 4 groups according to their stated pain location(s): calf only (C, n = 43); thigh and calf (TC, n = 18); buttock and calf (BC, n = 15); or buttock, thigh, and calf (BTC, n = 29). Outcomes were compared between CTRL, C, TC, BC and BTC groups using a one-way ANOVA with post-hoc comparisons to identify and assess statistically significant differences. RESULTS There were no significant differences between CTRL, C, TC, BC and BTC groups in distances walked or walking speed when either pain-free or experiencing claudication pain. Each participant with PAD had significantly dysfunctional biomechanical gait parameters, even when pain-free, when compared to CTRL (pain-free) walking data. During pain-free walking, out of the 18 gait parameters evaluated, we only identified significant differences in hip power generation during push-off (in C and TC groups) and in knee power absorption during weight acceptance (in TC and BC groups). There were no between-group differences in gait parameters while people with PAD were walking with claudication pain. CONCLUSIONS Our data demonstrate that PAD affects the ischemic lower extremities in a diffuse manner irrespective of the location of claudication symptoms. DATABASE REGISTRATION ClinicalTrials.gov NCT01970332.
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Affiliation(s)
- Hafizur Rahman
- School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA; Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - Todd Leutzinger
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - Molly Schieber
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Matthew A Fuglestad
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Holly DeSpiegelaere
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - G Matthew Longo
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Johanning
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA.
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Pizzimenti M, Meyer A, Charles AL, Giannini M, Chakfé N, Lejay A, Geny B. Sarcopenia and peripheral arterial disease: a systematic review. J Cachexia Sarcopenia Muscle 2020; 11:866-886. [PMID: 32648665 PMCID: PMC7432591 DOI: 10.1002/jcsm.12587] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with lower extremity peripheral arterial disease (PAD) and sarcopenia are a population at risk requiring specific and targeted care. The aim of this review is to gather all relevant studies associating sarcopenia and PAD and to identify the underlying pathophysiological mechanisms as well as potential therapeutic strategies to improve skeletal muscle function. METHODS A systematic review was carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Data extraction allowed the evaluation of 140 publications; 87 met the inclusion criteria; of which 79 were included in the final review, reporting sufficient data for epidemiological and diagnostic criteria, mechanical analysis, and therapeutic approaches. Epidemiological analysis and diagnostic criteria were based on 18 studies following 2362 PAD patients [31.39% (SD 7.61) women], aged 72.42 (SD 2.84); sarcopenia was present in 34.63% (SD 12.86) of the patients. Mechanical and pathway analysis were based on five animal studies and 29 clinical reports, showing significantly altered muscle strength and function in 1352 PAD patients [26.49% (SD 17.32) women], aged 67.67 (SD 5.14) years; impaired muscle histology in 192 PAD patients (9.2% (SD 11.22) women), aged 64.3 (SD 0.99) years; +58.63% (SD 25.48) of oxidative stress in 69 PAD patients [16.96% (SD 8.10) women], aged 63.17 (SD 1.43) years; mitochondriopathy in 153 PAD patients [29.39% (SD 28.27) women], aged 63.50 (SD 1.83) years; +15.58% (SD 7.41) of inflammation in 900 PAD patients [40.77% (SD 3.71) women], aged 74.88 (SD 2.76) years; and altered signalling pathways in 51 PAD patients [34.45% (SD 32.23) women], aged 72.25 (SD 5.25) years. Therapeutic approaches analysis was based on seven animal studies and 21 clinical reports. In total, 884 patients followed an exercise therapy, and 18 received an angiogenesis treatment; 30.84% (SD 17.74) were women. Mean ages of patients studied were 66.85 (SD 3.96). CONCLUSIONS Sarcopenia and lower extremity PAD have musculoskeletal consequences that directly impair patients' quality of life and prognosis. Although PAD is primarily a vascular disease, all etiological factors of sarcopenia identified so far are present in PAD. Indeed, both sarcopenia and PAD are accompanied by oxidative stress, skeletal muscle mitochondrial impairments, inflammation, inhibition of specific pathways regulating muscle synthesis or protection (i.e. IGF-1, RISK, and SAFE), and activation of molecules associated with muscle degradation. To date, besides revascularization, the best therapeutic strategy includes exercise, but approaches targeting the underlying mechanisms still deserve further studies.
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Affiliation(s)
- Mégane Pizzimenti
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France.,Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France
| | - Alain Meyer
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France.,Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France
| | - Anne-Laure Charles
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France
| | - Margherita Giannini
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France.,Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfé
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Geny
- FMTS, Department of Physiology, EA3072 Mitochondria, Oxidative Stress and Muscular Protection, University of Strasbourg, Strasbourg, France.,Department of Physiology and Functional Explorations, University Hospital of Strasbourg, Strasbourg, France
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Functional Improvement After Outpatient Cardiac Rehabilitation in Acute Coronary Syndrome Patients is Not Related to Improvement in Left Ventricular Ejection Fraction. High Blood Press Cardiovasc Prev 2020; 27:225-230. [PMID: 32219669 DOI: 10.1007/s40292-020-00374-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) improves the functional capacity and the prognosis of patients with coronary artery disease. AIM Our study was aimed at assessing the relationship between functional improvement (evaluated with 6-min Walk Test-6MWT) and the improvement in left ventricular ejection fraction (LVEF) after CR. METHODS We collected data from 249 patients (age 66.79 ± 11.06 years; males 81.52%) with a recent history of Acute Coronary Syndrome that performed CR. The functional improvement after CR was expressed as the Δ between distance covered at the final versus the initial 6-min Walking Test (6-MWT), while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR. RESULTS Patients were divided accordingly to their pre-rehab LVEF (≥ 55% vs < 55%). With superimposable age and baseline 6MWT distance covered (434.58 vs 405.12 m, p = 0.08), the latter group presented higher Δ meter values at 6MWT (167.93 vs 193.97 m, p = 0.018). However, no statistically significant positive correlation between Δ meters and Δ LVEF was found. Moreover, linear regression analyses found that nor baseline LVEF nor Δ LVEF were significant determinants of Δ meters when considering the whole group, with age, basal 6MWT and peak CK-MB as additional covariates in the model. CONCLUSION Although it could be expected that an increase in LVEF is related to the functional improvement after CR, no significant correlation was found in our population.
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Muscular Atrophy in Cardiovascular Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:369-391. [DOI: 10.1007/978-981-13-1435-3_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Harwood AE, King S, Totty J, Smith GE, Vanicek N, Chetter IC. A systematic review of muscle morphology and function in intermittent claudication. J Vasc Surg 2017; 66:1241-1257. [PMID: 28822657 DOI: 10.1016/j.jvs.2017.05.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Intermittent claudication (IC) is frequently associated with deterioration in walking capacity and physical function, and it can often result in an impairment in balance. Whereas supervised exercise is recommended by the National Institute for Health and Care Excellence as the first-line treatment, the mechanism behind walking improvement is poorly understood. The existing literature suggests that there may be some physiologic change to the skeletal muscle contributing to the functional impairment, but these data are conflicting. We therefore sought to undertake a systematic review to clarify the muscle properties of patients with IC. METHODS A systematic review of randomized and nonrandomized trials that investigated the role of muscle function in patients diagnosed with IC was undertaken using MEDLINE, Cochrane Central Register of Controlled Trials, and Embase databases. The searches were limited from 1947 to June 2016 in the English language. RESULTS The search yielded a total of 506 articles, of which 206 were duplicate articles. Of the remaining 300, a total of 201 were excluded from full-text analysis; 99 full-text articles were assessed for eligibility, with 30 articles deemed appropriate for inclusion in the review. There were four main categories of functional outcome measures: muscle strength, muscle size, muscle fiber type, and muscle metabolism. A total of 2837 patients were included in the study. Nine studies reported on muscle strength, incorporating isometric, concentric, eccentric, and endurance measures. Eight studies reported on muscle size, incorporating circumference, computed tomography scans, and ultrasound imaging techniques. Eleven studies reported on muscle fibers, incorporating fiber type proportions, fiber size, and capillarity measures. Seven papers reported on muscle metabolism, incorporating adenosine diphosphate recovery and phosphocreatine recovery measures. CONCLUSIONS Previous literature has found clear evidence that strength (of the calf and thigh musculature) and calf characteristics are related to mortality and functional declines. However, this review has demonstrated the vast array of muscle groups assessed and multiple methods employed to determine strength; therefore, it is unclear exactly what measure of "strength" is impaired. Furthermore, the underlying morphologic causes of potential changes in strength are unclear. This information is essential for designing optimal exercise interventions. The data acquired during this systematic review are heterogeneous, with a substantial lack of high-quality intervention-based studies. Future research should endeavor to establish standardized testing procedures and to implement randomized controlled trials for targeted therapeutic interventions.
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Affiliation(s)
- Amy E Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom.
| | - Stephanie King
- Department of Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, United Kingdom
| | - Joshua Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom
| | - Natalie Vanicek
- Department of Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, United Kingdom
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom
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Gommans LN, Fokkenrood HJ, van Dalen HC, Scheltinga MR, Teijink JA, Peters RJ. Safety of supervised exercise therapy in patients with intermittent claudication. J Vasc Surg 2015; 61:512-518.e2. [DOI: 10.1016/j.jvs.2014.08.070] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/11/2015] [Indexed: 12/21/2022]
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Guirro ECDO, Guirro RRDJ, Dibai-Filho AV, Pascote SCS, Rodrigues-Bigaton D. Immediate effects of electrical stimulation, diathermy, and physical exercise on lower limb arterial blood flow in diabetic women with peripheral arterial disease: a randomized crossover trial. J Manipulative Physiol Ther 2015; 38:195-202. [PMID: 25620607 DOI: 10.1016/j.jmpt.2014.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 07/24/2014] [Accepted: 08/14/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of high-voltage electrical stimulation (HVES), continuous short wave diathermy, and physical exercise on arterial blood flow in the lower limbs of diabetic women with peripheral arterial disease. METHODS A crossover study was carried out involving 15 diabetic women (mean age of 77.87 ± 6.20 years) with a diagnosis of peripheral arterial disease. One session of each therapeutic resource was held, with a 7-day washout period between protocols. Blood flow velocity was evaluated before each session and 0, 20, 40 and 60 minutes after the administration of each protocol. Two-way repeated-measures analysis of variance with Bonferroni post hoc test was used for the intragroup and intergroup comparisons. RESULTS In the intragroup analysis, a significant reduction (P < .05) was found in blood flow velocity in the femoral and popliteal arteries over time with HVES and physical exercise and in the posterior tibial artery with the physical exercise protocol. However, no significant differences were found in the intergroup analysis (P > .05). CONCLUSION Proximal blood circulation in the lower limb of diabetic women with peripheral arterial disease was increased by a single session of HVES and physical exercise, whereas distal circulation was only increased with physical exercise.
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Affiliation(s)
| | - Rinaldo Roberto de Jesus Guirro
- Professor, Postgraduate Program in Rehabilitation and Functional Performance, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Almir Vieira Dibai-Filho
- Doctoral Student, Postgraduate Program in Rehabilitation and Functional Performance, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Delaine Rodrigues-Bigaton
- Professor, Postgraduate Program in Physiotherapy, Methodist University of Piracicaba, Piracicaba, SP, Brazil
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Askew CD, Parmenter B, Leicht AS, Walker PJ, Golledge J. Exercise & Sports Science Australia (ESSA) position statement on exercise prescription for patients with peripheral arterial disease and intermittent claudication. J Sci Med Sport 2014; 17:623-9. [DOI: 10.1016/j.jsams.2013.10.251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 10/15/2013] [Accepted: 10/24/2013] [Indexed: 11/29/2022]
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Pilz M, Kandioler-Honetz E, Wenkstetten-Holub A, Doerrscheidt W, Mueller R, Kurz RW. Evaluation of 6- and 12-month supervised exercise training on strength and endurance parameters in patients with peripheral arterial disease. Wien Klin Wochenschr 2014; 126:383-9. [DOI: 10.1007/s00508-014-0548-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/13/2014] [Indexed: 01/08/2023]
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Guirro ECDO, Guirro RRDJ, Dibai-Filho AV, Montezuma T, Vaz MMDOLL. Decrease in Talocrural Joint Mobility is Related to Alteration of the Arterial Blood Flow Velocity in the Lower Limb in Diabetic Women. J Phys Ther Sci 2014; 26:553-6. [PMID: 24764632 PMCID: PMC3996420 DOI: 10.1589/jpts.26.553] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/04/2013] [Indexed: 12/25/2022] Open
Abstract
[Purpose] The purpose of this study was to correlate the talocrural range of motion
(ROM) and blood flow velocity in the lower limb arteries of diabetic women. [Subjects and
Methods] Thirty women were divided into a control group (G1), consisting of 15 sedentary
right-handed subjects (41.27 ± 7.24 years old) who had no history of blood system
disorder, and a diabetes group (G2), consisting of 15 sedentary right-handed subjects
(57.87 ± 6.20 years old) who had type 2 diabetes mellitus. Talocrural ROM was measured by
using goniometry for dorsiflexion and plantar flexion movements. In addition, blood flow
velocity of the dorsalis pedis, posterior tibial, and popliteal arteries was also
assessed. [Results] No significant differences were found between the groups by comparing
talocrural ROM and arterial blood velocity. However, a significant association was found
in G2 only between the following variables: plantar flexion and blood flow velocity of the
dorsalis pedis artery (rs = 0.57), plantar flexion and blood flow velocity of the
popliteal artery (rs = 0.50), and dorsiflexion and blood flow velocity of the posterior
tibial artery (rs = 0.57). [Conclusion] The decrease in talocrural ROM is related to a
decrease in the arterial blood flow velocity in diabetic women.
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Affiliation(s)
- Elaine Caldeira de Oliveira Guirro
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Almir Vieira Dibai-Filho
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Thais Montezuma
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Maíta Mara de Oliveira Lima Leite Vaz
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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