Changes in Function After a 6-Month Walking Intervention in Patients With Intermittent Claudication Who Are Obese or Nonobese

Supervised exercise training improves cardiorespiratory fitness and reduces perioperative risk in peripheral artery disease patients with intermittent claudication

INTRODUCTION

This study examined to what extent supervised aerobic and resistance exercise combined with continued unsupervised exercise training improves cardiorespiratory fitness and corresponding perioperative risk in peripheral artery disease (PAD) patients with intermittent claudication.

METHODS

A total of 106 patients (77% male) were enrolled into the study, alongside 155 healthy non-PAD control participants. Patients completed supervised exercise therapy (aerobic and resistance exercises of the upper and lower limbs) twice a week for 10 weeks. Thereafter, 52 patients completed 12 weeks of an unsupervised tailored home-based exercise. Pain-free walking distance (PWD), maximum walking distance (MWD), peak oxygen uptake ([Formula: see text]) and perioperative risk were assessed before and after both exercise interventions.

RESULTS

Patients were highly unconditioned relative to healthy controls ([Formula: see text]=11.9 vs 24.2ml/kg/min, p=<0.001) with 91% classified as high perioperative risk (peak oxygen uptake <15ml/kg/min). Supervised exercise increased PWD (+44±81m, p=<0.001), MWD (+44±71m, p=<0.001) and [Formula: see text] (+1.01±1.63ml/kg/min, p=<0.001) and lowered perioperative risk (91% to 85%, p=<0.001). When compared with supervised exercise, the improvements in PWD were maintained following unsupervised exercise (+11±91m vs supervised exercise, p=0.572); however, MWD and [Formula: see text] decreased (-15±48m, p=0.030 and -0.34±1.11ml/kg/min, p=0.030, respectively) and perioperative risk increased (+3%, p=<0.001) although still below baseline (p=<0.001).

CONCLUSIONS

Supervised aerobic and resistance exercise training and, to a lesser extent, unsupervised tailored exercise improves walking capacity and cardiorespiratory fitness and reduces perioperative risk in PAD patients with intermittent claudication.

Impact of obesity on walking capacity and cardiovascular parameters in patients with peripheral artery disease: A cross-sectional study

BACKGROUND

Patients with peripheral artery disease (PAD) present a high prevalence of obesity and metabolic syndrome, as well as diseases related to cardiovascular dysfunction. However, whether obesity influences walking capacity and cardiovascular function in patients with PAD is poorly understood.

OBJECTIVES

The objective of this study was to analyze the impact of obesity on walking capacity and cardiovascular parameters in patients with PAD.

DESIGN

This is a cross-sectional study.

SETTING

Patients were recruited from public hospitals of São Paulo.

METHODS

One-hundred two patients with PAD and symptoms of intermittent claudication were recruited and divided into 2 groups according to their body mass index: normal weight (<25 kg/m²) and overweight/obese (≥25 kg/m²). Patients were submitted to objective (6-minute walk test) and subjective measurements of walking capacity (Walking Impairment Questionnaire). In addition, cardiovascular parameters (office blood pressure, resting heart rate, arterial stiffness, vascular function, and heart rate variability) were obtained.

RESULTS

The speed domain of the Walking Impairment Questionnaire was lower in the overweight/obese group compared to the normal weight group (32 ± 20 vs 21 ± 16, respectively, P < .01). Resting heart rate was higher in overweight/obese patients (61 ± 10 vs 70 ± 12, respectively, P < .01). However, no other walking capacity or cardiovascular parameter variables were related to obesity in patients with PAD.

CONCLUSION

Obesity influences resting heart rate and walking speed in patients with PAD.

Body-weight goals, trends, and weight-loss techniques among patients with peripheral arterial disease

BACKGROUND:

Obesity contributes to negative outcomes in peripheral arterial disease (PAD). Little is known about the body-weight goals and trends among patients with PAD.

AIM:

The aim of this study was to explore self-reported body-weight trends and methods used to achieve weight loss in patients with PAD.

METHODS:

Data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) was utilized to compare individuals with PAD who were overweight and obese ( n = 240), to matched individuals without PAD ( n = 480). Self-reported body weight at age 25 years, 10 years prior and 1 year prior to the current assessment, and age and weight of heaviest body weight were compared. Self-reported weight-loss techniques during the past year were compared between groups.

RESULTS:

Individuals with PAD and controls reported similar weights 10 years prior (79.2 kg vs 78.5 kg; p = 0.60) and weight gain over the last 10 years of 5.7 kg. There was no significant difference in reported body weight at age 25 years, 10 years prior, 1 year prior, or heaviest weight. Compared with the control group, fewer participants with PAD reported attempted weight loss in the last year (27.50% vs 36.04%; p = 0.02) and were half as likely to report utilizing exercise as a weight-loss method (12.5% vs 21.7%; p = 0.003).

CONCLUSIONS:

These data indicate that those with PAD are less inclined to attempt weight loss, especially through means of increased physical activity. Future research is needed regarding the effectiveness of intentional weight-loss programs in this population.

Functional electrical stimulation improves quality of life by reducing intermittent claudication

OBJECTIVE

To determine if Functional Electrical Stimulation (FES) would improve ischemic pain, walking distance, and quality of life of patients with intermittent claudication.

DESIGN

Single blind, randomized block, two factorial design.

PATIENTS

Patients diagnosed with Peripheral Artery Disease (PAD) and intermittent claudication (IC). Ankle Brachial Index ranged 0.4-0.9 on at least one leg. Patients were randomly assigned to experimental (FES+Walk, N=13) or control (WALK, N=14) groups.

INTERVENTION

Experimental group patients received FES to the dorsiflexor and plantarflexor muscles while walking for 1h/day, six days/week for eight weeks. Control group patients received similar intervention without FES. A Follow-up period of both groups lasted eight weeks.

OUTCOME MEASURES

Outcome measures were taken at baseline (T₀), after intervention (T₁), and after follow-up (T₂). Primary measures included Perceived Pain Intensity (PPI), Six minute walk (6MW), and Peripheral Arterial Disease Quality of Life (PADQOL). Secondary measures included Intermittent Claudication Questionnaire (ICQ) and Timed Up and Go (TUG).

RESULTS

Group by time interactions in PPI were significant (P<0.001) with differences of 27.9 points at T₁ and 36.9 points at T₂ favoring the FES+Walk group. Groups difference in Symptoms and Limitations in Physical Function of the PADQOL reached significance (T₁=8.9, and T₂=8.3 improvements; P=0.007). ICQ was significant (T₁=9.3 and T₂=13.1 improvements; P=0.003). Improvement in 6MW and TUG tests were similar between groups.

CONCLUSIONS AND RELEVANCE

Walking with FES markedly reduced ischemic pain and enhanced QOL compared to just walking. FES while walking may offer an effective treatment option for the elderly with PAD and Intermittent Claudication.

TRIAL REGISTRATION

NIH-NIA 1R21AG048001 https://projectreporter.nih.gov/project_info_description.cfm?aid=8748641&icde=30695377&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC. https://clinicaltrials.gov/ct2/show/NCT02384980?term=David+Embrey&rank=1.