Abstract
Banister impulse-response (IR) model estimates the performance in response to the training impulses (TRIMPs). In 100 patients with peripheral artery disease (PAD), we tested by an IR model the predictability of the effects of a 6-month structured home-based exercise program. The daily TRIMPs obtained from prescribed walking speed, relative intensity and time of exercise determined the fitness-fatigue components of performance. The estimated performance values, calculated from the baseline 6-min and pain-free walking distance (6MWD and PFWD, respectively) were compared with values measured at visits through regression models. Interval pain-free walking at controlled speed prescribed during circa-monthly hospital visits (5 ± 1) was safely performed at home with good adherence (92% of scheduled sessions, 144 ± 25 km walked in 50 ± 8 training hours). The mean TRIMP rose throughout the program from 276 to 601 a.u. The measured 6MWD and PFWD values increased (+33 m and +121 m, respectively) showing a good fit with those estimated by the IR model (6MWD: R2 0.81; PFWD: R2 0.68) and very good correspondence (correlation coefficients: 0.91 to 0.95), without sex differences. The decay of performance without training was estimated at 18 ± 3 weeks. In PAD, an IR model predicted the walking performance following a pain-free exercise program. IR models may contribute to design and verify personalized training programs.
Highlights
A more aerobic program based on short pain-free walking periods was proposed into an original test-in train-out (TiTo) program prescribed at the hospital and performed at home at a controlled speed [24,25]
One hundred and twenty-four patients were addressed to the vascular rehabilitation program during the period of enrollment
The study has shown that the changes in walking performance observed during a structured progressive pain-free exercise program correspond to those predicted by a mathematical IR model based on two components, fitness and fatigue, directly related to the training load imposed
Summary
Inspired by the interesting objective to foresee these effects, the research of several authors involved in exercise physiology, as magisterially reviewed by Clarke et al [1], has tried to develop mathematical models to predetermine/calculate the adaptive response to training stressors [1,5,6] This approach, primarily of interest in sports to foster the performance and health of athletes [1,7–11], was considered of interest for rehabilitation [4] or for subjects with chronic diseases, such as patients undergoing cardiac rehabilitation [12–14], to design effective and sustainable programs. Repeated bouts of exercise at pain tolerance, such as those recommended during supervised treadmill training or for home training [15,18,19], may induce muscle damage [20,21] without hemodynamic improvements [22] and with variable effects according to the severity of disease or the characteristics of the patients [15,21,23] Unlike this approach, a more aerobic program based on short pain-free walking periods was proposed into an original test-in train-out (TiTo) program prescribed at the hospital and performed at home at a controlled speed [24,25]. We hypothesize that a proper combination of training variables structured according to the exercise principles aimed at attaining aerobic adaptations should evoke theoretically predictable progressive changes in walking performance in patients with PAD with equal response independently of sex
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