Improvement in 6-Minute Walking Distance after Supervised Exercise Training Is Related to Changes in Quality of Life in Patients with Lower Extremity Peripheral Artery Disease.

Lucia Mazzolai,Stefano Lanzi,Luca Calanca,André Berchtold

doi:10.3390/jcm10153330

Abstract

This study aimed to investigate the relationship between supervised exercise training (SET)-induced changes in treadmill performance and 6 min walking distance, and changes in general (physical and mental) self-perceived health-related quality of life (HRQoL) in symptomatic patients with lower extremity peripheral artery disease (PAD). This is an observational study investigating Fontaine stage II PAD patients participating in 3-month SET. Before and following SET, treadmill performance (pain-free (PFWD) and maximal (MWD)), and 6 min walking distance (6MWD) were assessed. Self-perceived HRQoL was assessed with the Medical Outcomes Study Short-Form 36 (SF-36). Ankle- and toe-brachial indexes were also measured. One-hundred forty-seven patients with PAD were included (64.9 ± 9.6 y, 70% men). After SET, PFWD (+102%, p ≤ 0.001), MWD (+87%, p ≤ 0.001), and 6MWD (+14%, p ≤ 0.001) significantly increased. All eight SF-36 subscale scores significantly improved following SET (p ≤ 0.04). SET significantly improved physical and mental component summaries of the SF-36 (p ≤ 0.001). Larger increases in 6MWD were associated with greater improvements in physical (β = 0.19; p = 0.02) and mental (β = 0.24; p = 0.005) component summaries of the SF-36. No significant relationship was observed between changes in treadmill performance and changes in physical and mental component summaries of the SF-36. These results show that improvements in 6MWD following SET are related to improvements in general self-perceived HRQoL in patients with symptomatic lower extremity PAD. On the contrary, changes in treadmill performance were not related to improvements in HRQoL. These results suggest that the 6 min walking test is an essential outcome measure to assess overall patient functional status following interventions in patients with PAD.

Highlights

Lower extremity peripheral artery disease (PAD) is mostly secondary to atherosclerotic arterial narrowing, resulting in reduced blood flow and oxygen delivery to the lower limbs [1,2]
The present study aims to evaluate the relationship between supervised exercise training (SET)-induced changes in treadmill performance and 6 min walking distance, and changes in general self-perceived health-related quality of life (HRQoL) in patients with symptomatic PAD
The association between patients’ perceived improvements in quality of life and changes in treadmill (PFWD and MWD) and functional (6MWD) walking performance following exercise therapy is understudied in patients with symptomatic PAD

Summary

Introduction

Lower extremity peripheral artery disease (PAD) is mostly secondary to atherosclerotic arterial narrowing, resulting in reduced blood flow and oxygen delivery to the lower limbs [1,2]. Patients with PAD have impaired walking performances and faster functional decline compared to healthy age-matched subjects [3,4]. These patients reduce their daily life physical activity, adopting a more sedentary lifestyle behavior, leading to further functional decline [5]. These functional limitations reduce health-related quality of life (HRQoL), which reflects a patient’s physical, mental, and social perceptions in relation to health [6]. Supervised exercise training (SET) is among the guideline-recommended therapies for PAD [1,2]. It is well known that SET increases treadmill performance (pain-free (PFWD)

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