Abstract
In patients with peripheral artery disease (PAD), supervised exercise at near-moderate pain improves walking ability but not ankle-brachial index (ABI) values. In a retrospective observational study, we determined vascular and functional effects of a 6-month structured pain-free exercise program in patients with claudication and compressible vessels. Four-hundred and fifty-nine consecutive patients were studied. Segmental limb pressures were measured and ABI calculated during circa-monthly hospital visits. The 6-min (6MWD) and the pain-free walking distance (PFWD) during the 6-min walking test were determined. Two daily 8-min sessions of slow–moderate in-home walking at increasing metronome-paced speed were prescribed. After excluding patients with unmeasurable ABI or incompletion of the program, 239 patients were studied. Safe and satisfactory (88%) execution of the prescribed training sessions was reported. During the visits, bilateral ABI improved (+ 0.07; p < 0.001) as well as the segmental pressures in the more impaired limb, with changes already significant after 5 weeks of slow walking. Both systolic and diastolic blood pressure decreased overtime (F = 46.52; p < 0.001; F = 5.52; p < 0.001, respectively). 6MWD and PFWD improved (41[0‒73]m p < 0.001 and 107[42‒190]m p < 0.001, respectively) with associated decrease of walking heart rate (F = 15.91; p < 0.001) and Physiological Cost Index (F = 235.93; p < 0.001). The variations of most parameters at different visits correlated to the training load calculated. In a regression model, the PFWD variations directly correlated with rate sessions completed, training load and ABI change and inversely with the baseline value (R2 = 0.27; p < 0.001). In the PAD population studied, moderate pain-free exercise improved ABI with associated progressive functional and cardiovascular changes occurring regardless of subjects characteristics.
Highlights
Physical exercise is an essential component of the management program in peripheral artery disease (PAD) [1, 2], a highly prevalent vascular disease associated to low physical function and high risk of cardiovascular events [3, 4]
Recommended exercise programs carried out under supervision three-weekly over 6–8 weeks at an intensity such as to evoke moderate-to-severe pain, are effective at improving walking ability [4,5,6]. These improvements are attributed to muscle adaptations, walking economy or greater accommodation to pain [4, 7] in absence of reported ankle-brachial index (ABI) or collateral blood flow changes [7, 8]
For the first time to our knowledge, the study describes the hemodynamic response to a structured progressive training in a real-world population of PAD patients with claudication enrolled in a home-based program
Summary
Physical exercise is an essential component of the management program in peripheral artery disease (PAD) [1, 2], a highly prevalent vascular disease associated to low physical function and high risk of cardiovascular events [3, 4]. Hemodynamic improvements have been observed following pain-free home-based exercise program [13,14,15,16,17,18] based on the FITT (frequency, intensity, time, type) principles which are differently combined with respect to the recommended programs [4, 19] This structured walking intervention [13,14,15, 20, 21], designed to minimize lactate accumulation and favor aerobic adaptations in the ischemic regions [16, 17] was translated into a clinical program. The so-called Test in–Train out (Ti–To) program is based on serial controls at hospital where adherence, patient’s mobility and hemodynamics are assessed
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