Abstract
This study aimed to investigate the effects of supervised exercise training (SET) on spatiotemporal gait and foot kinematics parameters in patients with symptomatic lower extremity peripheral artery disease (PAD) during a 6 min walk test. Symptomatic patients with chronic PAD (Fontaine stage II) following a 3 month SET program were included. Prior to and following SET, a 6 min walk test was performed to assess the 6 min walking distance (6MWD) of each patient. During this test, spatiotemporal gait and foot kinematics parameters were assessed during pain-free and painful walking conditions. Twenty-nine patients with PAD (65.4 ± 9.9 years.) were included. The 6MWD was significantly increased following SET (+10%; p ≤ 0.001). The walking speed (+8%) and stride frequency (+5%) were significantly increased after SET (p ≤ 0.026). The stride length was only significantly increased during the pain-free walking condition (+4%, p = 0.001), whereas no significant differences were observed during the condition of painful walking. Similarly, following SET, the relative duration of the loading response increased (+12%), the relative duration of the foot-flat phase decreased (−3%), and the toe-off pitch angle significantly increased (+3%) during the pain-free walking condition alone (p ≤ 0.05). A significant positive correlation was found between changes in the stride length (r = 0.497, p = 0.007) and stride frequency (r = 0.786, p ≤ 0.001) during pain-free walking condition and changes in the 6MWD. A significant negative correlation was found between changes in the foot-flat phase during pain-free walking condition and changes in the 6MWD (r = −0.567, p = 0.002). SET was found to modify the gait pattern of patients with symptomatic PAD, and many of these changes were found to occur during pain-free walking. The improvement in individuals’ functional 6 min walk test was related to changes in their gait pattern.
Highlights
Lower extremity peripheral artery disease (PAD) is a chronic atherosclerotic vascular morbidity that leads to the narrowing and/or occlusion of lower-limb arteries [1]
Our results showed that changes in stride length and frequency and in the relative duration of the foot-flat phase during the pain-free walking condition were related to changes in functional walking performance during the 6 min walk test (6MWT) following supervised exercise training (SET)
The results of the present investigation confirm previous findings, which showed that SET improves 6 min walking distance (6MWD) in symptomatic patients with PAD [9,23]
Summary
Lower extremity peripheral artery disease (PAD) is a chronic atherosclerotic vascular morbidity that leads to the narrowing and/or occlusion of lower-limb arteries [1]. Intermittent claudication—a pain occurring in the lower limbs during exercise and resolving with rest—is one of the typical manifestations of PAD [1]. Intermittent claudication has a huge impact on patients’ daily life activities, leading to reduced quality of life for these individuals [3,4]. Beyond the well-known manifestations of reduced walking capacities, physical function, altered muscular characteristics, and impaired balance [5,6,7,8,9], gait abnormalities have been documented in patients with PAD [10,11,12,13,14,15,16,17]. Previous investigations reported a reduction in walking speed and cadence, smaller step length, and greater stance phase duration in patients with PAD compared to age-matched non-PAD individuals [13,17,18]
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