Maximal Walking Time Research Articles

Specific slow tests are not mandatory in patients with extremely short standard (3.2km/hr 10% slope) test durations during exercise oximetry.

To compare the transcutaneous oxygen pressure results observed in patients with severe walking limitation during standard procedures (3.2km/hr, 10% slope) versus during a test performed at a low speed (2km/hr, 10% slope). In 31 patients, the decrease from rest of oxygen pressure (DROP) index was measured on both buttocks, both thighs and both calves during two consecutive tests on treadmill. The maximal walking time (MWT) and the minimal DROP values (DROPmin ) observed during the 2 tests were compared with t test. Correlation of DROPmin values during the slow and standard procedure was performed with linear regression. The -15mmHg cut-off value defined for standard test interpretation was used arbitrarily for the interpretation of slow test results. MWT was 80±52s versus 376±269s at standard and slow speed, respectively (p<.001). No difference on all recorded DROPmin values at a standard (-9.5±6.9mmHg) and slow (-10.5±7.9mmHg) speed was found; n=186, p=.168. Coefficient of correlation between DROPmin s found at the two tests was r=0.820 (p<.01), with regression line close to the line of identity. With the identical -15mmHg cut-off, 166 (89.2%) of 186 the results were classified similarly after standard and slow procedures. Specific slow treadmill procedures are not mandatory in patients with extremely short test durations when performing standard (3.2km/hr 10% slope) exercise oximetry. In patients expected to be unable to walk at standard speed, the -15mmHg normal limit seems to be valid for the interpretation of tests with a slow procedure (2.0km/hr).

Gait Training Methods and ChangesiIn Gait Parameters in Parkinson`s Disease (Literature Review)

Parkinson’s disease is a chronic progressive neurological disorder that can impact function to a variable degree. Changes in gait parameters are the most common signs of Parkinson’s disease. Patients with Parkinson’s disease walk with a reduced step length, step time, walking velocity and walking cadence, increased stride cycle time, coefficient of variation of the step amplitude and step time and increased risk to fall. So, various gait training methods are applied. The effect of rhythmic auditory stimulation on gait in Parkinson’s disease patients is analysed. We can use various kinds of music, metronome, scansion and clapping as a rhythmic auditory stimulation.One of gait training methods in Parkinson’s disease patients is treadmill training. There are attempts to combine treadmill training with transcranial magnetic stimulation and virtual reality. We can use Nordic walking method and because walking technique requires straight posture, trunk rotation, bigger step and heel stride. More often robot–assisted gait training is used in patients with Parkinson’s disease gait training. The effect of dual–tasking and walking with music methods for gait and balance training in patients with Parkinson’s disease is also analysed. This method requires participants to perform primary and secondary tasks at the same time. The secondary task can be cognitive or motor. Dual–tasking is widely analysed because opinions about applying this method are very controversial. Walking with music method is more often analysed in scientific literature. This method could not be compared to rhythmic auditory stimulation method because the latter requires precise walking to rhythm and walking with music method is oriented to emotional component (music is chosen according patients’ music taste). As these methods are applied, we can see an increase in chosen walking and maximal walking velocities, step length and time, distance covered, and decrease in the coefficient of variation of the step time and turning time.Keywords: Gait impairments, walking velocity, rhythmic auditory stimulation.

Machine learning methods are comparable to logistic regression techniques in predicting severe walking limitation following total knee arthroplasty.

Machine-learning methods are flexible prediction algorithms with potential advantages over conventional regression. This study aimed to use machine learning methods to predict post-total knee arthroplasty (TKA) walking limitation, and to compare their performance with that of logistic regression. From the department's clinical registry, a cohort of 4026 patients who underwent elective, primary TKA between July 2013 and July 2017 was identified. Candidate predictors included demographics and preoperative clinical, psychosocial, and outcome measures. The primary outcome was severe walking limitation at 6months post-TKA, defined as a maximum walk time ≤ 15min. Eight common regression (logistic, penalized logistic, and ordinal logistic with natural splines) and ensemble machine learning (random forest, extreme gradient boosting, and SuperLearner) methods were implemented to predict the probability of severe walking limitation. Models were compared on discrimination and calibration metrics. At 6months post-TKA, 13% of patients had severe walking limitation. Machine learning and logistic regression models performed moderately [mean area under the ROC curves (AUC) 0.73-0.75]. Overall, the ordinal logistic regression model performed best while the SuperLearner performed best among machine learning methods, with negligible differences between them (Brier score difference, < 0.001; 95% CI [- 0.0025, 0.002]). When predicting post-TKA physical function, several machine learning methods did not outperform logistic regression-in particular, ordinal logistic regression that does not assume linearity in its predictors. Prognostic level II.

Feasibility study to evaluate cycloidal vibration therapy for the symptomatic treatment of intermittent claudication

IntroductionIntermittent claudication (IC) is the most common symptom of peripheral arterial disease. Previous research has suggested that cycloidal vibration therapy (CVT) may induce angiogenesis and improvements in circulation. The objective of this feasibility study was to explore trial design and acceptability of the protocol to provide data to estimate the parameters required to design a definitive randomised control trial. This feasibility study specifically aimed to assess recruitment rate; attendance rates at baseline and follow-up; and safety, tolerability, and compliance with therapy device and additionally, to consider the potential efficacy of CVT as a novel treatment for intermittent claudication.MethodsPatients with intermittent claudication (IC) were recruited and CVT was applied at home for 30 min twice a day for a period of 12 weeks. Primary outcomes were pain-free walking time (PFWT) and maximum walking time (MWT) after 12 weeks of treatment. Secondary outcomes included the ankle-brachial index and ankle systolic blood pressure. Participants were assessed during active therapy phase at baseline, week 4, week 8, and week 12.ResultsThirty-four participants with IC were recruited: 30 (88%) male and 4 (12%) female. The rate of recruitment was 2.4 participants per month from a standard-size district general hospital. No participants left the study during the activity therapy stage, and no participant failed to attend their follow-up appointment. The general compliance with CVT was high. No participants dropped out during the treatment phase. The mean age of all participants was 68 years (IQR 60–75 years). Substantive improvements were seen in a comparison of differences in times to PFWT and MWT, in ABPI, and in systolic leg pressure in the treated leg. There was no evidence of a substantive difference from baseline in systolic leg pressure in the untreated leg. There were no immediate or delated treatment safety concerns of documented adverse effects with the treatment, all patients completed the required 12-week course indicated a high degree of patient acceptability.ConclusionThe statistically significant and substantive improvements from baseline after 12 weeks observed in PFWT and MWT in participants experiencing IC are comparable to improvements seen from other treatment options such as supervised exercise as reported by Stewart et al. (N Engl J Med 347:1941–1951, 2002). The substantive improvement in systolic leg pressure in the treated leg and the concurrent absence of a substantive change in systolic leg pressure in the untreated leg over the same period suggests a causative effect.This study has provided novel information relating to the number of potential eligible participants for a further research trial and potential association between CVT and improved symptoms. Additionally, it has established that CVT treatment is highly acceptable, as indicated by no participant drop-out in the treatment phase, and may potentially offer an alternative treatment option for patients experiencing IC. Furthermore, this study has assessed the variability of the primary outcome measure which provides vital information needed to calculate sample sizes for any future studies.In conclusion, this study has established the feasibility of using CVT to improve patients’ symptoms of IC and provides essential information which will contribute to the design of future research investigating whether the improvements seen are directly related to CVT.

Designing a New Shuttle Service to Meet Large-Scale Instantaneous Peak Demands for Passenger Transportation in a Metropolitan Context: A Green, Low-Cost Mass Transport Option

Currently, the green, sustainable development of metropolises is hindered by problems caused by Large-scale Instantaneous Peak-demands for Passenger-transportation (LIPP), such as traffic congestion and air pollution. To mitigate these problems, we propose a new type of demand-responsive service as an alternative to inefficient “door-to-door” service. The proposed service is based on service units designed to aggregate passengers for shuttle service. To guarantee service quality and efficiency, a maximum passenger walking time constraint, a request rejection mechanism and a scheme for ensuring solution feasibility are considered. Through numerical experiments, we prove the following: (i) the proposed transport option exhibits better performance (by 40.37% for passengers and by 35.79% for operators) than the door-to-door transport option for solving real cases. (ii) By testing different datasets, we prove that the proposed service is more suitable for the request distributions that are spatiotemporally concentrated. (iii) Regarding the individual components of the proposed clustering-first, routing-second solution framework, the proposed soft clustering algorithm exhibits better performance than the classical hard clustering method (by 8%), and the proposed routing algorithm is 1.5 times more efficient than the commercial solution software GAMS.

Empirical Analysis of Parking Behaviour of Conventional and Electric Vehicles for Parking Modelling: A Case Study of Beijing, China

An empirical study of the parking behaviour of Conventional Vehicles (CVs), Battery Electric Vehicles (BEVs), and Plug-in Hybrid Electric Vehicles (PHEVs) was carried out with the data collected in a paper-based questionnaire survey in Beijing, China. The study investigated the factors that might influence the parking behaviour, with a focus on the maximum acceptable time of walking from parking lot to trip destination, parking fee, the availability of charging posts, the state of charge of EVs and the range anxiety of BEVs. Several Multinomial Logit (MNL) models were developed to explore the relationships between individual attributes and parking choices. The results suggest that (1) the maximum acceptable walking time generally increases with the rise in the amount of saving for parking fee; (2) the availability of charging posts does not influence the maximum acceptable walking time when PHEVs and BEVs have sufficient charge, but the percentage of people willing to walk longer than eight minutes increases from around 35% to 46% when PHEVs are in a low stage of charge; (3) more than half of BEV drivers want the driving range of their vehicles to be one and a half times the driving distance before they depart, given the distance is 50 km. Based on the empirical findings above, a conceptual framework was proposed to explicitly simulate the parking behaviour of both CVs and EVs using agent-based modelling.

Using wearable monitors to assess daily walking limitations induced by ischemic pain in peripheral artery disease

To develop, assess the feasibility of, and determine the clinical validity of an event-based analysis method using wearable monitors to quantify walking pain manifestations (WPMs) and stops induced by walking pain (SIWPs) during daily life walking in people with peripheral artery disease (PAD). The following two conditions were studied: a standardized outdoor walking session (OWS) and a seven-day free-living measurement (FLM) period. The PAD participants (n=23) wore an accelerometer and a watch. They were asked to press the event marker button on the watch to indicate events related to WPMs and SIWPs. To assess the clinical validity of the method, the computed pain-free walking time (PFWT) and maximal walking time (MWT) were compared with the PFWT and MWT assessed using standard treadmill walking protocols, respectively. Following OWSs, the PFWT[OWS] and MWT[OWS] were significantly correlated with the PFWT[Strandness] (r=.955, P<.001) and MWT[Strandness] (r=.821, P<.001), respectively. During the FLM, PAD participants experienced only 2 WPMs/day and 1 SIWP/day, although severely limited on the treadmill and during the OWS. The average WPMs/day were moderately correlated with the PFWT[Strandness] (r=-.54, P=.016). The PFWT[FLM] was on average 12 times longer than the PFWT[Strandness] . Interestingly, the intensity of the walking bouts as assessed by the accelerometer counts during the FLM was significantly lower than that during the OWS (45±15 vs 66±20counts/s, P<.001). This new method offers opportunities for studies investigating the experience of living with PAD and the assessment of daily life walking capacity for both diagnostic and therapeutic purposes.

Effects of sildenafil on maximum walking time in patients with arterial claudication: The ARTERIOFIL study

BackgroundPatients with lower extremity peripheral artery disease (PAD) frequently experience claudication, a clinical symptom indicative of reduced walking capacity. Recommended care consists of exercise rehabilitation combined with optimal medical treatment and surgery. The effects of a single oral dose of sildenafil, a phosphodiesterase type-5 inhibitor, on patients with claudication are discussed. The aim of this study was to test the efficacy of a single 100 mg dose of sildenafil compared to placebo in terms of maximal walking time (MWT) in patients with claudication. MethodsThe ARTERIOFIL study is a crossover, double-blind, prospective, randomized, single-center study conducted at Angers University Hospital in France. MWT (primary endpoint) was assessed using a treadmill test (10% incline; 3.2 km/h). Secondary endpoints (pain-free walking time (PFWT), transcutaneous oximetry during exercise and redox cycle parameters and safety) were also studied. ResultsFourteen patients were included of whom two were ultimately excluded. In the 12 remaining patients, the MWT was significantly improved during the sildenafil period compared with the placebo period (300 s [95% CI 172 s–428 s] vs 402 s [95% CI 274 s–529 s] p < 0.01). Sildenafil had no significant effect on pain-free walking time or skin tissue oxygenation during exercise. According to redox cycle parameters, sildenafil significantly reduced blood glucose and pyruvate levels and the 3-hydroxybutyrate/acetoacetate ratio, while there was no significant effect on lactate, 3-hydroxybutyrate, acetoacetate and free fatty acid levels. Symptomatic transient hypotension was observed in two women. ConclusionsThe ARTERIOFIL study has shown that a single 100 mg oral dose of sildenafil had a significant effect on increase in MWT but had no significant effects on PFWT and oxygenation parameters in patients with claudication. A double-blind, prospective, randomized, multicenter study (VIRTUOSE©) is ongoing to evaluate the chronic effect of six month-long sildenafil treatment on MWT in PAD patients with claudication. Clinical trial registrationThis clinical trial was registered at clinicaltrials.gov, registration.number: NCT02832570, (https://clinicaltrials.gov/ct2/show/NCT02832570).

A Benders decomposition method for locating stations in a one-way electric car sharing system under demand uncertainty

We focus on a problem of locating recharging stations in one-way station based electric car sharing systems which operate under demand uncertainty. We model this problem as a mixed integer stochastic program and develop a Benders decomposition algorithm based on this formulation. We integrate a stabilization procedure to our algorithm and conduct a large-scale experimental study on our methods. To conduct the computational experiments, we develop a demand forecasting method allowing to generate many demand scenarios. The method is applied to real data from Manhattan taxi trips. We are able to solve problems with 100–500 scenarios, each scenario including 1000–5000 individual customer requests, under high and low cost values and 5–15 min of accessibility restrictions, which is measured as the maximum walking time to the operating stations.

Treadmill Measured vs. Questionnaire Estimated Changes in Walking Ability in Patients With Peripheral Artery Disease

Determining the maximum walking time (MWT) using the treadmill test is the gold standard method for evaluating walking capacity and treatment effect in patients with peripheral arterial disease (PAD). However, self reported functional disability is important when assessing quality of life. Changes in the Walking Estimated Limitation Calculated by History (WELCH) questionnaire scores were compared with the MWT. A cross sectional study was performed in patients with intermittent claudication. The treadmill test (3.2km/h; 10% gradient) and WELCH questionnaire were administered to all patients for objective evaluation of walking capacity. Given the log normal distribution of these parameters in patients with PAD, a log transformation was applied to the WELCH score (LnW) and maximum walking time (LnT). The responsiveness of the WELCH score was determined using mean changes and correlation coefficients of LnW and LnT changes. The effect of time on the "estimated minus real" (E- R) changes (LnW-change minus LnT-change) was assessed after categorisation of patients into various test-retest intervals. Patients who underwent lower limb revascularisation between the two tests and those who underwent medical treatment only were analysed. Correlation coefficients between LnW and LnT for tests 1 and 2 were r=0.514 and r=0.503, respectively (p<.001, for both). Correlation for LnW change vs. LnT change was 0.384 (p<.001). E- R was positive only early after surgery. E- R was negative for all test-retest intervals >1 year in revascularised and non-revascularised patients. Changes in WELCH scores correlated with changes observed on the treadmill in patients with intermittent claudication. For long test-retest intervals, WELCH changes tended to overestimate the worsening of walking impairment as compared with the measured difference observed in both revascularised and non-revascularised patients. A shortlived "honeymoon" (overestimation of the benefit for the shortest test-retest interval) was observed only in revascularised patients.

Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty

Background and purpose — Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA), mainly because of pain and restricted physical function. We developed a prediction model for 6-month knee range of motion, knee pain, and walking limitations in patients undergoing TKA surgery.Patients and methods — We performed a prospective cohort study of 4,026 patients who underwent elective, primary TKA between July 2013 and July 2017. Candidate predictors included demographic, clinical, psychosocial, and preoperative outcome measures. The outcomes of interest were (i) knee extension and flexion range of motion, (ii) knee pain rated on a 5-point ordinal scale, and (iii) self-reported maximum walk time at 6 months post TKA. For each outcome, we fitted a multivariable proportional odds regression model with bootstrap internal validation.Results — At 6 months post TKA, around 5% to 20% of patients had a flexion contracture ³ 10°, range of motion < 90°, moderate to severe knee pain, or a maximum walk time £ 15 minutes. The model c-indices (the probabilities to correctly discriminate between 2 patients with different levels of follow-up TKA outcomes) when evaluating these patients were 0.71, 0.79, 0.65, and 0.76, respectively. Each postoperative outcome was strongly influenced by the same outcome measure obtained preoperatively (all p-values < 0.001). Additional statistically significant predictors were age, sex, race, education level, diabetes mellitus, preoperative use of gait aids, contralateral knee pain, and psychological distress (all p-values < 0.001).Interpretation — We have developed models to predict, for individual patients, their likely post-TKA levels of knee extension and flexion range of motion, knee pain, and walking limitations. After external validation, they can potentially be used preoperatively to identify at-risk patients and to help patients set more realistic expectations about surgical outcomes.

Abstract 717: Sequential Inflow Occlusion and Walking Capacity in Large Animal Model of PAD

Introduction: Peripheral artery disease (PAD) affects over 8 million Americans over 40 years of age. PAD patients are heavily burdened by pain and walking dysfunction. Treatment paradigms for PAD are evolving, but optimal medical therapy, risk factor modification, and supervised exercise therapy (SET) are the first line therapies for these persons. SET improves walking time and may improve skeletal muscle perfusion. However, the mechanisms by which SET and other treatments are not well understood. Translational models of PAD may be useful in developing novel therapeutics for PAD patients. Objective: The objective of this work is to introduce a large animal (porcine) model of PAD that includes sequential occlusion of inflow that can be used on patient-like treadmills for SET or quantification of walking distance and dysfunction. Methods: Two female Yorkshire swine were accommodated to our treadmill one week prior to procedure. On day 0, swine underwent endovascular placement of a covered stent (GORE® VIABAHN® endoprosthesis) into the right external iliac artery followed by placement of a vascular plug (AMPLATZER, St. Jude Medical) inside this stent was used in the initial procedure. In order to mimic the common presentation of PAD patients having one leg more severely ischemic than the other, we performed a sequential occlusion of the ipsilateral internal iliac artery and contralateral external iliac artery one week later. Vascular flow were quantified by arteriogram, a modified ankle brachial index, and duplex ultrasound. Animals were walked weekly on a large animal treadmill with a 3.5 KM/HR pace and 10 degree incline until failure (pigs would slide to end of treadmill). Results: There were no technical failures or complications. One and three weeks after the initial procedure, pigs walked 40% and 45% of pre-procedural maximal walking time. There was sustained depression of the blood pressure ratio of ischemic hindlimb to unaffected forelimb (hindlimb index or HLI), which was significantly inhibited out to 6 weeks ( HLI of 0.4-0.63 ). Conclusion: We have created a pilot model of PAD that can be used for both SET testing and quantifying maximal walking time/distance. This model may be useful in testing novel therapeutics and validating promising mechanistic findings from small animals.

Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication.

Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication.

Home-based exercise programmes for individuals with intermittent claudication: A protocol for an updated systematic review and meta-analysis.

Background:The aim of this updated review is to consider the evidence base for the effectiveness of home-based exercise programmes as a treatment option for improving walking distance in patients with intermittent claudication.Methods:The Medline, EMBASE, CINAHL, PEDro and Cochrane CENTRAL databases will be searched for terms including ‘intermittent claudication’, ‘peripheral arterial disease’, ‘home-based exercise’ and ‘home-based walking’. No date restrictions will be used but only articles in the English language will be included. Both randomised and non-randomised trials of home-based exercise programmes versus a comparator arm will be included, and a meta-analysis using only the randomised controlled trials will be attempted if the assumptions of heterogeneity are met. Data extraction will include study details, sample description, intervention description, length of follow-up and outcomes measures. The primary outcome measure is objectively measured maximal walking distance or time, with secondary outcome measures including pain-free walking distance or time, changes in physical activity and quality of life. We will also provide a narrative description of the effective components of a home-based exercise intervention which can aid future recommendations.Conclusion:Overall, this proposed review and meta-analysis aims provide a comprehensive and complete overview of the evidence base for home-based exercise programmes, which can aid clinicians in the management of their patients.

Exercise for intermittent claudication.

Background Exercise programmes are a relatively inexpensive, low-risk option compared with other more invasive therapies for leg pain on walking (intermittent claudication (IC)). This is an update of a review first published in 1998. Objectives The prime objective of this review was to determine whether an exercise programme in people with intermittent claudication was effective in alleviating symptoms and increasing walking treadmill distances and walking times. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events and improving quality of life. Search methods For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched September 2013) and CENTRAL (2013, Issue 8). Selection criteria Randomised controlled trials of an exercise regimen versus control or versus medical therapy in people with IC due to peripheral arterial disease. Any exercise programme or regimen used in the treatment of intermittent claudication was included, such as walking, skipping and running. Inclusion of trials was not affected by the duration, frequency or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximal walking distance), ankle brachial index (ABI), quality of life, morbidity or amputation; if none of these were reported the trial was not included in this review. Data collection and analysis Two review authors independently extracted data and assessed trial quality. Main results Eleven additional studies were included in this update making a total of 30 trials which met the inclusion criteria, involving a total of 1816 participants with stable leg pain. The follow-up period ranged from two weeks to two years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises; generally supervised sessions were at least twice a week. Most trials used a treadmill walking test for one of the outcome measures. Quality of the included trials was moderate, mainly due to an absence of relevant information. The majority of trials were small with 20 to 49 participants. Twenty trials compared exercise with usual care or placebo, the remainder of the trials compared exercise to medication (pentoxifylline, iloprost, antiplatelet agents and vitamin E) or pneumatic calf compression; people with various medical conditions or other pre-existing limitations to their exercise capacity were generally excluded. Overall, when taking the first time point reported in each of the studies, exercise significantly improved maximal walking time when compared with usual care or placebo: mean difference (MD) 4.51 minutes (95% confidence interval (CI) 3.11 to 5.92) with an overall improvement in walking ability of approximately 50% to 200%. Walking distances were also significantly improved: pain-free walking distance MD 82.29 metres (95% CI 71.86 to 92.72) and maximum walking distance MD 108.99 metres (95% CI 38.20 to 179.78). Improvements were seen for up to two years, and subgroup analyses were performed at three, six and 12 months where possible. Exercise did not improve the ABI (MD 0.05, 95% CI 0.00 to 0.09). The effect of exercise, when compared with placebo or usual care, was inconclusive on mortality, amputation and peak exercise calf blood flow due to limited data. No data were given on non-fatal cardiovascular events. Quality of life measured using the Short Form (SF)-36 was reported at three and six months. At three months, physical function, vitality and role physical all significantly improved with exercise, however this was a limited finding as this measure was only reported in two trials. At six months five trials reported outcomes of a significantly improved physical summary score and mental summary score secondary to exercise. Only two trials reported improvements in other domains, physical function and general health. Evidence was generally limited for exercise compared with antiplatelet therapy, pentoxifylline, iloprost, vitamin E and pneumatic foot and calf compression due to small numbers of trials and participants. Authors' conclusions Exercise programmes are of significant benefit compared with placebo or usual care in improving walking time and distance in people with leg pain from IC who were considered to be fit for exercise intervention.

Soluble endoglin as a prognostic factor of the claudication distance improvement in patients with peripheral artery disease undergoing supervised treadmill training program

Conservative therapy after complete revascularization is increasing in popularity in patients with peripheral artery disease (PAD). The aim of the present study was to find determinants of the improvement of walking abilities and endothelial function in patients with PAD undergoing supervised treadmill training program (STTP). The presented study enclosed 66 patients in the mean age 65.4 ± 7.7 years with PAD who underwent a 3-month length STTP. We assessed the effect of following factors on the change of the flow-mediated dilatation value (ΔFMD), maximal walking time (ΔMWT), and pain-free walking time (ΔPFWT). The evaluation included several biochemical and anthropometric indices with special insight into markers of angiogenesis, including soluble endoglin (sEng), platelet-derived growth factor, and angiopoietin-2. Linear regression analysis for each of the variables and multi-factorial model analysis of variances was adopted to select the most influential determinants. The levels of sEng, a biomarker of several cardiovascular pathologies, were found to significantly predict the greater improvement of maximal walking time and pain-free walking time. Moreover, the linear regression analysis demonstrated, and analysis of variance confirmed that coronary artery disease and peracted endovascular interventions of lower limbs arteries are significant determinants of the better ΔFMD improvement. On the contrary, treatment with β-blockers and older age were poor predictors of ΔFMD increase. In conclusion, the sEng level could serve as a determinant of walking abilities change after STTP in patients with PAD. The treatment with β-blockers, the coexistence of coronary artery disease, and peracted endovascular interventions of lower limbs arteries are determinants of endothelial function.

Bypass surgery for chronic lower limb ischaemia.

Bypass surgery for chronic lower limb ischaemia.

Evaluation of the comprehensive health program "Sumida TAKE10!" for community-dwelling older adults, which aims to prevent or delay the need for long-term nursing care.

Objective The purpose of this study was to evaluate the comprehensive health program "Sumida TAKE10!", which aims to improve dietary habits and promote physical activity among community-dwelling older adults including the pre-frail elderly. This study has been ongoing since 2005 in Sumida Ward, Tokyo with the ultimate aim of preventing or delaying the need for long-term nursing care. We used the term "pre-frail elderly" for older adults who are at risk of requiring long-term care.Methods "Sumida TAKE10!" consists of a general lecture in a public hall followed by 5 educational sessions biweekly at 4-6 community centers. From 2008 to 2013, 402 participants aged ≥65 years were enrolled and included as subjects of the study. The main outcome measures were changes in 10 food intake frequencies, food frequency score (FFS), dietary variety score (DVS), frequency of exercise (obtained via questionnaire) and physical fitness (5-meter maximal walking time, 5-meter walking time, handgrip strength, one-leg standing time with eyes opened (time to upright posture for standing on one leg with eyes open), and the timed up & go test). The secondary outcome measures were changes in the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence score, appetite, frequency of walking and sports, self-rated health, frequency of leaving the house, communication with neighbors, engagement in hobbies, participation in group activities and participation in volunteer activities (obtained via questionnaire).Results Compared to baseline, all outcomes showed significant improvement. "Sumida TAKE10!" can improve dietary habits and increase the physical activity of participants. Positive secondary effects were seen for life function, self-rated health, and social activities. Almost identical positive results were obtained from the pre-frail elderly group, while improvement was also seen in the dietary habits of the subjects who do not cook.Conclusion These results suggest that this program may be useful for population-based approach programs. In addition, comprehensive programs like TAKE10! may increase the health consciousness of community-dwelling older adults.

Improving Walking with an Implanted Neuroprosthesis for Hip, Knee, and Ankle Control After Stroke

The objective of this work was to quantify the effects of a fully implanted pulse generator to activate or augment actions of hip, knee, and ankle muscles after stroke. The subject was a 64-year-old man with left hemiparesis resulting from hemorrhagic stroke 21 months before participation. He received an 8-channel implanted pulse generator and intramuscular stimulating electrodes targeting unilateral hip, knee, and ankle muscles on the paretic side. After implantation, a stimulation pattern was customized to assist with hip, knee, and ankle movement during gait.The subject served as his own concurrent and longitudinal control with and without stimulation. Outcome measures included 10-m walk and 6-minute timed walk to assess gait speed, maximum walk time, and distance to measure endurance, and quantitative motion analysis to evaluate spatial-temporal characteristics. Assessments were repeated under 3 conditions: (1) volitional walking at baseline, (2) volitional walking after training, and (3) walking with stimulation after training. Volitional gait speed improved with training from 0.29 m/s to 0.35 m/s and further increased to 0.72 m/s with stimulation. Most spatial-temporal characteristics improved and represented more symmetrical and dynamic gait. These data suggest that a multijoint approach to implanted neuroprostheses can provide clinically relevant improvements in gait after stroke. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to do the following: (1) Describe the rationale for evaluating a multijoint implanted neuroprosthesis to improvewalkingafter stroke; (2)Understand the study design and conclusions that can be inferred as a result of the design; and (3) Discuss the statistical significance and clinical relevance of changes between (a) volitional walking at baseline, (b) volitional walking after training, and (c) walking with stimulation after training. Advanced ACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Magnetic Resonance Venous Volume Measurements in Peripheral Artery Disease (from ELIMIT)

The relation between the arterial and venous systems in patients with impaired lower extremity blood flow remains poorly described. The objective of this secondary analysis of the Effectiveness of Intensive Lipid Modification Medication in Preventing the Progression on Peripheral Artery Disease Trial was to determine the association between femoral vein (FV) volumes and measurements of peripheral artery disease. FV wall, lumen, and total volumes were quantified with fast spin-echo proton density-weighted magnetic resonance imaging scans in 79 patients with peripheral artery disease over 2 years. Reproducibility was excellent for FV total vessel (intraclass correlation coefficient 0.924, confidence interval 0.910 to 0.935) and lumen volumes (intraclass correlation coefficient 0.893, confidence interval 0.873 to 0.910). Baseline superficial femoral artery volumes were directly associatedwith FV wall (r= 0.46, p <0.0001), lumen (r= 0.42, p=0.0001),and totalvolumes (r=0.46, p <0.0001). The 2-year change in maximum walking time was inversely associated with the 24-month change in FV total volume (r=-0.45, p= 0.03). Inconclusion, FV volumes can be measured reliably with fast spin-echo proton density-weighted magnetic resonance imaging, and baseline superficial femoral artery plaque burden is positively associated with FV volumes, whereas the 2-year change in FV volumes and leg function show an inverse relation.