Walking Capacity In Patients Research Articles

Association of mental health with walking capacity in patients with claudication: a cross-sectional study

Objectives The purpose of this investigation was to verify the association between mental health (MH) indicators with walking capacity in patients with PAD. Methods Two hundred and forty-six patients with PAD and claudication symptoms participated in this study. Physical function was assessed objectively with the 6-min walk test (6MWT) and subjectively using the Walking Impairment Questionnaire (WIQ). MH was assessed by the World Health Organization Quality of Life-Bref (WHOQOL-Bref) (six questions were selected − 1, 2, 10, 16, 19, and 26). Patients were divided into tertile groups according to their composite z-score for mental health (Low MH, Middle MH, and High MH). Results The High MH group presented higher scores (p < 0.05) for the WIQ (distance = 26.8 ± 25.6, speed = 25.4 ± 17.3, and stairs = 33.6 ± 27.5), claudication onset distance (161.6 ± 83.6 m), and total walking distance (352.9 ± 79.6 m) compared to Low MH (WIQ distance = 14.8 ± 16.2, 17.7 ± 13.0, and stairs = 22.7 ± 20.7). Additionally, the High MH group presented a longer claudication onset distance (115.5 ± 70.5 m), and total walking distance in 6MWT (306.6 ± 83.2 m), and higher scores in the total walking distance compared to Middle MH (309.5 ± 93.6 m) (p < 0.05). Conclusion In patients with PAD, MH was positively associated with walking capacity. Based on these results, treatments that can improve mental health, through different mechanisms, can also positively influence the ability of these patients to walk.

Effect of 10.6-μm CO2 laser moxibustion on the fastest 15-m walking time in patients with knee osteoarthritis: a double-blind, sham-controlled, multi-site randomized trial

BackgroundIn this study, we investigated the impact of 10.6-μm CO2 laser moxibustion (LM) on the fastest 15-m walking time in individuals suffering from knee osteoarthritis (KOA).MethodsA total of 392 individuals diagnosed with KOA and meeting the specified eligibility criteria were assigned randomly into two groups: the LM treatment group and the sham LM control group (ratio 1:1). Both groups received either LM therapy or simulated LM therapy to address the affected area of the knee joint. This treatment was administered three times a week for a duration of 4 weeks.ResultsIn the LM group, the fastest 15-m walking times at both Week 4 and Week 12 were significantly reduced compared to the times before treatment (all P < 0.05). However, in the sham LM group, there were no notable differences in the fastest 15-m walking times after treatment (all P > 0.05). Moreover, the LM group exhibited shorter 15-m walking times than the sham LM group at both Week 4 and Week 12 (all P < 0.05).ConclusionThe use of CO2 LM can lead to a substantial enhancement in the fastest 15-m walking time of individuals suffering from KOA, and its therapeutic impact can last for a minimum of 8 weeks post-treatment. The fastest 15-m walking time serves as an indicator of alterations in the walking capacity of patients with KOA.

Critically appraised paper: High-intensity interval training is an effective method for enhancing walking capacity in patients with chronic stroke [synopsis

Critically appraised paper: High-intensity interval training is an effective method for enhancing walking capacity in patients with chronic stroke [synopsis

OC 34.3 Walking Capacity in Patients with Acute Deep Vein Thrombosis is Associated with the Location of Thrombosis and is Reduced in Patients with a History of Previous Deep Vein Thrombosis

OC 34.3 Walking Capacity in Patients with Acute Deep Vein Thrombosis is Associated with the Location of Thrombosis and is Reduced in Patients with a History of Previous Deep Vein Thrombosis

Critically appraised paper: High-intensity interval training is an effective method for enhancing walking capacity in patients with chronic stroke [commentary

Critically appraised paper: High-intensity interval training is an effective method for enhancing walking capacity in patients with chronic stroke [commentary

The Effect of Exercise Modalities on Walking Capacity in Patients With Intermittent Claudication: A NETWORK META-ANALYSIS.

Despite extensive research on the effect of supervised exercise therapy on walking performance in patients with symptomatic peripheral arterial disease (PAD), it remains unclear which training modality provides the greatest improvement in walking capacity. The objective of this study was to compare the effect of different types of supervised exercise therapy on walking capacity in individuals with symptomatic PAD. A random-effect network meta-analysis was performed. The following databases were searched from January 1966 to April 2021: SPORTDiscus, CINAHL, MEDLINE, AMED, Academic Search Complete and, Scopus. Trials had to include at least one type of supervised exercise therapy for patients with symptomatic PAD, with an intervention lasting ≥2 wk with ≥5 training sessions, and an objective measure of walking capacity. Eighteen studies were included for a total sample of 1135 participants. Interventions duration ranged from 6-24 wk and included aerobic exercise (treadmill walking, ergometer, and Nordic walking), resistance training (lower and/or upper body), a combination of both, and underwater exercise. Results showed that combined training improved treadmill walking capacity to a comparable extent to aerobic walking (+122.0 [24.2-219.8] m vs +106.8 [34.2-179.4] m), but with a larger effect size (1.20 [0.50-1.90] vs 0.67 [0.22-1.11]). Similar results were observed for the 6-min walk distance, with combined training being the most promising modality (+57.3 [16.2-98.5] m), followed by underwater training (+56.5 [22.4-90.5] m) and aerobic walking (+39.0 [12.8-65.1] m). While not statistically superior to aerobic walking, combined exercise seems to be the most promising training modality. Aerobic walking and underwater training also improved walking capacity for patients with symptomatic PAD.

The Comparable Effect of tDCS and Core Exercises on Balance and Mobility in Patients With Multiple Sclerosis

Objectives: As a major feature of the disease, motor-related complications, including loss of balance and reduced ability to walk were seen in multiple sclerosis (MS). The purpose of this study was to investigate the effect of core stability exercises and transcranial direct-current stimulation (tDCS) as a non-invasive brain stimulation on balance, walking capacity, and quality of life in patients with MS. Methods: In this randomized clinical trial study with a pretest-posttest design, 29 female patients with an Expanded Disability Status Scale (EDSS) of less than 4.5 (3.75±1.31) and a mean age of 38.36±7.99 years were purposefully selected from patients referring to MS society of Tehran during 2021 and then randomly assigned to the following three groups: core stability exercises, anodal tDCS, and sham. Variables, such as balance, walking capacity, and quality of life were measured before and after the interventions. Subjects in the core stability training group participated in core stability exercises for three weeks, and subjects in both sham and anodal tDCS groups received direct brain electrical stimulation for five sessions. Results: A significant improvement in balance and walking capacity were seen both in the anodal tDCS and the core stability training groups (P&lt;0.05). Moreover, mobility was significantly changed in the tDCS group (P&lt;0.05). However, no significant difference in the quality of life was seen between the groups. Discussion: Our findings indicate comparable effects of tDCS, and core stability training on balance and walking capacity in patients with MS. Therefore, in addition to exercises, tDCS can be considered a promising tool for the neurorehabilitation of patients with MS.

Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke

For walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization. To assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke. This multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled. Participants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated. The main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training. Of 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, -9 to 33 m]; mean difference, 15 m [95% CI, -13 to 42 m]; P = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m]; P = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m]; P = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue. These findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains. ClinicalTrials.gov Identifier: NCT03760016.

Open Versus Closed Kinetic Chain Exercise: a Comparison of Walking Capacity in Chronic Post-Stroke Phase

Introduction: The chronic post-stroke phase is often accompanied by various sensory, cognitive, motoric, coordination, and balance impairments. Decreased strength and motoric control contribute to walking capacity in patients with stroke. This study aims to evaluate the effect of Open Kinetic Chain (OKC) vs Closed Kinetic Chain (CKC) exercise on walking capacity in the chronic post-stroke phase. Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) were reported to improve functional mobility and balance in the chronic post-stroke phase. However, there is a lack of studies emphasizing the effect of OKC and CKC on walking capacity.&#x0D; Methods: This study is a quasi-experimental pre- and post-controlled trial group design. Twenty subjects were randomized into two groups of equal size: the CKC group (n=10) and the OKC group (n=10). There was one subject from each group who dropped out at the end of the study. CKC and OKC groups were trained for 6 weeks. The walking capacity was measured with 2 Minutes Walking Test (2WMT).&#x0D; Results: 2WMT results showed improvement in both groups after 6 weeks of intervention, 56,17 ± 10,95 ± to 57,43 ± 11,29 in CKC group (p&lt;0.001) and 57,04 ± 8,58 to 58,19 ± 8,77 in OKC group (p&lt;0.002).&#x0D; Conclusion: CKC and OKC exercise significantly improve the 2WMT results after 6 weeks of intervention.&#x0D; Keywords: Chronic post-stroke phase, walking capacity, open kinetic chain exercise, closed kinetic chain exercise

Effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with lumbar spinal stenosis with neurogenic claudication: a randomized controlled clinical trial protocol

BackgroundLumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is a leading cause of disability which is intimately related to a decrease in walking capacity. Walking limitation has negative physical and mental impacts on patients. Recent guidelines recommend the use of conservative treatment options such as exercises before considering surgery. Unfortunately, dedicated healthcare resources for the conservative management of patients with LSS causing NC are uncommon. Thus, it is important to develop accessible and specific rehabilitation programs aimed at improving patients’ self-management, especially with regard to walking capacity. The aim of this study is to evaluate the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC.Methods/designThis is a prospective randomized controlled parallel-group clinical trial. Sixty-six patients with LSS causing NC will be recruited from identified clinics and local advertisements. The intervention group will receive standardized education and specific exercises while the control group will only receive a standardized education. The program in both groups will last for 6 weeks with 5 evaluation time points (baseline, week 2, week 4, week 6, and week 12). The primary outcome will be walking capacity measured with the Self-Paced Walking Test, and the secondary outcomes will be back and leg pain intensity, LSS-related disability, self-efficacy, level of physical activity, anxiety, depression, gait pattern characteristics, balance, and global perceived change.DiscussionThis study will assess the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC. By measuring objective gait pattern characteristics, the study will also provide new information about the impact of NC on gait pattern that could eventually improve the evaluation and the management of LSS.Trial registrationClinicalTrials.gov NCT05513326. Registered on August 22, 2022

Open Versus Closed Kinetic Chain Exercise: a Comparison of Walking Capacity in Chronic Post-Stroke Phase

ABSTRACTIntroduction: The chronic post-stroke phase is often accompanied by various sensory, cognitive, motoric, coordination, and balance impairments. Decreased strength and motoric control contribute to walkingcapacity in patients with stroke. Open Kinetic Chain (OKC) and Closed Kinetic Chain (CKC) were reported to improve strength, functional mobility and balance in the chronic post-stroke phase. However, there is aphysiologically differences between CKC and OKC exercise. This study aims to compare the result of two methods of progressive resistant training (PRT) on walking capacity in the chronic post-stroke phase.Methods: This study is a quasi-experimental pre- and post-controlled trial group design. Twenty subjects were randomized into two groups of equal size: the CKC group (n=10) and the OKC group (n=10). Therewas one subject from each group who dropped out at the end of the study. CKC and OKC groups were trained for 6 weeks. The walking capacity was measured with 2 Minutes Walking Test (2WMT).Results: 2WMT results showed improvement in both groups after 6 weeks of intervention, while CKC group show greater improvement in walking distance 56,17 ± 10,95  to 57,43 compared to OKC group57,04 ± 8,58 to 58,19 ± 8,77 (p&lt;0.002).Conclusions: This study shows CKC group showed slightly better improvement in walking capacity after 6 weeks of progressive resistance training compare to OKC group. However, there were no statisticallydifferences between the groups

Effects of adding high- vs low-intensity resistance training to endurance training in patients with heart failure: preliminary results of a randomized controlled trial

Abstract Background In current ESC/EAPC guidelines, adding resistance training to endurance training is advised for patients with heart failure (HF), but the optimal intensity of the resistance training is unknown (40–80% of 1RM is advised). Purpose To investigate the effects of high- vs low-intensity resistance training as an adjunct to endurance training on: aerobic capacity (primary outcome), walking capacity, muscle strength and quality of life in patients with HF. Methods Forty patients with HF were consecutively recruited in the cardiac rehabilitation center of the Hospital East-Limburg in Belgium. Patients were block-randomized (by age and sex) by an independent researcher to receive maximally 45 supervised sessions (3x/week) of high-intense (HI: 3 exercises, 3x12 repetitions, 55–70%1RM) or low-intense resistance training (LI: 3 exercises, 3x22 repetitions, 35–40%1RM) as an adjunct to endurance training (30 min/session; 50–75% VO2max). The aerobic capacity (VO2max) was measured by a blinded assessor with a ramp cardiopulmonary cycling test (+5–30W/min). Walking distance was assessed with a 6-minute walk test (6MWT), maximal strength with 1RM (leg-press, pull-down and dip), and quality of life with the Minnesota questionnaire. An unpaired t-test, Mann-Whitney U test or ANCOVA were used for between-group analysis, and paired t-test or Wilcox sign-rank test for the within-group analysis. Results Both groups had similar baseline characteristics and training adherence (HI vs LI; 20 vs 20 subjects; Age: 62±9 vs 59±13 years; Sex: 76% vs 79%male; BMI: 27±58 vs 29±4 kg/m2; LVEF: 35±10 vs 38±6%; Adherence: 33±10 vs 36±10 sessions; p&amp;gt;0.05). There were no adverse events. Both groups had significant within-group improvements in aerobic and walking capacity (VO2max: LI (n=20) vs HI (n=19), p≤0.010; 6MWT distance: p≤0.007) (Figure 1), but these improvements did not differ between groups (VO2max: p=0.855; 6MWT distance: p=0.854). The LI group improved significantly more in muscle strength than the HI group (dip and leg-press: p&amp;lt;0.001). Although the LI group significantly improved in the quality of life (Minnesota score reduction: p=0.028), the quality of life did not differ between groups (Minnesota score: p=0.756). Conclusions Both low-and high-intense resistance training are similarly beneficial for improving aerobic and walking capacity in patients with HF. Surprisingly, low-intense resistance training seems superior to high-intense training in improving muscle strength. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University

Three weeks of rehabilitation improves walking capacity but not daily physical activity in patients with multiple sclerosis with moderate to severe walking disability.

Patients with multiple sclerosis have low levels of physical activity. This is of concern because low activity levels are related to cardiovascular disease, poor walking ability, and reduced quality of life. The aim of this study was to evaluate the impact of rehabilitation on daily physical activity and walking capacity in patients with multiple sclerosis who have moderate to severe walking disability. This exploratory, observational study of 24 patients with multiple sclerosis examined daily physical activity, walking capacity and fatigue before and after 3 weeks of inpatient rehabilitation. Inpatient rehabilitation included physiotherapy (30-60 min, 5 times/week), strength and endurance training (30-45 min, 3-5 times/week), occupational therapy (30 min, 2-3 times/week), and neuropsychological training (30 min, 2 times/week). There were no specific interventions to target daily levels of physical activity. Daily physical activity did not change after rehabilitation (physical activity: effect size = -0.23, 95% confidence interval (95% CI) 0.02‒0.62). There were significant improvements in walking capacity (Two-Minute Walk Test: effect size = 0.74, 95% CI 0.31‒1.16, +17 m, 20.2%) and mobility (Timed Up and Go Test: effect size = 0.65, 95% CI 0.22‒1.07, ‒2.1 s, 14.9%). Motor and cognitive fatigue (Fatigue Scale for Motor: effect size = 0.56, 95% CI 0.14‒0.99 and Cognitive Functions: effect size = 0.44, 95% CI 0.01‒0.86) improved significantly after rehabilitation. Three weeks of rehabilitation improved walking capacity, but not daily physical activity, in patients with multiple sclerosis with moderate to severe walking disability. To increase physical activity, it may be necessary to add specific behavioural interventions to the rehabilitation programme. The intervention plan should include strategies to overcome personal and environmental barriers.

Core stability-based balance training and kinesio taping for balance, trunk control, fear of falling and walking capacity in patients with multiple sclerosis: A randomized single-blinded study

BackgroundTrunk performance-based therapies are important in the Multiple Sclerosis (MS) rehabilitation process since they have been associated with balance, trunk performance, fall prevention, and walking capacity. Kinesio taping (KT) is a popular approach that has recently been used to treat a variety of musculoskeletal and neuromuscular impairments. Therefore, the aim of this single-blind, randomized controlled study was to investigate the effects of KT combined trunk stabilization-based balance training on balance, trunk control, walking capacity, and fear of falling in patients with MS. Material and methodsThirty patients diagnosed with MS were randomly assigned to the KT group or the control group. The control group received core stability-based balance training and the KT group was treated with KT applied on global trunk muscles in addition to core stability-based balance training. Balance was measured with the Mini BESTest, trunk control with the Trunk Impairment Scale, fear of falling with the Falls Efficacy Scale and walking capacity with the 2-minute walk test. ResultsBalance, trunk control, fear of falling, and walking capacity of all the patients improved after treatment (p < 0.05). No superiority was found between the groups in terms of treatment efficacy (p > 0.05). ConclusionIn conclusion, core stability-based balance training was effective in patients with MS, and the addition of KT had no additional effect in terms of balance, trunk control, fear of falling, and walking capacity.

Predictors of walking capacity in patients with peripheral arterial disease.

Walking capacity is severely impaired in patients with peripheral arterial disease (PAD). Given the prognostic importance of walking capacity, the level of evidence on possible predictors of walking capacity in patients with PAD is insufficient. To investigate the predictors of walking capacity in patients with PAD. A total of 51 patients with PAD were included in this cross-sectional study. Walking capacity was determined with 6‑minute walk test (6MWT) and walking impairment questionnaire (WIQ). Functional mobility was assessed with repeated sit-to-stand test (RSS) and timed up and go test (TUG). Hand-held dynamometer was used to measurement lower extremity muscle strength. Balance was assessed with Biodex Balance System-limit of stability (BBS-LOS). Fatigue was evaluated with fatigue impact scale (FIS). There was astrong correlation between 6MWT walking distance and WIQ, two methods of assessing walking capacity (r = 0.835 p < 0.001). The 6MWT was correlated with RSS, TUG, lower extremity muscle strength, BBS-LOS and FIS. The WIQ was correlated with RSS, TUG, BBS-LOS and FIS. The RSS and FIS were independent determinants of the 6MWT and WIQ, accounting for 68% and 57% of the variance, respectively. This study demonstrated that functional mobility and fatigue were independent predictors of walking capacity in patients with PAD. Both subjective and objective measurement methods can be used for determining the level of walking capacity in the patients with PAD.

Manual therapy and canal enlargement exercises versus conventional physiotherapy in lumbar stenosis – a study protocol

INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as ‘Neurogenic Claudication’ (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy &amp; Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), Antero-Posterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.

Effect of frailty on physical activity levels and walking capacity in patients with peripheral artery disease: A cross-sectional study

BackgroundThis study aimed to analyze the effect of frailty on walking capacity and physical activity levels of patients with peripheral artery disease (PAD). MethodsA cross-sectional study including 216 symptomatic PAD patients (e.g. claudication) was conducted. Moreover, the frailty profile was established, for which six-minute walk test, Walking Impairment Questionnaire (WIQ), and physical activity level were evaluated. ResultsFrailty was prevalent in 13.4%, 72.2%, and 14.4% of frail, pre-frail, and not-frail patients, respectively. Walking capacity was lower in frail patients than in not-frail patients (p < 0.024). The domains of distance and speed of WIQ were lower in frail patients than in not-frail patients, and these domains were also lower in pre-frail than in not-frail patients (p < 0.050 for all). The domain of stairs was lower in frail patients than in not-frail and pre-frail patients (p = 0.016). Physical activity levels were similar among groups (p > 0.050). ConclusionFrailty is associated with further walking impairment in patients with PAD.

Effect of Transcutaneous Spinal Direct Current Stimulation (TsDCS) Combined with Other Therapies on Walking Capacity in Patients with Neurological Disorders: A Systematic Review

Effect of Transcutaneous Spinal Direct Current Stimulation (TsDCS) Combined with Other Therapies on Walking Capacity in Patients with Neurological Disorders: A Systematic Review

Body mass-normalized moderate dose of dietary nitrate intake improves endothelial function and walking capacity in patients with peripheral artery disease.

Peripheral artery disease (PAD) is characterized by the accumulation of atherosclerotic plaques in the lower extremity conduit arteries, which impairs blood flow and walking capacity. Dietary nitrate has been used to reduce blood pressure (BP) and improve walking capacity in PAD. However, a standardized dose for PAD has not been determined. Therefore, we sought to determine the effects of a body mass-normalized moderate dose of nitrate (0.11 mmol nitrate/kg) as beetroot juice on serum nitrate/nitrite, vascular function, walking capacity, and tissue oxygen utilization capacity in patients with PAD. A total of 11 patients with PAD received either nitrate supplement or placebo in a randomized crossover design. Total serum nitrate/nitrite, resting BP, brachial and popliteal artery endothelial function (flow-mediated dilation, FMD), arterial stiffness (pulse-wave velocity, PWV), augmentation index (AIx), maximal walking distance and time, claudication onset time, and skeletal muscle oxygen utilization were measured pre- and postnitrate and placebo intake. There were significant group × time interactions (P < 0.05) for serum nitrate/nitrite, FMD, BP, walking distance and time, and skeletal muscle oxygen utilization. The nitrate group showed significantly increased serum nitrate/nitrite (Δ1.32 μM), increased brachial and popliteal FMD (Δ1.3% and Δ1.7%, respectively), reduced peripheral and central systolic BP (Δ-4.7 mmHg and Δ-8.2 mmHg, respectively), increased maximal walking distance (Δ92.7 m) and time (Δ56.3 s), and reduced deoxygenated hemoglobin during walking. There were no changes in PWV, AIx, or claudication (P > 0.05). These results indicate that a body-mass normalized moderate dose of nitrate may be effective and safe for reducing BP, improving endothelial function, and improving walking capacity in patients with PAD.

Effects of structured home-based exercise training on circulating endothelial progenitor cells and endothelial function in patients with intermittent claudication.

Exercise training improves walking capacity in patients with intermittent claudication (IC). Endothelial progenitor cells (EPCs), endothelial microparticles (EMPs), and endothelial dysfunction could play a role in this process. We measured EPCs and EMPs in a group of 60 patients with IC, and in a control group of 20 individuals without IC, before a treadmill test and 2, 24, and 48 hours after the test. Thirty patients with IC were randomly assigned to perform a 12-week home-based exercise training program. The EPC count, flow-mediated dilation (FMD) of the brachial artery, pain-free walking time (PFWT), and maximum walking time (MWT) were measured at the baseline and after the exercise training program. In patients with IC, EMPs significantly increased 2 hours after the treadmill test, whereas EPCs significantly increased after 24 hours. Among the subjects assigned to complete the training program, we observed a significant increase in the number of EPCs after 12 weeks, as well as an improvement in FMD, PFWT, and MWT. A significant correlation between the variation of EPCs, FMD, and MWT was found. The increase of EPCs and FMD were independent determinants of the walking capacity improvement, without significant interaction. Our results suggest that EPCs mobilization contributes to the improvement of walking capacity in patients with IC undergoing structured physical training. A number of different, partly independent, mechanisms are involved in this process, and our results highlight the potential role of EMPs release and endothelial function improvement. ClinicalTrials.gov Identifier: NCT04302571.