A “test in‐train out” program versus a “go home and walk” intervention for home‐based exercise therapy in patients with peripheral artery disease: A randomized controlled trial

Manfredini, Fabio; Traina, Luca; Ficarra, Valentina; Gandolfi, Giorgio; Argentoni, Antonio; Straudi, Sofia; Gasbarro, Vincenzo; Lamberti, Nicola

doi:10.1111/sms.14584

Cited by 4 publications

(2 citation statements)

References 51 publications

(167 reference statements)

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“…The Ex group was also characterized by fewer vascular procedures than the revascularization group, probably due to the systemic effect of the structured exercise. In particular, the TiTo program, administered to the subjects in the present study, was found to be effective at determining hemodynamic peripheral adaptations in the arteries of both the lower and upper limbs [ 40 , 41 , 42 , 43 , 44 ], resulting in a low revascularization rate 3 years after discharge from the program [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

To Treat or not to Treat? The Fate of Patients with Intermittent Claudication Following Different Therapeutic Options

Tsolaki,

Traina,

Savriè

et al. 2024

Rev. Cardiovasc. Med.

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Background: Peripheral artery disease (PAD) is recognized as a significant contributor to the public health burden in the cardiovascular field and has a significant rate of morbidity and mortality. In the intermediate stages, exercise therapy is recommended by the guidelines, although supervised programs are scarcely available. This single-center observational study aimed to evaluate the long-term outcomes of patients with PAD and claudication receiving optimal medical care and follow-up or revascularization procedures or structured home-based exercise. Methods: The records of 1590 PAD patients with claudication were assessed at the Vascular Surgery Unit between 2008 and 2017. Based on the findings of the recruitment visit, patients were assigned to one of the three following groups according to the available guidelines: Revascularization (Rev), structured exercise therapy (Ex), or control (Co). The exercise program was prescribed at the hospital and executed at home with two daily 10-minute interval walking sessions at a pain-free speed. The number and date of deaths, all-cause hospitalizations, and peripheral revascularizations for 5 years were collected from the Emilia-Romagna regional database. Results: At entry, 137 patients underwent revascularization; 1087 patients were included in the Ex group, and 366 were included in the Co group. At baseline, patients in the Rev group were significantly younger and had fewer comorbidities ( p 0.001). A propensity score matching analysis was performed, and three balanced subgroups of 119 patients were each created. The mortality rate was significantly ( p 0.001) greater in the Co (45%) group than in the Rev (11%) and Ex (11%) groups, as was the incidence of all-cause hospitalizations (Co: 95%; Rev 56%; Ex 60%; p 0.001). There were no differences in peripheral revascularizations (Co: 19%; Rev: 17%; Ex 11%). Conclusions: In PAD patients with claudication, both revascularization procedures and structured home-based exercise sessions are associated with better long-term clinical outcomes than walking advice and follow-up only.

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Section: Discussionmentioning

confidence: 99%

To Treat or not to Treat? The Fate of Patients with Intermittent Claudication Following Different Therapeutic Options

Tsolaki,

Traina,

Savriè

et al. 2024

Rev. Cardiovasc. Med.

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“…Furthermore, considering a minimal clinically important difference for walking speed set at 20%, Straudi et al observed that most of the responders were PwMS that walked slower at the pretreatment assessment. 14 Benefits of low-intensity training at progressively increasing intensity have also been observed in PwMS when empowered by blood flow restriction, 15 muscular and haemodynamic responses in diseases such as peripheral arterial disease, [16][17][18] stroke 19 20 and dialysis patients. [21][22][23] From a neurological point of view, there is limited information regarding the mechanisms of cerebral reorganisation after gait rehabilitation using RAGT.…”

Section: How This Study Might Affect Research Practice or Policymentioning

confidence: 99%

Traditional versus progressive robot-assisted gait training in people with multiple sclerosis and severe gait disability: study protocol for the PROGR-EX randomised controlled trial

Baroni,

Lamberti,

Gandolfi

et al. 2024

BMJ Open Sport Exerc Med

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Gait disorders are the most frequent symptoms associated to multiple sclerosis (MS). Robot-assisted gait training (RAGT) in people with MS (PwMS) has been proposed as a possible effective treatment option for severe motor disability without significant superiority when compared to intensive overground gait training (OGT). Furthermore, RAGT at high intensity may enhance fatigue and spasticity. This study aims to evaluate the effects of a low-intensity RAGT at progressively increasing intensity compared to conventional RAGT and OGT in PwMS and moderate to severe walking impairment. 24 PwMS will be recruited and assigned to one of the three treatment groups: low-intensity RAGT at progressively increasing intensity, conventional RAGT and OGT. All participants will receive 3-weekly treatment sessions of 3 hours each for 4 weeks. In the first 2 hours of treatment, all participants will receive a rehabilitation programme based on stretching exercises, muscle strengthening and educational interventions. During the last hour, subjects will undergo specific gait training according to the assignment group. Outcomes will be assessed before and after treatment and at 3-month follow-up. The primary outcome is walking speed. Secondary outcomes include mobility and balance, psychological measures, muscle oxygen consumption, electrical and haemodynamic brain activity, urinary biomarkers, usability, and acceptability of robotic devices for motor rehabilitation. The results of this study will provide a safe, affordable and non-operator-dependent, intervention for PwMS. Results in terms of functional, psychological, neurophysiological and biological outcomes will confirm our hypothesis. The study’s trial registration number:NCT06381440.

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Exercise, Dialysis, and Environment: A Narrative Review in an Ecological Perspective

Piva,

Storari,

Battaglia

et al. 2024

Kidney Blood Press Res

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Patient empowerment and environmental sustainability may contribute to creating efficient and resilient healthcare models. Chronic kidney diseases call for a sustainable approach aimed to improve physical function and mental health of patients and possibly to contribute to the slowing down of the evolution towards the end stage of renal disease (ESRD) with a reduction of the environmental and economic impact . Summary Multidisciplinary interventions should be implemented particularly at the final stages when patients are exposed to sedentariness, reduced health-related quality of life (HR-QoL), high cardiovascular morbidity and mortality and the health care services to high costs and participation in environmental pollution. Ecological strategies based on specific nutritional approaches, exercise and environment should be designed and tested. In particular, introduction to physical exercise represents a useful replacement therapy to counteract the hazards derived from the sedentary behavior of ESRD patients, being low physical function associated with poor clinical outcomes. A more active and healthy lifestyle, particularly in the natural environment, could impact on HR-QoL, mental and physical wellbeing but also on socialization, with lower levels of anxiety and fatigue stress. Otherwise the combination of sustainable models of exercise into the patients' daily routine can be enhanced by the biophilic design called to reproduce a natural environment in the dialysis center. Finally, the involvement of the personnel and of the health professionals to properly manage the exercise interventions and the related factors (location, modality, dose, intensity and duration) might improve the patients’ participation. In particular, ecological programs should be broadly inclusive aimed to target the lowest performing populations through minimal feasible doses of exercise. Key Messages Moving towards an ecological framework of lifestyle change, in the very advanced stages of kidney disease the potential synergies between environment, diet, and exercise may improve the physical and mental health of the patients and reduce the impact of dialysis.

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A “test in‐train out” program versus a “go home and walk” intervention for home‐based exercise therapy in patients with peripheral artery disease: A randomized controlled trial

Cited by 4 publications

References 51 publications

To Treat or not to Treat? The Fate of Patients with Intermittent Claudication Following Different Therapeutic Options

To Treat or not to Treat? The Fate of Patients with Intermittent Claudication Following Different Therapeutic Options

Traditional versus progressive robot-assisted gait training in people with multiple sclerosis and severe gait disability: study protocol for the PROGR-EX randomised controlled trial

Exercise, Dialysis, and Environment: A Narrative Review in an Ecological Perspective

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