Cardiac rehabilitation in patients with peripheral arterial disease after revascularization

Abstract

Objectives To evaluate safety, feasibility, and benefit of cardiac rehabilitation (CR) in patients with peripheral arterial disease (PAD) who undergo revascularization. Methods We conducted a prospective, non-randomized, pilot study to assess the feasibility, safety, and benefit of CR in PAD patients after revascularization compared to standard of care (controls). CR feasibility was assessed by the ability to complete 36 sessions. Safety was defined as the absence of adverse cardiovascular events during CR. Quality of life (QoL) assessment was performed using SF-36 form (Medical Outcomes Study 36-Item Short-Form Health Survey) and PAD-specific quality of life questionnaire (VascuQOL6). Other endpoints included incidence of claudication during 6-minute walk test (6MWT), mean distance, and number of laps walked. All outcome data were collected before and after CR completion. Standard statistical tests were used for comparisons. Results This study enrolled 20 subjects (CR group = 10). Mean age was 60.70 (±7.13) and 63.1 (±9.17) years in CR and controls, respectively ( p-value > 0.05). Fifty percent and 60% were female in CR and control group, respectively. All subjects completed 36 CR sessions without adverse events. The increase in mean distance walked during 6MWT was higher in the CR group compared to control group (63.7 m vs. 10.5 m, p = 0.043). Change in mean number of laps walked was higher in the CR group (3.5 vs. –1.1; p < 0.01). Scores on 6 of 8 scales of SF-36 and VascuQOL6 were higher in the CR group, though not statistically significant. Conclusion CR is safe, feasible, and improves walking ability in ambulatory patients with PAD after arterial revascularization.

Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal

“…Besides that, patients who were not enrolled in CR reported concomitant medical problems (28%), namely musculoskeletal problems (15%), as a common barrier to CR. Thus, personalized programs more adapted to these medical limitations could address this major barrier and promote CR adherence [ 12 , 50 , 51 , 52 ].…”

Cardiac Rehabilitation in Patients with Peripheral Artery Disease—A Literature Review in COVID-19 Era

“…No statistically significant differences were identified between the two groups in terms of treadmill walking ability or perimeter walking without IC. It is noteworthy that the study had an overall dropout rate of 23% in the home exercise group and 28% in the supervised treadmill exercise group, pointing difficulties in terms of adherence for PAD patients especially during COVID-19 pandemic [76,79,[81][82][83][84].…”

“…They also identified that increases in the distances to onset and to maximal claudication pain during treadmill exercise are independently related to three essential parts of a CR program which can be considered predictors of the changes in claudication pain distances: claudication pain end point used during the exercise training program, the length of the program and the type of exercise. Based on the results from the metaregression analysis, Gardner et al concluded that the most effective exercise programs for patients with PAD include 3 sessions per week, 30 min each, at intensity close to the point of maximum or near-maximum pain onset during exercise for at least 6 months [76,79].…”

“…Home-based walking exercises are more accessible and easier to accept for PAD patients. Regardless of the presence or absence of symptoms, they improve both treadmill walking performance and walk distance in the 6MWT [76,79,81,82]. Furthermore, the benefits of home-based walking sessions in improving both walking capacity and the 6MWT parameters, compared to supervised treadmill exercise programs, have been proved since 2011 through several randomized trials.…”

“…Even so, trials demonstrated that walking until the onset of intermittent claudication is also beneficial. Rest breaks are acceptable for PAD patients, with the recommendation to resume walking exercise as soon as leg pain has subsided (Table 3) [76,79,[81][82][83][84]. Collins et al also investigated the role of behavioral intervention methods on the adherence of PAD patients to home-based exercise programs.…”