Exercise-based interventions and health-related quality of life in intermittent claudication: a 20-year (1989–2008) review

Abstract

Peripheral arterial disease (PAD) is a chronic, progressive disease with significant cardiovascular risk. Symptoms include pain in leg muscles on walking, relieved by rest (intermittent claudication). Treatment aims to maintain or improve quality of life (QoL) by minimising ischaemic symptoms and preventing progression to vascular occlusion. Management strategies include exercise-based interventions. Research from 1989 to 2008 was systematically reviewed to identify the QoL impact of exercise-based interventions in patients with intermittent claudication. Twenty-three studies were identified. Five were randomized controlled trials. Studies were summarized in terms of exercise interventions, QoL measures used and QoL findings. The majority used a generic QoL instrument; most commonly the Short Form Health Survey (SF-36). Eleven studies reported beneficial effects on the SF-36 Physical Functioning scale. Some also reported positive effects on the scales of Bodily Pain, Role-Physical, Vitality, General Health and the Physical Component Score. In seven studies, a disease-specific measure was used. In six of these, both generic and disease-specific questionnaires were used. Diseasespecific measures demonstrated greater improvements across a range of QoL domains. Greater use of disease-specific measures and an extended follow-up period may enable a more definitive picture to emerge regarding effects of exercise on QoL in intermittent claudication.

Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community

“…We hypothesized that lower ABI value, including borderline low ABI (ABI <1.00),19 would be comprehensively associated with reduced health‐related QOL in community‐dwelling older adults. Some people (particularly as they age) may value QOL relatively more than merely survival, and PAD‐specific management (eg, supervised exercise, pharmacotherapy, and revascularization) has been shown to improve QOL in some patients 20, 21. Thus, our findings may have clinical and public health implications.…”

Exercise Training and Peripheral Arterial Disease

“…There are several comprehensive meta analyses (69, 88, 290, 304, 326, 738, 985), exhibiting some overlap in studies evaluated, and a host of excellent reviews presenting various aspects of exercise training in patients with PAD that should be consulted (108, 127, 133, 290, 304, 336, 578, 597, 618, 699, 728, 743, 744, 748, 764, 886–888, 985). The wealth of this information and attention reveals the extensive clinical interest in the myriad of biological responses to exercise that can impart potential benefits to patients with PAD.…”

“…These are most easily identified as those domains related to physical health, level of independence, pain and discomfort, energy and fatigue, mobility and activities of daily living (90). Thus, patients with PAD exhibit substantial impairment, often related to the severity of disease, in: physical index, including mobility, recreation, and work deficits; body care; sleep and rest; psychosocial index, social interactions; and even a small impact on depression (326, 881, 900). The dominance of reduced quality of life index based primarily upon physical condition, with the resultant impact that can have on mobility, leisure time activities, level of independence, fatigue, potential social interactions, raises the expectation that improved activity tolerance induced by exercise training can have a major influence on the overall quality of life of the patients with PAD.…”

The role of nutrition and body composition in peripheral arterial disease

“…Although defined as atherosclerosis of the abdominal aorta and arteries outside the heart, the term PAD is most commonly used to describe arterial disease of the infrarenal aorta and the lower extremities. 2 PAD is as common, but not as well known, as the other components of the cardiovascular disease burden, and is associated with an equal or higher risk of morbidity and fatal cardiovascular events, and a higher health economic cost, than coronary or stroke syndromes. 3,4 In the US population, PAD affects 4–14% of individuals aged 50–80 years.…”