Gait changes after supervised exercise training in patients with symptomatic lower extremity peripheral artery disease

Abstract

This study aimed to investigate the effects of supervised exercise training (SET) on walking performance and spatiotemporal gait changes in patients with symptomatic lower extremity peripheral artery disease (PAD). In this single-arm prospective nonrandomized cohort study, patients with Fontaine stage II PAD following a 3-month SET program were included. Before and after SET, a constant-load treadmill test was performed to determine the pain-free and maximal walking distances (PFWD and MWD, respectively). During this test, spatiotemporal gait parameters were assessed. The ankle–brachial index (ABI) and toe–brachial index (TBI) were also measured. Twenty-seven patients with PAD (64.0 ± 1.9 y, 74% men) were included. Following SET, the PFWD (+68%; p = 0.001) and MWD (+79%; p ⩽ 0.001) significantly increased. The ABI and TBI did not change significantly. Following SET, the stride duration, stride frequency, stride length, and double support phase duration did not change significantly. In contrast, subphases of stance showed significant changes: the loading response (+8%; p = 0.03) and foot-flat (+2%; p = 0.01) phases were significantly longer, whereas the push-off phase (–7%; p = 0.002) was significantly shorter. A significant positive correlation was found between changes in the foot-flat phase and changes in PFWD ( r = 0.43, p = 0.03). A significant negative correlation was found between changes in the push-off phase and changes in PFWD ( r = −0.39, p = 0.05). No significant correlations were found between changes in relative durations of the subphases of stance and MWD. These results indicate that changes in temporal gait parameters during the foot contact phase potentially constitute an underlying mechanism of delayed claudication distance in patients with symptomatic PAD.

Improvement in 6-Minute Walking Distance after Supervised Exercise Training Is Related to Changes in Quality of Life in Patients with Lower Extremity Peripheral Artery Disease

“…The Angiofit study is a longitudinal observational cohort of symptomatic patients (Fontaine stage II) participating in multimodal SET with stable uni- or bilateral lower limb claudication and resting ankle-brachial index (ABI) ≤ 0.9 or decreased post-exercise ABI > 20%. We recently showed that our clinical multimodal SET is effective in improving walking performance and quality of life [ 18 , 19 , 20 ] and that these improvements are maintained up to 12 months follow-up in patients with symptomatic PAD [ 20 ]. Compared to these previous observations [ 18 , 19 , 20 ], in the present study we included all patients participating in our clinical SET program up to 2020, having performed walking tests (treadmill and 6 min) and self-perceived HRQoL questionnaire.…”

“…We recently showed that our clinical multimodal SET is effective in improving walking performance and quality of life [ 18 , 19 , 20 ] and that these improvements are maintained up to 12 months follow-up in patients with symptomatic PAD [ 20 ]. Compared to these previous observations [ 18 , 19 , 20 ], in the present study we included all patients participating in our clinical SET program up to 2020, having performed walking tests (treadmill and 6 min) and self-perceived HRQoL questionnaire. Exclusion criteria are inability to participate in SET three times weekly, critical limb ischemia, and cardiac contraindication to exercise.…”

“…The clinical multimodal SET program was coordinated by an angiologist and directly supervised by an exercise physiologist (SL), as recently described elsewhere [ 18 , 19 , 20 ]. SET consisted of 36 sessions lasting 30–60 min, spread over a 3-month period (3x/week).…”

“…SET consisted of 36 sessions lasting 30–60 min, spread over a 3-month period (3x/week). Twice weekly, patients performed outdoor Nordic walking, and once weekly indoor circuit training focused on strengthening of lower limbs [ 18 , 19 , 20 ]. During Nordic walking sessions, patients were encouraged to exercise until development of moderate-severe claudication before resting [ 11 ].…”

Multimodal Supervised Exercise Training Is Effective in Improving Long Term Walking Performance in Patients with Symptomatic Lower Extremity Peripheral Artery Disease

“…The multimodal SET consisted of three 50-min sessions per week over a 3-month period (for a total of 36 sessions) and was coordinated by a vascular physician, and all sessions were supervised by a clinical exercise physiologist specialist in vascular rehabilitation [16,17].…”