Gender differences following supervised exercise therapy in patients with intermittent claudication

Gommans, Lindy N.M.; Scheltinga, Marc R.; Sambeek, Marc R.H.M. van; Maas, Angela H.E.M.; Bendermacher, B.L.; Teijink, Joep A.W.

doi:10.1016/j.jvs.2015.03.076

Cited by 49 publications

(50 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…SET improved walking, haemodynamic, and metabolic outcomes in home or clinical settings using treadmills or other calf‐muscle flexing interventions, but not using stretching exercises . Structured exercise programmes generated more improvement in PAD‐related walking and QOL than non‐structured exercise or exercise advice alone, doubling pain‐free and maximum walking distance for both men and women in 3 months with men experiencing greater gains …”

Section: Resultsmentioning

confidence: 99%

“…For those with severe PAD, significant walking improvements were reported for up to 7 years for those receiving SET (6 studies treating 364 patients) and/or invasive ER . Three studies improved walking outcomes for 48 patients with severe PAD receiving autologous stem cells compared with controls High IPC improved peak walking time ( P < .04) compared with 20 minutes of daily walking after patients with severe PAD received 16 weeks of treatment, with each intervention increasing peak walking time from 4 weeks onwards …”

Section: Resultsmentioning

confidence: 99%

“…Each intervention is followed by the number of studies supporting its beneficial effects on patients with PAD (number of subjects receiving the intervention) [Color figure can be viewed at wileyonlinelibrary.com] generated more improvement in PAD-related walking and QOL than non-structured exercise or exercise advice alone, 23 doubling pain-free and maximum walking distance for both men and women in 3 months with men experiencing greater gains. 59…”

Section: Improved Walking Distance (44 Studies On 2109 Patients)mentioning

confidence: 99%

See 2 more Smart Citations

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

View full text Add to dashboard Cite

Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD. Key Messages• Peripheral arterial disease (PAD) progresses in severity from impaired walking and quality of life (QOL) through increasing likelihood of pain, ulceration, gangrene, amputation, or death and magnifies clinical, economic, and patient burdens of venous insufficiency or diabetes • improving PAD-related patient-centred outcomes requires consistent early, effective PAD diagnosis and effective treatment to improve lower limb perfusionAbbreviations: ABI, ankle-to-brachial systolic blood pressure index (ratio), optimally performed using handheld Doppler ultrasound; ALU, arterial leg ulcers; CLI, critical limb ischaemia; DAPT, dual antiplatelet therapy, for example, aspirin plus low molecular weight heparin; DFU, diabetic foot ulcers; ER, endovascular revascularisation; HBO, hyperbaric oxygen; IC, intermittent claudication; IPC, intermittent pneumatic compression of the calf muscle; MLU, mixed aetiology leg ulcers complicated with peripheral arterial disease; NMES, neuromuscular electrical stimulation sufficient to cause contraction of the calf muscle; PAD, peripheral arterial disease; PPG, photoplethysmography a technique for measuring venous emptying; QOL, quality of life; RCT, randomised clinical trial; SET, structured exercise therapy supervised by a professional; SOC, standard of care; TcPO 2 , transcutaneous partial pressure of oxygen; VLU, venous leg ulcer.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Improved Walking Distance (44 Studies On 2109 Patients)mentioning

confidence: 99%

See 1 more Smart Citation

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

View full text Add to dashboard Cite

show abstract

“…Pre-existing collaterals improve the prognosis in patients with ischemic diseases, but some patients never develop angiographically-identifiable collateral vessels [3,4,5,8,9]. Additionally, females appear to have a worse prognosis than males for peripheral arterial occlusive disease (PAOD) [64,65,66], possibly due to impaired collateral development [70]. Collateral vessels develop through arteriogenesis in response to increased shear stress that triggers a cascade of events involving endothelial cell activation, macrophage recruitment, matrix degradation, and smooth muscle/endothelial cell proliferation.…”

Section: Discussionmentioning

confidence: 99%

“…For example, women do not seem to respond to treatment as well as men. There is a higher incidence of wound complications after bypass grafting in women [64], a higher rate of hospital mortality [65], and less positive results from exercise treatment than in males [66]. Additionally, females with PAOD appear to have a worse prognosis than males, with a shorter walking distance [67], and a higher rate of critical limb ischemia [68].…”

Section: Introductionmentioning

confidence: 99%

The Impacts of Sex and Myogenic Cell Transplantation on Collateral Capillary Arteriogenesis

Sivesind

View full text Add to dashboard Cite

Current treatments for peripheral arterial occlusive disease (PAOD), including angioplasty and bypass grafting fail in up to 25% of patients, or are not indicated in up to 50%, so there is a need to develop additional treatment options. Patients with native collaterals have a better prognosis, so a treatment such as cell transplantation that promotes collateral arteriogenesis is a potential PAOD treatment. Unfortunately, bone marrow derived stem cells, the main cell type that has been investigated, have limited clinical effectiveness in enhancing pre‐existing collateral growth. Therefore, delivering a stem cell type native to the collateral‐containing tissue, such as myogenic stem cells, could have improved outcomes. Additionally, about 20% of patients never develop collaterals, and no one, to our knowledge, has evaluated the effect of cell therapy on collateral capillary arteriogenesis (CCA), which can reperfuse ischemic tissue in animals without native arteriolar collaterals and therefore represents a potential therapeutic target in patients who lack native collaterals. To test the hypothesis that myogenic cells enhance CCA, we ligated the spinotrapezius feed artery in Balb/C mice to induce CCA, and delivered myogenic cells, thrombin (positive control), or vehicle to the muscle. Seven days post ligation, ‐‐‐‐arterialized collateral capillary (ACC) number and diameter were determined. As expected, thrombin increased ACC number, but myogenic cells had no effect, 9.3 ± 0.5 vs 7.1 ± 0.4, respectively. However, myogenic cells increased ACC diameter as compared to untreated (12.1 ± 0.8 μm vs 10.3 ± 0.3 μm, respectively) and both myogenic cells and thrombin increased the maximum ACC diameter (29.9 ± 3.4 μm and 27.9 ± 2.0 μm vs 18.8 ± 1.1 μm, respectively). These results are consistent with previous studies indicating that thrombin enhances arteriogenesis and suggest that myogenic cells have a similar effect, but likely without the deleterious pro‐inflammatory effects of thrombin. Because myogenic cells increase arteriogenesis and macrophages are an essential part of arteriogenesis, we also tested the hypothesis that myogenic cells increase macrophage content by performing CD68 staining. Although macrophage number increased following ligation, neither myoblasts nor thrombin further increased macrophage number. The lack of difference in macrophage number despite enhanced CCA could be because the day‐7 timepoint was too late, as macrophages peak around day‐3, or because a shift towards either classically‐activated macrophages or alternatively‐activated macrophages, which have a greater effect on arteriogenesis, would not be detected by the CD68 stain. Therefore, future studies may include a day‐3 timepoint and a stain for alternatively‐activated macrophages. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

show abstract

Exercise for intermittent claudication

Lane

Harwood

Watson

et al. 2017

Cochrane Database of Systematic Reviews

337

169

View full text Add to dashboard Cite

Background Exercise programmes are a relatively inexpensive, low-risk option compared with other, more invasive therapies for treatment of leg pain on walking (intermittent claudication (IC)). This is the fourth update of a review first published in 1998. Objectives Our goal was to determine whether an exercise programme was effective in alleviating symptoms and increasing walking treadmill distances and walking times in people with intermittent claudication. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events, and improving quality of life. Search methods For this update, the Cochrane Vascular Information Specialist searched the Specialised Register (last searched 15 November 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10) via the Cochrane Register of Studies Online, along with trials registries. Selection criteria Randomised controlled trials of an exercise regimen versus control or versus medical therapy for people with IC due to peripheral arterial disease (PAD). We included any exercise programme or regimen used for treatment of IC, such as walking, skipping, and running. Inclusion of trials was not affected by duration, frequency, or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximum walking distance), ankle brachial index (ABI), quality of life, morbidity, or amputation; if none of these was reported, we did not include the trial in this review. Data collection and analysis For this update (2017), RAL and AH selected trials and extracted data independently. We assessed study quality by using the Cochrane 'Risk of bias' tool. We analysed continuous data by determining mean differences (MDs) and 95% confidence intervals (CIs), and dichotomous data by determining risk ratios (RRs) and 95% CIs. We pooled data using a fixed-effect model unless we identified significant heterogeneity, in which case we used a random-effects model. We used the GRADE approach to assess the overall quality of evidence supporting the outcomes assessed in this review.

show abstract

Gender differences following supervised exercise therapy in patients with intermittent claudication

Abstract: Women with IC benefit less during the first 3 months of SET and have lower absolute walking distances after 12 months of follow-up compared with men. More research is needed to determine whether gender-based IC treatment strategies are required.

Cited by 49 publications

References 41 publications

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Peripheral arterial disease: Scoping review of patient‐centred outcomes

The Impacts of Sex and Myogenic Cell Transplantation on Collateral Capillary Arteriogenesis

Exercise for intermittent claudication

Contact Info

Product

Resources

About