Multimodal Supervised Exercise Significantly Improves Walking Performances Without Changing Hemodynamic Parameters in Patients With Symptomatic Lower Extremity Peripheral Artery Disease

Abstract

We evaluated the outcome of multimodal supervised exercise training (SET) on walking performances and different hemodynamic parameters (ankle/toe-brachial index [ABI/TBI], and transcutaneous oxygen pressure [TcPO2]) in patients with symptomatic lower extremity peripheral artery disease (PAD). Whether hemodynamic parameters predict walking performances at baseline and following SET was also investigated. Fontaine stage II PAD’s patients following a 3-month SET were retrospectively included. Hemodynamic parameters and walking performances (pain-free [PFWD], maximal [MWD], and 6-minute [6MWD] walking distance) were measured in each patient. Eighty-five symptomatic PAD patients were included. Following SET, PFWD, MWD, and 6MWD significantly increased (+142%, +94%, +14%; respectively; P ≤ .001). Toe-brachial index significantly increased (MD: 0.04 ± 0.01; P = .02), whereas ABI and TcPO2 did not change significantly. At baseline, patients with higher TBI and TcPO2 performed significantly better (PFWD: β = 0.25, P = .01 for TBI; PFWD: β = 0.30, P = .005, and MWD: β = 0.22, P = .04, for TcPO2). No significant relationship was observed at baseline between ABI and walking performances. Baseline values of hemodynamic parameters did not significantly correlate with changes in walking performances. Multimodal SET significantly improves walking performances. Following SET, no significant changes in ABI and TcPO2 were observed. Toe-brachial index values significantly improved after SET. However, this increase was very modest and its clinical relevance remains questionable. Although baseline TBI and supine TcPO2 values predict baseline walking performances, no association was found between baseline hemodynamic parameters and changes in walking performances following SET.

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

“…However, in our study, we observed that ABI was significantly increased at 6 months compared with the post SET values (mean difference: 0.06). In addition, as we already showed elsewhere [ 16 ], TBI increased significantly following SET (mean difference 0.04). Surprisingly, the values remained significantly higher at each following endpoint.…”

“…Past studies have abundantly proved the effectiveness of SET on walking performance in patients with claudication [ 8 , 11 , 12 , 13 , 16 , 22 , 23 , 24 ]. In agreement with these studies, our results show an improvement in walking capacities assessed by PFWD, MWD, and by 6MWD after a 3-month SET.…”

“…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].…”

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.…”