Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease

Mazari, Fayyaz; Khan, Junaid; Carradice, Daniel; Samuel, Nehemiah; Rahman, Mohd Norhisham Azmi Abdul; Gulati, Sumit; Lee, H L D; Mehta, Tapan; McCollum, P.T.; Chetter, Ian

doi:10.1002/bjs.7710

Cited by 120 publications

(81 citation statements)

References 38 publications

(85 reference statements)

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“…Em todos os estudos o processo de randomização foi descrito e em 10 ECR a sequência de alocação foi descrita [25][26][27][28][29][30]33,35,37,42]. O processo de cegamento dos participantes, cuidadores e avaliadores foi descrito em oito estudos [11,18,26,27,32,38,41,43]. Nenhum dos estudos apresentou a descrição dos processos de cegamento dos resultados.…”

Section: /11unclassified

“…Quanto às taxas de abandono, foram relatadas por 11 entre os 23 estudos apresentaram dados sobre as taxas de abandono [25,28,31,[33][34][35][37][38][39]41,42]. A adesão às intervenções foi reportada em oito ECR, nos quais foi computado o número total de sessões realizadas no total previsto apresentados por porcentagem [25,[27][28][29][30]33,35,36].…”

Section: /11unclassified

“…Em um estudo foi utilizado o questionário EuroQol5 para avaliar a qualidade de vida de pacientes em prevenção secundária de reabilitação cardíaca, apresentando melhora significativa nos cinco domínios (mobilidade, cuidados pessoais, atividades habituais, dor/mal estar e ansiedade/depressão) no primeiro, quarto e décimo segundo meses após o evento cardiovascular [30]. No estudo de Mazari et al [38] foi utilizado o questionário específico para portadores de doenças vasculares (Vascular Quality of Life Survey -VascuQol) que encontrou melhora em 71% dos pacientes com angioplastia transluminal percutânea que participavam do programa de exercícios supervisionados, foram acompanhados durante um ano e apresentaram melhora clínica sustentada, mas sem vantagem significativa na qualidade de vida.…”

Section: /11unclassified

“…Alguns estudos apresentaram o perfil lipídico [26][27][28]33,37,38,44] como medida de resultado e encontraram diferenças na magnitude da redução das lipoproteínas a partir do modelo de intervenção do exercício. Os modelos de treinamento com durações superiores a 12 semanas apresentaram reduções significativas no LDL-c (colesterol ligado à lipoproteína de baixa densidade) e triglicerídeos, e aumento no HDL-c (colesterol ligado à lipoproteína de alta densidade).…”

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Envelhecimento saudável e atividade física: uma revisão sistemática sobre os efeitos do exercício nas doenças cardiovasculares

Estrela¹,

Bauer

2017

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. AbStRActAims: To perform a systematic review of randomized controlled trials that assess the benefits of physical exercise (regular or competitive) for the health of the elderly and prevention of cardiovascular diseases. Methods: Publications in PubMed, Web of Science, Library of Congress, Cochrane, and in databases with records of clinical trials between 2005 and 2016, and also in the proceedings of major congresses on cardiovascular diseases in the elderly were investigated using the terms defined in accordance with the "patient, intervention, comparison, and outcome" methodology. The following key words were used: physical effort, exercise, exercise therapy, physical activity, physical fitness, resistance training, cardiovascular disease, C-reactive protein, dyslipidemia, heart failure, cardiac insufficiency, revascularization, cardiac stent and heart transplant. Only randomized clinical trials with individuals aged over 60 years were included. The articles were assessed independently by two reviewers.Results: A total of 3,672 studies were assessed and 24 that met the inclusion criteria were selected. Most of these studies had small sample sizes and showed physical exercise as health-promoting. Only 16 studies reported the relationship of adherence to physical exercise as a preventive factor against cardiovascular diseases. The outcome measures included quality of life, physical ability or fitness status, muscle strength, heart rate, psychological aspects, inflammatory and nutritional markers, and progression of cardiovascular diseases. There is strong evidence that aerobic exercise improves physical fitness, muscle strength, and the quality of life of elderly patients with cardiovascular disease. Conclusions:The benefits of exercise training for elderly patients with cardiovascular disease are well established, supporting the prescription of exercise training for their regular treatments. Interventions that use exercise need to be progressively included in cardiovascular treatment regimens, although the best exercise protocol for patients with cardiovascular disease is not yet fully established.

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Envelhecimento saudável e atividade física: uma revisão sistemática sobre os efeitos do exercício nas doenças cardiovasculares

Estrela¹,

Bauer

2017

Sci Med

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“…[10][11][12][13] The low proportion of all referred claudicants included in most IC interventional trials makes it difficult to generalize results to the majority of IC patients.…”

Section: Editorial See P 929 Clinical Perspective On P 947mentioning

confidence: 99%

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

et al. 2014

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I ntermittent claudication (IC) is the most common symptomatic presentation in peripheral arterial disease, and ≈20 to 40 million individuals in the world experience classic IC symptoms.1 IC may also cause a substantial loss of walking function and thereby reduce health-related quality of life (HRQoL). As a manifestation of atherosclerosis, IC confers an increased risk for cardiovascular and cerebrovascular events and premature death. 2,3 This risk can be modified by medical intervention, and the leg symptoms can be reduced by exercise; thus, the generally accepted first-line treatment in patients with IC is risk factor modification, medical treatment, and exercise training. 4,5 Exercise training under supervision of a physiotherapist is often recommended because this approach has been shown to provide better short-term results (6-12 months) than with structured training advice alone. 6,7 However, current practice is different. Supervised exercise training programs are largely unavailable in most countries; hence, the majority of claudicants in Europe do not receive this treatment option. 8 Furthermore, a recent systematic review (National Institute for Health and Clinical Excellence) showed uncertain and probably very poor compliance to supervised training. 9 Health-economic modeling demonstrated that supervised training is cost-effective only when HRQoL results are extrapolated beyond the end of existing trial data and under the assumption of activity-induced benefits in terms of mortality and cardiovascular events. Editorial see p 929 Clinical Perspective on p 947Background-The quality of evidence for invasive revascularization in intermittent claudication is low or very low. This prospective, randomized, controlled study tested the hypothesis that an invasive treatment strategy versus continued noninvasive treatment improves health-related quality of life after 1 year in unselected patients with intermittent claudication. Methods and Results-After clinical and duplex ultrasound assessment, unselected patients with intermittent claudication requesting treatment for claudication were randomly assigned to invasive (n=79) or noninvasive (n=79) treatment groups. The quality of evidence for invasive interventions in IC is still low or very low.9 Most available studies evaluating invasive treatment have used rather selective inclusion criteria, enrolling patients with vascular lesions (eg, in specific vessel segments, of a certain length and severity, and with suitable anatomy for endovascular treatment). [10][11][12][13] The low proportion of all referred claudicants included in most IC interventional trials makes it difficult to generalize results to the majority of IC patients.14 In this context, we sought to perform a "real world" study to test the hypothesis that an invasive (surgical or endovascular) treatment strategy compared with continued medical therapy improves HRQoL in relatively unselected IC patients receiving best medical treatment and structured (nonsupervised) training advice. Methods General Des...

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Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication

Fakhry

Spronk

Laan

et al. 2015

JAMA

208

116

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Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease

Abstract: NCT00798850 (http://www.clinicaltrials.gov).

Cited by 120 publications

References 38 publications

Envelhecimento saudável e atividade física: uma revisão sistemática sobre os efeitos do exercício nas doenças cardiovasculares

Envelhecimento saudável e atividade física: uma revisão sistemática sobre os efeitos do exercício nas doenças cardiovasculares

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication

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