Total body recumbent stepping vs treadmill walking in supervised exercise therapy: A pilot study

Abstract

Background: Treadmill walking is the most commonly recommended exercise modality in supervised exercise therapy (SET) for peripheral artery disease (PAD); however, other modalities may be equally effective and more tolerable for patients. The primary aim of this single-blind, randomized pilot study was to compare the feasibility, safety, and preliminary efficacy of a treadmill walking (TM) versus a total body recumbent stepping (TBRS) exercise program for treatment of PAD. Methods: Participants ( n = 19) enrolled in a 12-week SET program and were randomized to either a TM ( n = 9) or TBRS ( n = 10) exercise group that followed current SET exercise guidelines. Feasibility, safety, and efficacy outcomes were assessed. Results: SET attendance was 86% and 71%, respectively, for TBRS and TM groups ( p = 0.07). Session exercise dose (metabolic equivalents of task [MET] minutes) (mean [SD]) for TM was 117.6 [27.4] compared to 144.7 [28.7] in the TBRS group ( p = 0.08). Study-related adverse events were nine in 236 training hours and three in 180 training hours for the TBRS and TM groups, respectively. There were no significant differences between groups for improvement in 6-minute walk distance (mean [SD]) (TM: 133.2 ft [53.5] vs TBRS: 154.8 ft [49.8]; p = 0.77) after adjusting for baseline 6-minute walk distance. Conclusion: This is the first randomized study comparing TBRS to TM exercise in SET using current SET guidelines. This pilot study showed that TBRS is a feasible and safe exercise modality in SET. This study provides preliminary efficacy of the use of TBRS exercise in SET programs following current guidelines. Larger studies should be conducted to confirm these findings.

What does the future hold for structured exercise training for people with PAD? Ideas from two Masters of the Society for Vascular Medicine

“…23 Examples include arm cycling, [24][25][26] leg cycling, 25,26 and, most recently, total body recumbent stepping (TBRS). 27 Many of these studies have shown patient improvement following these alternative modes of exercise. In this issue, Salisbury and colleagues report the outcomes of a randomized pilot study comparing TBRS to traditional treadmill walking within a clinical supervised exercise program, demonstrating similar walking improvements in both groups.…”

“…In this issue, Salisbury and colleagues report the outcomes of a randomized pilot study comparing TBRS to traditional treadmill walking within a clinical supervised exercise program, demonstrating similar walking improvements in both groups. 27 However, it remains to be determined in whom nonwalking exercise is more effective compared to walking exercise. Thus, larger definitive trials testing alternative modes of exercise versus walking exercise are needed to determine best practices for different subgroups of patients with PAD.…”

Exercise therapy for peripheral artery disease in 2022: Progress and a prediction

“…In this issue of Vascular Medicine , two original research investigations describe preliminary results of novel exercise interventions for PAD. 2,3 Identifying novel forms of exercise is important for patients with PAD who prefer an alternative to walking exercise or who are unable to participate in walking exercise due to extreme ischemic leg symptoms or frailty. Lanzi and colleagues report a pilot study of descending stair walking as an alternative form of exercise for people with PAD.…”

“…Salisbury and colleagues studied the effects of 12 weeks of total body recumbent stepping, compared to traditional treadmill exercise training, in a pilot randomized clinical trial of 19 people with PAD. 3 Total recumbent stepping exercise is a low-impact aerobic exercise, consisting of pushing pedals (i.e. ‘stepping’) while in a reclined position.…”

“…At 12-week follow-up, there was no significant difference in 6-minute walk improvement between total body recumbent stepping and supervised treadmill exercise (+47.1 vs +40.5 m, p = 0.68). 3 A nonexercise control group was not included. Further definitive studies with larger sample sizes are needed to assess whether descending stair walking and recumbent stepping exercise are effective forms of exercise that significantly improve walking performance in people with PAD.…”