Training Rather Than Walking The Test In - Train Out Program for Home-Based Rehabilitation in Peripheral Arteriopathy

Abstract

xercise training is an effective, low-cost therapy that improves the functional ability of patients with intermittent claudication. [1][2][3][4] Its diffusion could be favoured by models of intervention that would help ensure functional and cardiovascular improvements, patient compliance and lower costs for the healthcare system.In order to optimise these positive outcomes, the model of intervention and the prescribed exercise intensity are of primary importance. Unfortunately, specific recommendations regarding exercise prescription and programming are limited. 2 However, it is known that exercise is preferably carried out at moderate to near-maximal pain, and that better results are obtained at the hospital under the supervision of the rehabilitative team. These center-based programs for peripheral arterial disease (PAD) have been found to be more effective at improving walking ability in training up to 6 months compared with home-based programs, with unclear effect of supervision. 5,6 On the other hand, home-based programs, which are based on simple instructions about the exercise to be performed (eg, walk up to pain tolerance), in general, show higher long-term adherence to exercise, with lower cost to the healthcare system. 6 An alternative model without supervision, based on the assessment of functional capacity at hospital during monthly check-ups and a personalized prescription of exercise to be performed at home at maximal asymptomatic speed (MAS) has been developed recently. 7,8 This novel approach to rehabilitation for patients with PAD, the 'test in -train out' program (Ti-To), aims to combine the advantages of a traditional home-based program (eg, long-term adherence and lower cost) with those of a supervised program (especially, exercise at selected intensities).The Ti-To program makes use of the MAS; that is, the walking intensity below the individual pain threshold speed (PTS) 9 that combines pain-free training with functional, hemodynamic and cardiovascular adaptations. 7 The present study aimed to test the effectiveness of the Ti-To program on walking ability and hemodynamic parameters in a group of patients exercising at home at their MAS compared with patients following a traditional home-based free walking exercise (Tr-E) at self-selected speeds up to pain tolerance over a 6-month period. Background Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E). Methods and Results A total of 143 patients with claudication (117 men, average age 68±10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise hea...

Don’t stop walking: an in-home rehabilitation program for peripheral artery disease patients during the COVID-19 pandemic.

“…All the patients enrolled were executing the "Test in -Train out" (Ti-To), structured, pain-free home-based exercise program [5,6]. Ti-To program include a center-based phase and a home-based phase with walking exercises.…”

“…The exercise program ends when the patients reach a pain-free walking distance that is normal for their sex and age or when a stable satisfactory performance is attained. Additional details on the exercise program are reported elsewhere [5,25].…”

“…A team member called all the patients enrolled to check their health status and to update the exercise program. The scheduled training program progression [5,25], was con rmed if the patients reported regular program execution in the absence of general or peripheral symptoms. Otherwise, the progression was delayed in the presence of incomplete execution or limiting symptoms, with the patients being advised to repeat part of the previous program in the following weeks.…”

“…Structured exercise, with supervised exercise being preferred and more effective [3], is part of a comprehensive program to manage disability and cardiovascular risk [4]; however, in recent years, various home-based structured programs have been proposed [2] based on indoor [5,6] or outdoor (guided or assisted by wearable technologic devices, etc.) walking [2,[7][8][9].…”

Avaliação da saturação tecidual de oxigênio durante o sintoma claudicante em pacientes com doença arterial periférica

“…12 It is therefore necessary to reach levels close to maximum claudication symptoms during training, if the optimal adaptations in PAD patients' capacity to walk are to be achieved. 13 However, since the feeling of claudication symptoms close to the maximum are reported subjectively by the patient during exercise sessions, it cannot be guaranteed that the patient is reaching the ischemic threshold because oxygen saturation is unknown at the time of training. Near-Infrared Spectroscopy (NIRS) offers the possibility of noninvasive and objective evaluation of blood flow in the muscles and oxygenation levels under both static and dynamic conditions, enabling reductions in oxygen supply during effort to be verified.…”