What is the correct level of claudication pain to prescribe? Universal inconsistency within guidelines, a painful issue

Seed, Sally A; Harwood, Amy; Sinclair, Jonathan Kenneth; Egun, Anselm; Birkett, Stefan T

doi:10.1177/17085381231155940

Cited by 3 publications

(6 citation statements)

References 17 publications

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“…PAD trials did not distinguish between symptom intensity and common training intensity measures 4 9 11–13 16 21–24. Claudication pain severity does not necessarily correlate with exercise intensity 15 20. When assuming that exercise intensity is a determinant of the physiological response to training,23 the sole monitoring of claudication pain is limiting.…”

Section: Introductionmentioning

confidence: 94%

“…However, little guidance is offered regarding training intensity. Training session monitoring using common training intensity measures, such as % of peak heart rate (%HR peak ), cardiorespiratory fitness (%VO 2peak ) or the rate of perceived exertion (RPE), remains underused 9 15 20. PAD trials did not distinguish between symptom intensity and common training intensity measures 4 9 11–13 16 21–24.…”

Section: Introductionmentioning

confidence: 99%

“…When assuming that exercise intensity is a determinant of the physiological response to training,23 the sole monitoring of claudication pain is limiting. This may prevent the comparison of the effectiveness of exercise training in these patients20 and also potentially explain the variability usually observed in the extent of improvements 4 25. In this context, it has been demonstrated that vigorous-intensity exercise can improve VO 2peak more than light-to-moderate exercise therapy intensity in these patients 13 15.…”

Section: Introductionmentioning

confidence: 99%

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Short-duration aerobic high-intensity intervals versus moderate exercise training intensity in patients with peripheral artery disease: study protocol for a randomised controlled trial (the Angiof-HIIT Study)

Lanzi,

Pousaz,

Fresa

et al. 2024

BMJ Open

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IntroductionSupervised exercise training is among the first-line therapies for patients with peripheral artery disease (PAD). Current recommendations for exercise include guidance focusing on claudication pain, programme and session duration, and frequency. However, no guidance is offered regarding exercise training intensity. This study aims to compare the effects of 12-week-long supervised walking exercise training (high-intensity interval training (HIIT) vs moderate-intensity exercise (MOD)) in patients with chronic symptomatic PAD.Methods and analysisThis study is a monocentric, interventional, non-blinded randomised controlled trial. 60 patients (30 in each group) will be randomly allocated (by using the random permuted blocks) to 12 weeks (three times a week) of HIIT or MOD. For HIIT, exercise sessions will consist of alternating brief high-intensity (≥85% of the peak heart rate (HRpeak)) periods (≤60 s) of work with periods of passive rest. Patients will be asked to complete 1 and then 2 sets of 5–7 (progressing to 10–15×60 s) walking intervals. For the MOD group, exercise training sessions will consist of an alternation of periods of work performed at moderate intensity (≤76% HRpeak) and periods of passive rest. Interventions will be matched by training load. The primary outcome will be the maximal walking distance. Secondary outcomes will include functional performance, functional capacity, heath-related quality of life, self-perceived walking abilities, physical activity and haemodynamic parameters.Ethics and disseminationThe Angiof-HIIT Study was approved by the Human Research Ethics Committee of the Canton de Vaud (study number: 2022-01752). Written consent is mandatory prior to enrolment and randomisation. The results will be disseminated via national and international scientific meetings, scientific peer-reviewed journals and social media.Trial registration numberNCT05612945.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-duration aerobic high-intensity intervals versus moderate exercise training intensity in patients with peripheral artery disease: study protocol for a randomised controlled trial (the Angiof-HIIT Study)

Lanzi,

Pousaz,

Fresa

et al. 2024

BMJ Open

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“…[3] A moderate-to-severe claudication pain during exercise may correspond "only" to moderate exercise intensity. [3,7] Methods of prescribing exercise intensity are underused to individualize exercise training in patients with PAD. [3] Recently, 2 meta-analyses demonstrated the superiority of vigorous exercise training on cardiorespiratory fitness [3,8] and walking performance improvements, [3] suggesting the importance of exercise intensity monitoring during SET to optimize outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…[ 3 ] A moderate-to-severe claudication pain during exercise may correspond “only” to moderate exercise intensity. [ 3 , 7 ]…”

Section: Introductionmentioning

confidence: 99%

The PAD-adapted 30-20-10 during Nordic walking: A new exercise training session in patients with symptomatic peripheral artery disease

Hagen,

Malatesta,

Calanca

et al. 2024

Medicine

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This study aimed to investigate the feasibility of a peripheral artery disease (PAD)-adapted 30-20-10 Nordic walking session in patients with symptomatic PAD and to compare the cardiovascular response of this new training session to a traditional walking (TW) and 4 × 4 minutes Nordic walking session. This is a prospective observational study. Patients with Fontaine stage II PAD were included. Patients participated in Nordic walking sessions, which were randomly assigned as TW, 4 × 4 minute intervals, and peripheral artery disease adapted 30-20-10 exercise session (PAD-adapted 30-20-10 sessions). PAD-adapted 30-20-10 and 4 × 4 minutes sessions consisted of 4 repetitions of 4 minutes of effort followed by 3 minutes of passive recovery. PAD-adapted 30-20-10 session was characterized by 4 continuous 1-min repetitions at 3 different walking speeds [high (30 seconds), moderate (20 seconds) and low (10 seconds)]. During the 4 × 4 minutes session, patients were asked to cover the maximal distance at a constant speed. During TW session, patients were asked to walk at a speed inducing moderate-to-severe claudication pain. Heart rate, rating of perceived exertion (RPE) and claudication pain intensity using a visual analog scale were assessed. The perceived enjoyment of each session was assessed using a visual analog scale ranging from 0 (not enjoyable) to 10 (very enjoyable). Eleven patients with chronic symptomatic PAD were included (62 ± 13 years; 54% women). The mean heart rate during the time of effort was significantly higher in PAD-adapted 30-20-10 group than in 4 × 4 minutes and TW groups (127 ± 12, 122 ± 12, 114 ± 11 bpm, respectively; P ≤ .001). The mean rating of perceived exertion (16 ± 1, 15 ± 1, 13 ± 1; P ≤ .001) and claudication pain intensity (8 ± 1, 7 ± 1; 7 ± 1 mm; P ≤ .019) were significantly higher during PAD-adapted 30-20-10 sessions than during 4 × 4 minutes and TW sessions. The perceived enjoyment was similar among sessions (8.7 ± 1.6 for TW, 8.6 ± 1.7 for 4 × 4 minutes, and 8.8 ± 1.8 mm for PAD-adapted 30-20-10 sessions; P = .935). The PAD-adapted 30-20-10 session is feasible and induces higher cardiovascular stimulation and claudication pain than 4 × 4 minutes and TW procedures in patients with symptomatic PAD. Despite these different responses, a similar perceived enjoyment among the sessions has been shown. Future investigations are needed to examine the effects of this new training session in these patients.

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Commentary to Seed et al. ‘What is the correct level of claudication pain to prescribe? Universal inconsistency within guidelines, a painful issue’

Lanzi

Mazzolai

2023

Vascular

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What is the correct level of claudication pain to prescribe? Universal inconsistency within guidelines, a painful issue

Cited by 3 publications

References 17 publications

Short-duration aerobic high-intensity intervals versus moderate exercise training intensity in patients with peripheral artery disease: study protocol for a randomised controlled trial (the Angiof-HIIT Study)

Short-duration aerobic high-intensity intervals versus moderate exercise training intensity in patients with peripheral artery disease: study protocol for a randomised controlled trial (the Angiof-HIIT Study)

The PAD-adapted 30-20-10 during Nordic walking: A new exercise training session in patients with symptomatic peripheral artery disease

Commentary to Seed et al. ‘What is the correct level of claudication pain to prescribe? Universal inconsistency within guidelines, a painful issue’

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