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Exercise for intermittent claudication

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Jul 14, 2007.

  1. NewsBot

    NewsBot The Admin that posts the news.

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    Supervised exercise therapy for intermittent claudication in a community-based setting is as effective as clinic-based.
    J Vasc Surg. 2007 Jun;45(6):1192-6.
    Bendermacher BL, Willigendael EM, Nicolaï SP, Kruidenier LM, Welten RJ, Hendriks E, Prins MH, Teijink JA, de Bie RA.
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. John Spina

    John Spina Active Member

    An exercise regimen can help with this because collateral circulation is formed.
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Exercise performance in patients with peripheral arterial disease who have different types of exertional leg pain.
    Gardner AW, Montgomery PS, Afaq A.
    J Vasc Surg. 2007 Jul;46(1):79-86.
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Supervised exercise training for intermittent claudication: lasting benefit at three years.
    Ratliff DA, Puttick M, Libertiny G, Hicks RC, Earby LE, Richards T.
    Eur J Vasc Endovasc Surg. 2007 Sep;34(3):322-6.
     
  6. NewsBot

    NewsBot The Admin that posts the news.

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    Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease.
    Crowther RG, Spinks WL, Leicht AS, Sangla K, Quigley F, Golledge J.
    J Vasc Surg. 2008 Feb;47(2):303-9
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Claudication distances and the Walking Impairment Questionnaire best describe the ambulatory limitations in patients with symptomatic peripheral arterial disease
    Sara A. Myers, Jason M. Johanning, Nick Stergiou et al
    Journal of Vascular Surgery
    Volume 47, Issue 3, March 2008, Pages 550-555.e1

     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Exercise for intermittent claudication.
    Watson L, Ellis B, Leng GC.
    Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000990.
     
  9. David Smith

    David Smith Well-Known Member

    Dear all

    I have to ask " is it worth the effort"? statistically significant but is it realy clinically significant?

    All the cited studies show improvement in walking distance post supervised exercise for a period of time. statistical percentages of 120% - 190% improvement are quoted, which didn't include those who dropped out fo various reasons. These figures appear significant but are they?

    If the the average distance of painfree walking or distance to point where the subject had to stop and rest was say 500 metres then 20% improvement only = 600mtrs. a 90% improvement = 950mtrs. However most of these studies seem to indicate a much lower baseline than 500mtrs and overal improvement appear to be around the 100mtr mark ie 100mtrs further then 12 months ago.

    Would thid be a significant improvement to the patient after 12 months of painful therapy?

    Dave Smith
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Adrenergic and neuropeptide Y Y1 receptor control of collateral circuit conductance: influence of exercise training
    Jessica C. Taylor, H. T. Yang, M. Harold Laughlin, and Ronald L. Terjung
    J Physiol 2008 586: 5983-5998.
    Adrenergic inhibition increases collateral circuit conductance in rats following acute occlusion of the femoral artery
    Jessica C. Taylor, Zeyi Li, H. T. Yang, M. Harold Laughlin, and Ronald L. Terjung
    J Physiol 2008 586: 1649-1667
    Science Daily are reporting:
    Peripheral Artery Disease: Pain When Walking Can Be Reduced With Moderate Exercise, Study Suggests
     
  11. NewsBot

    NewsBot The Admin that posts the news.

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    Plantar flexion: an effective training for peripheral arterial disease.
    Wang E, Hoff J, Loe H, Kaehler N, Helgerud J.
    Eur J Appl Physiol. 2008 Nov;104(4):749-56.
     
  12. NewsBot

    NewsBot The Admin that posts the news.

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    Effects of exercise training on calf tissue oxygenation in men with intermittent claudication.

    Figoni SF, Kunkel CF, Scremin AM, Asher A, Banks NL, Rivera A, Tin JK, Cohen B.
    PM R. 2009 Oct;1(10):932-40.
     
  13. NewsBot

    NewsBot The Admin that posts the news.

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    Strength training increases walking tolerance in intermittent claudication patients: randomized trial.
    Ritti-Dias RM, Wolosker N, de Moraes Forjaz CL, Carvalho CR, Cucato GG, Leão PP, de Fátima Nunes Marucci M.
    J Vasc Surg. 2010 Jan;51(1):89-95.
     
  14. NewsBot

    NewsBot The Admin that posts the news.

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    A systematic review of randomized controlled trials: Walking versus alternative exercise prescription as treatment for intermittent claudication.
    Parmenter BJ, Raymond J, Dinnen P, Singh MA.
    Atherosclerosis. 2011 May 5. [Epub ahead of print]
     
  15. NewsBot

    NewsBot The Admin that posts the news.

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  16. Selwyn Firth

    Selwyn Firth Member

    iT HAS BEEN ESTABLISHED FOR A NUMBER OF YEARS THAT EXERCISE BENEFITS THOSE WITH iNTERMITTENT CLAUDICATION. THE REAL QUESTION IS HOW TO MOTIVATE PEOPLE WITH im TO DO MORE EXERCISE????
     
  17. NewsBot

    NewsBot The Admin that posts the news.

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    The effect of exercise training on ankle-brachial index in type 2 diabetes
    Bethany Barone Gibbs, Devon A. Dobrosielski, Andrew D. Althouse, Kerry J. Stewart
    Atherosclerosis; Available online 14 July 2013
     
  18. Admin2

    Admin2 Administrator Staff Member

    Press Release:
    Study aims to help patients with peripheral artery disease become more active
     
  19. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Press Release:
    Blood growth factor boosts effect of exercise in peripheral artery disease
     
  20. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Exercise for intermittent claudication.
    Lane R, Ellis B, Watson L, Leng GC.
    Cochrane Database Syst Rev. 2014 Jul 18;7:CD000990
     
  21. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Characterising the physical activity and sedentary behaviour patterns of patients with Peripheral Arterial Disease
    Power, Rebecca
    Masters Thesis; Waterford Institute of Technology; 2014
     
  22. LeonW

    LeonW Active Member

    Establish a govt funded thingy that they have to sign in to a gym to get $ for going a certain amount of times per week, to the gym.
    The govt could save $ by motivating ppl to go to the gym.
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    True cadence and step accumulation are not equivalent: The effect of intermittent claudication on free-living cadence
    B. Stansfield, C. Clarke, P. Dall, J. Godwin, R. Holdsworth, M. Granat
    Gait & Posture; Articles in Press
     
  24. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Improved Walking Claudication Distance with Transcutaneous Electrical Nerve Stimulation: An Old Treatment with a New Indication in Patients with Peripheral Artery Disease.
    Labrunée, Marc MD; Boned, Anne PT; Granger, Richard MSc; Bousquet, Marc MD; Jordan, Christian MD; Richard, Lisa MD; Garrigues, Damien MD; Gremeaux, Vincent MD, PhD; Sénard, Jean-Michel MD, PhD; Pathak, Atul MD, PhD; Guiraud, Thibaut PhD
    American Journal of Physical Medicine & Rehabilitation/ in press
     
  25. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Intensive Walking Exercise for Lower Extremity Peripheral Arterial Disease: a Systematic Review and Meta-analysis.
    Lyu X, Li S, Peng S, Cai H, Liu G, Ran X.
    J Diabetes. 2015 May 5
     
  26. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Gender differences following supervised exercise therapy in patients with intermittent claudication
    Lindy N.M. Gommans, MD, Marc R.M. Scheltinga, MD, PhD, Marc R.H.M. van Sambeek, MD, PhD, Angela H.E.M. Maas, MD, PhD, Bianca L.W. Bendermacher, MD, PhD, Joep A.W. Teijink, MD, PhD
    The Journal of Vascular Surgery; September 2015Volume 62, Issue 3, Pages 681–688
     
  27. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Gastrocnemius muscle architecture and Achilles tendon properties influence walking distance in claudicants with peripheral arterial disease
    Stephanie Louise King PhD, Natalie Vanicek PhD and Thomas Daniel O'Brien PhD
    Muscle & Nerve; Accepted Article
     
  28. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Press Release:
    New study aims to reduce pain caused by poor blood circulation
    Dec 10, 2015
     
  29. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Exercise for intermittent claudication.
    Lane R, Harwood A, Watson L, Leng GC.
    Cochrane Database Syst Rev. 2017 Dec 26;12:CD000990. doi: 10.1002/14651858.CD000990.pub4
     
  30. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    The role of psychopathology in perceiving, reporting and treating intermittent claudication. A systematic review.
    Sliwka A et al
    International Angiology : a Journal of the International Union of Angiology [10 Sep 2018]
     
  31. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis
    Belinda J Parmenter et al
    Br J Sports Med Published Online First: 12 April 2019
     
  32. NewsBot

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    Attached Files:

  33. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Effects of Intermittent Calf Muscle Electrical Stimulation on Walking Capacity in Claudicants Living with Type 2 Diabetes.
    Christian Ellul, Cynthia Formosa, and Alfred Gatt
    Journal of the American Podiatric Medical Association: January 2020, Vol. 110, No. 1, Article_1.
     
  34. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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  35. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Resistance training as a treatment for older persons with peripheral artery disease: a systematic review and meta-analysis
    Belinda J Parmenter et al
    British Journal of Sports Medicine 2020;54:452-461.
     
  36. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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    Supervised Exercise Training Improves 6 min Walking Distance and Modifies Gait Pattern during Pain-Free Walking Condition in Patients with Symptomatic Lower Extremity Peripheral Artery Disease
    Stefano Lanzi et al
    Sensors (Basel). 2021 Nov 30;21(23):7989
     
  37. NewsBot

    NewsBot The Admin that posts the news.

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    News Release 12-Jul-2022
    Female sex is associated with additional treatments following surgical therapies for intermittent claudication

    (Boston)—It turns out that your sex may determine how you are treated for circulatory problems in the legs that cause muscle pain during walking or exercise. This condition, intermittent claudication (IC), is one of the more common conditions evaluated by vascular surgeons for both non-operative and operative treatment. While a patient’s sex has been shown to influence outcomes of treatments or interventions for other vascular disorders, whether this is also true for IC had been unclear.

    A new study from researchers at Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) has found that female sex is associated with more re-interventions after surgical treatment for IC. Additionally, guideline-directed medical therapy, including aspirin and statin use, was used less frequently among female compared with male patients in both the pre-operative and post-operative settings.

    “Based on these findings, we recommend that vascular interventionists treating female patients with intermittent claudication increase their efforts to maximize medical therapy and discuss with their patients the differences in intervention durability based on patient sex,” explained first author Scott R. Levin, MD MSc, clinical instructor at BUSM.

    The researchers conducted a retrospective analysis of patients undergoing vascular interventions for IC in more than 800 academic and nonacademic centers in North America from 2010-20. Among the 64,752 peripheral vascular interventions (PVI), 38 percent were performed in female patients. Out of the 9,314 infrainguinal bypasses (IIB) and 3,227 suprainguinal bypasses (SIB), 30 and 37 percent were performed in female patients, respectively. Female compared with male sex was associated with increased re-interventions after PVI, IIB and SIB at one year.

    Additionally, they found that regardless of patient sex, one-year amputation rates were higher than expected compared to medical management (smoking cessation, aspirin and statin therapy, a walking program) alone prompting Levin to recommend that surgeons attempt an adequate period of medical therapy prior to offering invasive interventions for IC.

    According to the researchers, increasing medical options, particularly for an elective vascular procedure, is essential and an area for immediate improvement. “However, this is only one factor that may mitigate the disparity in re-intervention rates by patient sex. Future prospective analysis is warranted to assess the reasons for the type of intervention offered, as well as for suboptimal medical therapy, treatment failures, and need for re-intervention among female patients,” said Levin who also is a resident physician in general surgery at BMC.

    These findings appear online in the journal Annals of Vascular Surgery.
     
  38. NewsBot

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    News Release 27-Jul-2022
    ”No pain, no gain” approach improves walking ability with peripheral artery disease
    DALLAS, July 27, 2022 — Walking for exercise at a pace that induced pain or discomfort improved walking ability among people with peripheral artery disease, or PAD, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    About 150,000 nontraumatic amputations occur annually, according to the 2021 American Heart Association policy statement: Reducing Nontraumatic Lower-Extremity Amputations by 20% by 2030: Time to Get to Our Feet. Between 8 and 10 million people in the United States have PAD. The condition disproportionately affects Black people, American Indian people and those of low socioeconomic status.

    The condition occurs when the arteries that transport blood from the heart throughout the body narrow, reducing blood and oxygen flow. It usually affects the legs and feet causing symptoms while walking, such as cramping, weakness, fatigue, aching and pain or discomfort that subside within 10 minutes of rest. Previous research found that walking for exercise, particularly on a treadmill while supervised by a staff member, improves walking ability and walking distance among people with PAD. What remained unclear were the potential effects of walking at a pace that induced symptoms such as leg pain on speed, strength and balance.

    This study examined the effects of home-based walking for exercise among 264 people with PAD who were participating in a randomized clinical trial, called the Low-Intensity Exercise Intervention in PAD (LITE), which included 305 people overall. From September 2015 to December 2019, participants enrolled in the LITE study at four U.S. medical centers (Northwestern University, Tulane University, University of Minnesota and University of Pittsburgh). Their average age was 69 years, 48% were women and 61% were Black adults.

    Researchers randomly assigned participants to one of three groups for 12 months. The first group (38%) walked at home at a comfortable pace; the second group (41%) walked at home at a pace that induced leg symptoms; while the third group (21%) did not walk for exercise. Both walking exercise groups wore an ActiGraph, a device that monitored the intensity of their walking and the time walked.

    Personalized thresholds for the ActiGraph intensity that corresponded to walking for exercise at a pace that induced leg symptoms (high intensity) and that corresponded to walking for exercise at a comfortable pace without leg symptoms (low intensity) were defined for each individual randomized to an exercise intervention. Participants randomized to exercise wore their ActiGraph device during walking exercise activity and uploaded data on exercise frequency, intensity and duration to the study website.

    At the study’s start and at 6 and 12 months, participants completed three tests of leg function: walking speed over a four-meter distance (13 feet) at usual pace, walking speed over a four-meter distance at fastest pace and the short physical performance battery (SPPB) consisting of four-meter walking velocity at usual pace, a standing balance test and the time for five repeated chair rises.

    The key findings were:

    At six months, participants whose walking pace induced leg pain or discomfort walked 11 feet per minute faster, and at 12 months, they walked more than 16 feet per minute faster than participants whose walking pace did not induce leg pain or discomfort. Compared to non-exercisers, participants in the group that walked for exercise at a pace inducing leg pain or discomfort walked nearly 13 feet per minute faster at six months, however, this increase was not statistically significant at 12 months.
    At 12 months, people who walked for exercise with leg pain or discomfort scored almost 1 point higher on the sum of the three leg function tests (the short physical performance battery), out of a total of 13 points (0-12), compared to people who walked at a comfortable pace with no leg pain. For those walking for exercise at a comfortable pace, there was no improvement in walking speed at six months or 12 months compared to non-exercisers.

    “We were surprised by the results because walking for exercise at a pace that induces pain in the legs among people with PAD has been thought to be associated with damage to leg muscles,” said senior study author Mary M. McDermott, M.D., the Jeremiah Stamler Professor of Medicine in the division of general internal medicine and geriatric medicine and of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “Based on these results, clinicians should advise patients to walk for exercise at a pace that induces leg discomfort, instead of at a comfortable pace without pain.”

    This underscores the benefits of walking for exercise at a pace that induces leg pain or discomfort. “This finding is consistent with “no pain, no gain” with regard to walking exercise in PAD,” McDermott said.

    “Exercise that induces leg pain is beneficial, though difficult,” McDermott said. “We now are working to identify interventions that can make the higher intensity exercise easier—and still beneficial—for people with PAD.”

    It is important to note that study participants walked at home, so the results may not apply to walking on a treadmill in the presence of a health professional, which is the standard of care and first line therapy according to clinical practice guidelines. In addition, the outcomes in this report were not pre-specified outcomes for this clinical trial. Therefore, these findings must be confirmed in future research.

    In May 2022, the American Heart Association and 24 collaborating organizations launched the PAD National Action Plan, a guide to assist in the prevention of PAD complications, treatment of cardiovascular risk and improvement of quality of life for those living with the disease.

    “PAD is a lifelong medical condition, but people with PAD can lead active and long lives,” said American Heart Association volunteer expert and PAD National Action Plan writing group member Joshua Beckman, M.D., director of Vascular Medicine Section and professor of medicine Vanderbilt University in Nashville, Tennessee. “If you notice walking is becoming more difficult, keeping up with others is hard, or you have pain when you walk, talk with a doctor and describe when it happens and how it feels.”
     
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