Exercise Interventions for Patients with Peripheral Arterial Disease
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Date
2024-01-09
Authors
Harding, Aaron
Journal Title
Journal ISSN
Volume Title
Publisher
University of Oregon
Abstract
Peripheral arterial disease (PAD) is atherosclerosis of the arteries outside of the heart and brain, particularly the lower extremities, and represents an advanced burden of cardiovascular disease. Patients with PAD have a high risk of morbidity and mortality. In addition, PAD leads to an accelerated decline in physical function and increased disability in both symptomatic and asymptomatic patients. Evidenced-based guidelines recommend walking in a supervised setting as the primary mode of exercise for patients with PAD. However, many patients are either unwilling or unable to tolerate the exercise due to the symptoms of claudication pain. The primary purpose of this dissertation was to expand on the standard practice and explore novel exercise and other training techniques that could improve the outcomes of patients with PAD.The study in chapter IV compared a novel combination treadmill and ambulation training protocol (COMBO) with a commonly used standard treadmill only training protocol (STAND) on patients with PAD. This was the first study to compare the difference between two training protocols on six-minute walk test (6MWT) performance in patients with PAD. The improvement in 6MWT total distance did not differ between the COMBO and STAND training protocols. However, both the 6MWT claudication onset distance and claudication onset time were greater in the COMBO group versus the STAND group. The results of this study suggest that ambulation training may improve 6MWT performance compared treadmill only training in patients with PAD.
The study in chapter V investigated the effect of an active walking warm-up on the results of the 6MWT distance in patients with PAD. The study was the first to assess the effect of an active warm-up on the 6MWT in patients with PAD. The 6MWT total distance did not differ between the WARM-UP and NO WARM-UP conditions. Additionally, neither the 6MWT claudication onset distance nor claudication onset time differed between the WARM-UP and NO WARM-UP conditions. The results of this study suggest that an active warm-up of 10-12 minutes of walking on a treadmill at a workload between 1.4-2.1 METs may not be enough of a stimulus to increase 6MWT distance in patients with PAD.
Chapter VI was a review article intended to explore novel exercise and other interventions that could challenge the current paradigm of exercise training for patients with PAD. This was accomplished by reviewing the literature showing improved outcomes, particularly 6MWT distance, with exercise in patients with PAD, discussing the current state of practice of PAD rehabilitation (SET for PAD), introducing overground ambulation in the supervised clinical setting, reviewing the literature on the effect of acute and chronic passive heating in patients with PAD, and discussing directions for future research with ambulation training and passive heating, two interventions that have shown improvement in 6MWT performance in patients with PAD.
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Keywords
Cardiovascular Physiology, Exercise Physiology, Peripheral Arterial Disease, Six-Minute Walk Test