Education and home based training for intermittent claudication: functional effects and quality of life

Abstract

Background

Supervised exercise programs increase physical performance in patients with peripheral artery disease (PAD). However, there are a limited number of programs, and to date they have failed to provide evidence of long-term adherence to exercise or any meaningful effect on Quality of Life (QoL). We created a program of therapeutic education and a personalized program of reconditioning exercise for patients with PAD.

Methods

Patients with an ankle-brachial index (ABI) below 0.9 in at least one limb, and an absolute claudication distance (ACD) ≤500 meters, were included in the study. Quality of Life (QoL) as measured by SF-36, cardiovascular risk factors and functional parameters were evaluated at 0, 3, 6 and 12 months.

Results

Forty-six patients completed the program. Cardiovascular risks were controlled and stabilized over time. SF-36 scores improved significantly and remained stable. Initial and absolute claudication distance (ICD and ACD) as well as other functional parameters improved significantly (6 months: +138 m or +203% ICD and +139 m or +84% ACD). Ten patients (22%) did not show improvement in ICD or ACD within the first 3 months, but their SF-36 score did increase at subsequent visits. Interestingly, these patients had a significantly lower ACD at baseline.

Conclusions

This study measured beneficial effects of an educational therapeutic program for patients with PAD. The results demonstrate a significant improvement in functional and QoL parameters during the first 3 months of coaching, and long-term persistence of the results even when patients were no longer coached.

Keywords

Peripheral artery disease therapeutic education exercise programs Quality of Life (QoL)cardiovascular risks

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References

Lloyd-Jones

Adams

Carnethon

. Heart disease and stroke statistics 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: 480–486.

Steg

Bhatt

Wilson

. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007; 297: 1197–1206.

McDermott

Liu

Greenland

. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA 2004; 292: 453–461.

Hirsch

Criqui

Treat-Jacobson

. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286: 131713–24.

McDermott

Guralnik

Ferrucci

. Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication. Circulation 2008; 117: 2484–2491.

McDermott

Ferrucci

Simonsick

. The ankle brachial index and change in lower extremity functioning over time: the Women's Health and Aging Study. J Am Geriatr Soc 2002; 50: 238–246.

Smolderen

Hoeks

Pedersen

. Lower-leg symptoms in peripheral arterial disease are associated with anxiety, depression, and anhedonia. Vasc Med 2009; 14: 297–304.

Regensteiner

Hiatt

Coll

. The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program. Vasc Med 2008; 13: 15–24.

Dormandy

Heeck

Vig

. The natural history of claudication: risk to life and limb. Semin Vasc Surg 1999; 12: 123–137.

10.

Hamburg

Balady

. Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation 2011; 123: 87–97.

11.

Casillas

Troisgros

Hannequin

. Rehabilitation in patients with peripheral arterial disease. Ann Phys Rehabil Med 2011; 54: 443–461.

12.

Watson

Ellis

Leng

. Exercise for intermittent claudication. Cochrane Database Syst Rev 2008, pp. CD000990–CD000990.

13.

Guidon

McGee

. One-year effect of a supervised exercise programme on functional capacity and quality of life in peripheral arterial disease. Disabil Rehabil 2013; 35: 397–404.

14.

Fakhry

Spronk

de Ridder

. Long-term effects of structured home-based exercise program on functional capacity and quality of life in patients with intermittent claudication. Arch Phys Med Rehabil 2011; 92: 1066–1073.

15.

Wind

Koelemay

. Exercise therapy and the additional effect of supervision on exercise therapy in patients with intermittent claudication. Systematic review of randomised controlled trials. Eur J Vasc Endovasc Surg 2007; 34: 1–9.

16.

Ashworth

Chad

Harrison

. Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev. 2005, pp. CD004017–CD004017.

17.

Thompson

Buchner

Pina

. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003; 107: 3109–3116.

18.

Hankey

Norman

Eikelboom

. Medical treatment of peripheral arterial disease. JAMA 2006; 295: 547–553.

19.

Manfredini

Malagoni

Mascoli

. Training rather than walking: the test in -train out program for home-based rehabilitation in peripheral arteriopathy. Circ J 2008; 72: 946–952.

20.

Lafitte

Barandon

Pucheu

. After acute coronary syndrome, diabetic patients with peripheral vascular disease remain at high risk of cardiovascular events despite secondary prevention measures. Arch Cardiovasc Dis 2010; 103: 97–105.

21.

Lafitte

Pradeau

Leroux

. Efficacy over time of a short overall atherosclerosis management programme on the reduction of cardiovascular risk in patients after an acute coronary syndrome. Arch Cardiovasc Dis 2009; 102: 51–58.

22.

St-Cyr Tribble

Gallagher

Bell

. Empowerment interventions, knowledge translation and exchange: perspectives of home care professionals, clients and caregivers. BMC Health Serv Res 2008; 8: 177–177.

23.

Aujoulat

Luminet

Deccache

. The perspective of patients on their experience of powerlessness. Qual Health Res 2007; 17: 772–785.

24.

Malagoni

Vagnoni

Felisatti

. Evaluation of patient compliance, quality of life impact and cost-effectiveness of a ‘test in-train out' exercise-based rehabilitation program for patients with intermittent claudication. Circ J 2011; 75: 2128–2134.

25.

Ware

Jr Sherbourne

. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473–483.

26.

Duprez

de Backer

de Buyzere

Clement

. Estimation of walking distance in intermittent claudication: need for standardization. Eur Heart J 1999; 20: 641–644.

27.

McDermott

Ades

Guralnik

. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA 2009; 301: 165–174.

28.

McDermott

Greenland

Liu

. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med 2002; 136: 873–883.

29.

Lafitte

Pucheu

Latry

. Predictors of cardiovascular prognosis in patients receiving optimized secondary prevention measures after acute coronary syndrome. Eur J Prev Cardiolo 2013; 20: 283–290.

30.

Aujoulat

Marcolongo

Bonadiman

. Reconsidering patient empowerment in chronic illness: a critique of models of self-efficacy and bodily control. Soc Sci Med 2008; 66: 1228–1239.

31.

McDermott

Liu

Guralnik

. Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. JAMA 2013; 310: 57–65.

32.

van Asselt

Nicolai

Joore

. Cost-effectiveness of exercise therapy in patients with intermittent claudication: supervised exercise therapy versus a ‘go home and walk' advice. Eur J Vasc Endovasc Surg 2011; 41: 97–103.

33.

Nicolai

Teijink

Prins

. Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication. J Vasc Surg 2010; 52: 348–355.

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