Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More

Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Annals of internal medicine (Impact Factor: 17.81). 02/2006; 144(1):10-20. DOI: 10.7326/0003-4819-144-1-200601030-00005
Source: PubMed


Exercise rehabilitation programs increase treadmill walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication. However, it is unknown whether patients with PAD who walk for exercise regularly have less functional decline than those with less walking activity.
To determine whether patients with PAD who report that they walk for exercise 3 or more times per week have less annual functional decline than those who walk for exercise less frequently.
Prospective cohort study with a median follow-up of 36 months (interquartile range, 24 to 36 months).
Academic medical center.
417 men and women with PAD.
Participants were classified at baseline and annually according to the number of times they reportedly walked for exercise each week. Functional assessments (6-minute walk distance, 4-meter walking speed, summary performance score) were measured at baseline and annually. Results were adjusted for age, sex, ethnicity, comorbid conditions, body mass index, ankle-brachial index, education, leg symptoms, cigarette use, geriatric depression score, previous year's level of functioning, and patterns of missing data.
Compared with those who exercised less frequently, patients who walked for exercise 3 or more times per week had a significantly smaller average annual decline in 6-minute walking distance (-48.0 feet per year compared with -56.6 feet per year for those who walked 1 to 2 times per week and -79.4 feet per year for nonexercisers; P for trend = 0.037). Patients who walked for exercise at least 3 times per week experienced a smaller average annual decline in the usual-paced 4-meter walking velocity (-0.014 m/s per year compared with -0.022 m/s per year for those who walked 1 to 2 times per week and -0.045 m/s per year for nonexercisers; P = 0.005). Similar findings were observed for the fast-paced 4-meter walk. The subset of asymptomatic patients who walked for exercise 3 or more times per week had annual declines in 6-minute walking performance (P = 0.107), normal-paced walking velocity (P = 0.065), and the summary performance score (P = 0.115); however, these declines were smaller than those observed in asymptomatic participants who walked fewer than 3 times per week.
Because this was an observational study, associations reported here cannot be construed as causal relationships. Sample sizes for subgroup analyses were small, which limited statistical power.
Among patients with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year. Similar trends were observed in the subset of asymptomatic patients with PAD. These findings may be particularly important for the numerous patients with PAD who do not have access to supervised walking exercise programs.

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Available from: Gary J Martin, Mar 28, 2014
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    • "Lavoie et al. (2004) found evidence for this hypothesis in myocardial ischemia patients with depressive symptomatology who underwent exercise stress tests. On the other hand, worse performance on the treadmill exercise test may be indicative for poor daily functioning and more functional decline (McDermott et al., 2006). Daily functioning, and more specifically walking behaviour seems to be of vital importance to help reduce the cardiovascular complications and mortality, even in populations with severe limitations (Smith et al., 2007). "
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    • "Supervised exercise training is recommended for a minimum of 30–45 minutes in sessions performed at least 3 times per week for a minimum of 12 weeks (Hirsch et al 2006) and preferably for 6 months or longer (Gardner et al 1995). Among persons with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year (McDermott et al 2006). "
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    ABSTRACT: Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism treated in elderly patients with peripheral arterial disease (PAD) of the lower extremities. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in patients with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all elderly patients with PAD without contraindications to these drugs. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are (1) incapacitating claudication in patients interfering with work or lifestyle; (2) limb salvage in patients with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and (3) vasculogenic impotence.
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    • "Recent data has shown that exercise has benefits for patients with peripheral arterial disease [9], yet ironically, exercise becomes limited due to pain and fatigue associated with the disease. During exercise, the sympathetic nervous system mediates vasoconstriction in both unutilized muscle and viscera to redistribute blood flow to exercising muscles [10]. "
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