Effect of Sex on Vascular Adaptations to Isometric Handgrip Training in Elderly Patients with Peripheral Artery Disease: A Randomized Controlled Trial

2021 ◽  
pp. 1-4
Author(s):  
Paulo L. Oliveira ◽  
Marilia A. Correia ◽  
Nelson Wolosker ◽  
Lauro C. Vianna ◽  
Raphael M. Ritti-Dias ◽  
...  
Keyword(s):  
Older Adults ◽  
Peripheral Artery Disease ◽  
Controlled Trial ◽  
Maximum Voluntary Contraction ◽  
Control Group ◽  
Flow Mediated Dilation ◽  
Peripheral Artery ◽  
Isometric Handgrip ◽  
Artery Disease ◽  
Isometric Handgrip Training

<b><i>Background:</i></b> Isometric handgrip training (IHT) promotes vascular adaptations in different populations. <b><i>Aims:</i></b> We assessed the sex differences in vascular adaptations of IHT in a sample of older adults with symptomatic peripheral artery disease (PAD). <b><i>Methods:</i></b> Fifty-three older patients with symptomatic PAD (6 women and 13 men in IHT and 13 women and 21 men in the control group) participated in this study. The IHT group performed 3 sessions per week, for 8 weeks, consisting of 4 sets of isometric contractions for 2 min at 30% of maximum voluntary contraction and a 4-min interval between sets. The control group received a compression ball in order to minimize the placebo effects, representing sham training. Blood flow and brachial flow-mediated dilation were analyzed at before and after 8 weeks of intervention. We compared the responses (Δ = post-pre values) of each group (women control, women IHT, men control, and men IHT) with a Kruskal-Wallis test. <b><i>Results:</i></b> There were no differences in all groups after 8 weeks of IHT in Δ brachial diameter (<i>p</i> = 0.850), Δ flow-mediated dilation (<i>p</i> = 0.241), Δ time to peak diameter (<i>p</i> = 0.528), and Δ FMD/AUC (<i>p</i> = 0.397). <b><i>Conclusions:</i></b> There are no effects of sex on vascular adaptation after 8 weeks of IHT in older adults with symptomatic PAD.

scholarly journals Effectiveness of Home-Based Pain-Free Exercise versus Walking Advice in Patients with Peripheral Artery Disease: A Randomized Controlled Trial

2021 ◽  
Vol 4 (2) ◽  
pp. 29
Author(s):  
Fabio Manfredini ◽  
Nicola Lamberti ◽  
Luca Traina ◽  
Gladiol Zenunaj ◽  
Chiara Medini ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Controlled Trial ◽  
Ankle Brachial Index ◽  
Exercise Program ◽  
Walking Distance ◽  
Control Group ◽  
Peripheral Artery ◽  
Free Exercise ◽  
Home Based ◽  
Artery Disease

Exercise therapy in the intermediate stages of peripheral artery disease (PAD) represents an effective solution to improve mobility and quality of life (QoL). Home-based programs, although less effective than supervised programs, have been found to be successful when conducted at high intensity by walking near maximal pain. In this randomized trial, we aim to compare a low-intensity, pain-free structured home-based exercise (SHB) program to an active control group that will be advised to walk according to guidelines. Sixty PAD patients aged > 60 years with claudication will be randomized with a 1:1 ratio to SHB or Control. Patients in the training group will be prescribed an interval walking program at controlled speed to be performed at home; the speed will be increased weekly. At baseline and after 6 months, the following outcomes will be collected: pain-free walking distance and 6-min walking distance (primary outcome), ankle-brachial index, QoL by the VascuQoL-6 questionnaire, foot temperature by thermal camera, 5-time sit-to-stand test, and long-term clinical outcomes including revascularization rate and mortality. The home-based pain-free exercise program may represent a sustainable and cost effective option for patients and health services. The trial has been approved by the CE-AVEC Ethics Committee (898/20). Registration details: Clinicaltrials.gov NCT04751890 [Registered: 12 February 2021].

Individual Differences in Response to Supervised Exercise Therapy for Peripheral Artery Disease

2020 ◽  
pp. 019394592097747
Author(s):  
Mary O. Whipple ◽  
Erica N. Schorr ◽  
Kristine M.C. Talley ◽  
Julian Wolfson ◽  
Ruth Lindquist ◽  
...  
Keyword(s):  
Older Adults ◽  
Peripheral Artery Disease ◽  
Exercise Therapy ◽  
Poor Response ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Meaningful Improvement ◽  
Supervised Exercise ◽  
Patient Reported ◽  
Artery Disease

Nonresponse to exercise has been extensively examined in young athletes but is seldom reported in studies of aerobic exercise interventions in older adults. This study examined the prevalence of nonresponse and poor response to exercise in functional and quality of life outcomes and response patterns between and among older adults undergoing 12-weeks of supervised exercise therapy for the management of peripheral artery disease ( N = 44, mean age 72.3 years, 47.7% female). The prevalence of nonresponse (no change/decline in performance) in walking distance was 31.8%. The prevalence of poor response (lack of a clinically meaningful improvement) was 43.2%. Similar patterns of response were observed in both objective and patient-reported measures of physical function. All participants improved in at least one outcome; only two participants improved in all measured outcomes. Additional research should examine modifiable predictors of response to inform programming and maximize an individual’s potential benefit from exercise therapy.

scholarly journals RS16. Malnutrition and Mortality in Frail and Nonfrail Older Adults Undergoing Interventions for Peripheral Artery Disease

2019 ◽  
Vol 69 (6) ◽  
pp. e198
Author(s):  
Laura M. Drudi ◽  
Rita Mancini ◽  
Matthew Ades ◽  
Julia Rodighiero ◽  
Sonya Page ◽  
...  
Keyword(s):  
Older Adults ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Artery Disease

The risk of peripheral artery disease in older adults - seven-year results of the getABI study

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 403-410 ◽  
Author(s):  
Dietmar Krause ◽  
Ina Burghaus ◽  
Ulrich Thiem ◽  
Ulrike S. Trampisch ◽  
Matthias Trampisch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Density Lipoprotein ◽  
Current Smoker ◽  
Repeated Measurements ◽  
Peripheral Artery ◽  
Artery Disease

Abstract. Background: To assess the risk of peripheral artery disease (PAD) in older adults and the contribution of traditional and novel risk factors to the incidence of PAD. Patients and methods: 344 general practitioners (GPs), trained by vascular specialists all over Germany, enrolled 6,880 unselected participants aged 65 years or older (getABI study). The onset of PAD was determined by a regression method in the course of repeated measurements of the ankle brachial index (ABI) over seven years. PAD onset was defined by the declining linear regression ABI line reaching 0.9 or by PAD symptoms. Results: The cumulative PAD incidence over seven years was 12.9%, corresponding to an incidence rate of 20.3 per 1000 person years (95% confidence interval [95%CI] 18.8 to 21.7). Logistic regression analysis showed that traditional risk factors contributed significantly to the risk of PAD: current smoker status (odds ratio 2.65, 95%CI 2.08 to 3.37), diabetes (1.35, 95%CI 1.13 to 1.62), and low-density lipoprotein >130 mg/dl (1.26, 95%CI 1.07 to 1.48). Three novel risk factor candidates showed significant impact on PAD incidence: elevated sensitive C-reactive protein level (1.23, 95%CI 1.05 to 1.45), impaired estimated glomerular filtration rate (1.27, 95%CI 1.03 to 1.56), and elevated homocysteine level (1.19, 95%CI 1.01 to 1.41). Conclusions: Older adults in Germany have a PAD risk of 12.9% per seven years. Potentially modifiable traditional PAD risk factors yield high impact on PAD incidence. Novel risk factor candidates may contribute to the risk of PAD

Agreement Between StepWatch3 and ActiGraph wGT3X+ for Measuring Step-Based Metrics in People With Peripheral Artery Disease

2021 ◽  
pp. 1-12
Author(s):  
Pierre Jéhannin ◽  
Alexis Le Faucheur ◽  
Ségolène Chaudru ◽  
Aline Taoum ◽  
Guillaume Mahé ◽  
...  
Keyword(s):  
Older Adults ◽  
Peripheral Artery Disease ◽  
Low Frequency ◽  
Step Count ◽  
Peripheral Artery ◽  
Free Living ◽  
Outdoor Walking ◽  
Artery Disease

The authors investigated the agreement between StepWatch3™ (SW3) and ActiGraph™ wGT3X+ monitors for measuring step-based metrics in patients with peripheral artery disease and older adults. In 23 patients with peripheral artery disease and 38 older participants, the authors compared the metrics obtained during an outdoor (400-m track) walking session (step count) and a 7-day free-living period (step count and 60/30/5/1-min maximal or peak step accumulation) using the SW3 (ankle) and the wGT3X+ (hip) with the low-frequency extension filter enabled (wGT3X+/LFE) or not (wGT3X+/N). During outdoor walking session, agreement was high, particularly for wGT3X+/LFE: correlations ≥.98, median absolute percentage errors <1%, and significant equivalence using a ± 15% equivalence zone or narrower. In free living, no wGT3X+ method was equivalent to SW3 for step count. The wGT3X+/LFE was equivalent to SW3 regarding all step accumulation metrics using a ± 20% equivalence zone or narrower, with median absolute percentage errors <11%. The wGT3X+/LFE method is the best option for comparisons with SW3 in peripheral artery disease and older adults.

Abstract 15456: Enhanced Vasoconstrictor Sensitivity to Exercise Pressor Reflex Engagement in Peripheral Artery Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Zhaohui Gao ◽  
Matthew D Muller ◽  
Cheryl Blaha ◽  
Aimee Cauffman ◽  
Kristen Brandt ◽  
...  
Keyword(s):  
Blood Flow ◽  
Peripheral Artery Disease ◽  
Plantar Flexion ◽  
Maximum Voluntary Contraction ◽  
Ankle Brachial Index ◽  
Peak Exercise ◽  
Peripheral Artery ◽  
Exercise Pressor Reflex ◽  
Pressor Reflex ◽  
Artery Disease

Exercise is associated with a rise in heart rate, blood pressure (BP) and blood flow to active skeletal muscle that is mediated by the exercise pressor reflex and modified by regional release of vasodilator factors. In peripheral artery disease (PAD) the exercise pressor reflex is enhanced and the ability to raise blood flow to the affected limb is impaired. To assess the functional impact of the enhanced exercise pressor reflex on regional blood flow in limbs affected by PAD, we determined beat-by-beat BP and mean blood velocity (MBV, Doppler) in the popliteal artery, and calculated vascular conductance index (VC, MBV/mean BP) in the exercising (ipsilateral) or contralateral resting leg during graded rhythmic plantar flexion exercise in 7 patients with symptomatic PAD (age 67±2 yrs, body-mass-index 27.9±1.1) and in 5 healthy age-matched controls (2 exercise trials with each leg). At peak exercise (2.0 kg, 1 contraction/sec), the pressor effect was greatest in PAD when exercise was performed with the “ischemic” leg (ankle-brachial index 0.58±0.05; mean ΔBP +9.1±2.0 mmHg), lower with the less affected leg (ankle brachial index 0.76±0.07; mean ΔBP +6.9±1.6 mmHg) and lowest in the controls (ankle brachial index 1.11±0.04; mean ΔBP +3.9±1.8 mmHg). In controls, VC increased in the exercising leg ( P <0.05) but did not change in the inactive contralateral leg ( P =NS). Similarly, in PAD, VC increased in the exercising “ischemic” leg ( P <0.05) but did not change in the inactive contralateral leg ( P =NS). In sharp contrast, while VC increased in the less affected exercising leg ( P <0.05), in the contralateral resting “ischemic” leg VC decreased by 24±10% ( P <0.05). Similarly, when static handgrip at 30% maximum voluntary contraction to fatigue served as the exercise stimulus, vasoconstriction was noted in the “ischemic” leg (n=5; P <0.05). Thus, unlike in the exercising leg, in the resting “ischemic” leg activation of the exercise pressor reflex resulted in substantial vasoconstriction. This suggests that despite activation of peripheral vasodilator mechanisms downstream to the arterial obstruction, the vasculature of the “ischemic” leg is exquisitely sensitive to reflex vasoconstriction.

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