Intermittent claudication (IC) is the most common symptom of peripheral arterial disease, which significantly affects walking ability, functional capacity and quality of life. Supervised exercise ...programs (SEP) are recommended as first-line treatment, but recruitment and adherence rates are poor. The time required to complete a SEP is the most common barrier to participation cited by patients who decline. High-intensity interval training (HIIT) is more time efficient than current SEPs and therefore has the potential to overcome this barrier. We conducted a systematic review to appraise the evidence for HIIT programs for IC.
MEDLINE, Embase, and CENTRAL databases were searched for terms related to HIIT and IC. Randomized and nonrandomized trials that investigated HIIT for the treatment of IC were included, with no exclusions based on exercise modality, protocol, or use of a comparator arm. Outcome measures were walking distances, peak oxygen uptake, recruitment and adherence rates, and quality of life. The risk of bias was assessed using the Cochrane tool and study quality using a modified Physiotherapy Evidence Database scale.
Nine articles reporting eight studies were included in the review. HIIT seems to improve walking distances and oxygen uptake in relation to controls, with improvements attainable in just 6 weeks. When HIIT was compared with low-intensity exercise, it seemed that longer low-intensity programs were required to obtain similar benefits to those from short-term HIIT.
Initial evidence suggests that HIIT may provide benefits for patients with IC. Initially, pilot studies of low-volume, short-term HIIT vs usual SEPs are required. This strategy will allow for larger randomized, controlled trials to be appropriately designed and adequately powered to further explore the potential benefits of HIIT in IC.
Supervised exercise programs (SEP) are effective for improving walking distance in patients with intermittent claudication (IC) but provision and uptake rates are suboptimal. Access to such programs ...has also been halted by the Coronavirus pandemic. The aim of this review is to provide a comprehensive overview of the evidence for home-based exercise programs (HEP).
This review was conducted in according with the published protocol and PRISMA guidance. Medline, EMBASE, CINAHL, PEDro, and Cochrane CENTRAL were searched for terms relating to HEP and IC. Randomized and nonrandomized trials that compared HEP with SEP, basic exercise advice, or no exercise controls for IC were included. A narrative synthesis was provided for all studies and meta-analyses conducted using data from randomized trials. The primary outcome was maximal walking distance. Subgroup analyses were performed to consider the effect of monitoring. Risk of bias was assessed using the Cochrane tool and quality of evidence via GRADE.
We included 23 studies with 1907 participants. Considering the narrative review, HEPs were inferior to SEPs which was reflected in the meta-analysis (mean distance MD, 139 m; 95% confidence interval CI, 45-232 m; P = .004; very low quality of evidence). Monitoring was an important component, because HEPs adopting this strategy were equivalent to SEPs (MD, 8 m; 95% CI, –81 to 97; P = .86; moderate quality of evidence). For HEPs vs basic exercise advice, narrative review suggested HEPs can be superior, although not always significantly so. For HEPs vs no exercise controls, narrative review and meta-analysis suggested HEPs were potentially superior (MD, 136 m; 95% CI, –2 to 273 m; P = .05; very low quality of evidence). Monitoring was also a key element in these comparisons. Other elements such as appropriate frequency (≥3× a week), intensity (to moderate-maximum pain), duration (20 progressing to 60 minutes) and type (walking) of exercise were important, as was education, self-regulation, goal setting, feedback, and action planning.
When SEPs are unavailable, HEPs are recommended. However, to elicit maximum benefit they should be structured, incorporating all elements of our evidence-based recommendations.
We present new subarcsecond-resolution Karl G. Jansky Very Large Array (VLA) imaging at 10 GHz of 155 ultraluminous (Lbol ∼ 1011.7-1014.2 L ) and heavily obscured quasars with redshifts z ∼ 0.4-3. ...The sample was selected to have extremely red mid-infrared-optical color ratios based on data from the Wide-Field Infrared Survey Explorer (WISE) along with a detection of bright, unresolved radio emission from the NRAO VLA Sky Survey (NVSS) or Faint Images of the Radio Sky at Twenty cm Survey. Our high-resolution VLA observations have revealed that the majority of the sources in our sample (93 out of 155) are compact on angular scales <0 2 (≤1.7 kpc at z ∼ 2). The radio luminosities, linear extents, and lobe pressures of our sources are similar to young radio active galactic nuclei (e.g., gigahertz-peaked spectrum GPS and compact steep-spectrum CSS sources), but their space density is considerably lower. Application of a simple adiabatic lobe expansion model suggests relatively young dynamical ages (∼104-7 yr), relatively high ambient ISM densities (∼1-104 cm−3), and modest lobe expansion speeds (∼30-10,000 km s−1). Thus, we find our sources to be consistent with a population of newly triggered, young jets caught in a unique evolutionary stage in which they still reside within the dense gas reservoirs of their hosts. Based on their radio luminosity function and dynamical ages, we estimate that only ∼20% of classical large-scale FR I/II radio galaxies could have evolved directly from these objects. We speculate that the WISE-NVSS sources might first become GPS or CSS sources, of which some might ultimately evolve into larger radio galaxies.
A systematic review was conducted to identify the range of terminology used in studies to describe maximum walking distance and the exercise testing protocols, and testing modalities used to measure ...it in patients with intermittent claudication. A secondary aim was to assess the implementation and reporting of the exercise testing protocols. CINAHL, Medline, EMBASE and Cochrane CENTRAL databases were searched. Randomised controlled trials whereby patients with intermittent claudication were randomised to an exercise intervention were included. The terminology used to describe maximal walking distance was recorded, as was the modality and protocol used to measure it. The implementation and reporting quality was also assessed using pre-specified criteria. Sixty-four trials were included in this review. Maximal walking distance was reported using fourteen different terminologies. Twenty-two different treadmill protocols and three different corridor tests were employed to assess maximal walking distance. No single trial satisfied all the implementation and reporting criteria for an exercise testing protocol. Evidence shows that between-study interpretation is difficult given the heterogenous nature of the exercise testing protocols, test endpoints and terminology used to describe maximal walking distance. This is further compounded by poor test reporting and implementation across studies. Comprehensive guidelines need to be provided to enable a standardised approach to exercise testing in patients with intermittent claudication.
Objectives
Supervised exercise programmes (SEPs) are a vital treatment for people with intermittent claudication, leading improvements in walking distance and quality of life and are recommended in ...multiple national and international guidelines. We aimed to evaluate the use and structure of SEPs in the United Kingdom (UK).
Design
We conducted an anonymous online survey using the Jisc platform comprising of 40 questions. The survey was designed to address key areas such as access, provision, uptake and delivery of SEPs in the United Kingdom. Ethical approval was obtained from Coventry University (P108729).
Methods
The list of trusts providing vascular services was obtained from the National Vascular Registry (NVR) report. The survey was disseminated via social media, The Vascular Society of Great Britain and Ireland and the Society for Vascular Technology. Data were exported to a Microsoft Excel document and analysed using simple descriptive statistics.
Results
Of 93 vascular units identified, we received response from 48. Of these, 23 had access to an exercise programme (48%). The majority of SEPs were exclusively for PAD patients (77%), with 21% using integrated services. 67% of respondents were providing a circuit-based programme, and 5 out of 23 were meeting the dose recommendations in the UK National Institute for Health and Care Excellence (NICE) guidelines. Respondents felt that programmes were moderately to extremely important to patients, slightly to very important to clinicians and not at all important to slightly important to commissioning/funding bodies.
Conclusion
SEPs are a well-established first-line treatment for patients with IC and they are recommended by NICE guidelines. Despite this, many patients still do not have access to an exercise programme, and clinicians do not feel that they have support from commissioning/funding bodies to develop them. There is an urgent need for funding, development and delivery of SEPs in the United Kingdom.
All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents ...different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research.
Purpose
To assess whether ad libitum water ingestion of different temperatures is sufficient to prevent dehydration-related exacerbations of thermal and cardiovascular strain, during exposure to ...conditions representative of a heatwave.
Methods
Twelve participants (mean ± SD; 25 ± 4 years) exercised for 180 min at 3 METs in 40.1 ± 0.6 °C, 40.4 ± 2.1%RH four times: (i) consuming 20 °C water ad libitum (AL20); (ii) consuming 4 °C water ad libitum (AL4); (iii) replacing no fluids (NOFR); (iv) replacing sweat losses (FULLFR). Fluid consumption (FC), dehydration (%DEH), rectal temperature (
T
re
), rate–pressure product (RPP), forearm blood flow (FBF), mean skin temperature (
T
sk
), and local sweat rate (LSR) were measured/determined.
Results
FC was greater in AL20 (1.30 ± 0.41 L) than AL4 (1.03 ± 0.32 L;
P
= 0.003). %DEH was lower (
P
< 0.001) in AL20 (0.11 ± 0.76%), AL4 (0.43 ± 0.64%), and FULLFR (0.01 ± 0.12%) compared to NOFR (1.93 ± 0.28%). %DEH was lower in AL20 than AL4 (
P
= 0.003). In NOFR, end-trial changes in
T
re
were greater (
P
< 0.001) (1.05 ± 0.27 °C) compared to all other trials, but similar among AL20 (0.72 ± 0.30 °C), AL4 (0.76 ± 0.25 °C) and FULLFR (0.74 ± 0.35 °C). End-trial RPP was higher (
P
< 0.001) in NOFR (12,389 ± 1578 mmHg·bpm) compared to all other trials, but similar among FULLFR (11,067 ± 1292 mmHg·bpm), AL20 (11,214 ± 2078 mmHg·bpm) and AL4 (11,089 ± 1795 mmHg·bpm). No differences in
T
sk
or LSR were observed among trials, but FBF was lower in NOFR compared to FULLFR (2.84 ± 0.69 vs. 3.52 ± 0.96 ml/100 ml/min;
P
= 0.029).
Conclusion
4 °C or 20 °C ad libitum water ingestion prevented dehydration levels that exacerbate thermal/cardiovascular strain, despite blunted fluid intake with 4 °C water. Higher core temperatures with NOFR are attributed to impaired internal heat distribution secondary to a lower FBF.
A novel high-intensity interval training (HIIT) program has demonstrated feasibility for patients with intermittent claudication (IC). The aim of this study was to explore patient perspectives of the ...HIIT program to inform refinement and future research.
All patients screened and eligible for the ‘high intensity interval training in patients with intermittent claudication (INITIATE)’ study were eligible to take part in a semistructured interview. A convenience subsample of patients was selected from 3 distinct groups: 1) those who completed the HIIT program, 2) those who prematurely discontinued the HIIT program, and 3) those who declined the HIIT program. Interviews considered patients views of the program and experiences of undertaking and/or being invited to undertake it. Interviews were audio recorded, transcribed verbatim, and analyzed via thematic analysis.
Eleven out of 31 participants who completed the program and 12 out of 38 decliners were interviewed. No participants who withdrew from the program agreed to interview. The 3 key themes were; personal reflections of the program; program facilitators and barriers; and perceived benefits. Completers enjoyed taking part, reported symptomatic improvement and would complete it again. Practical and psychological barriers exist, such as transport and motivation. Changes to the program were suggested.
Findings support the acceptability of this novel HIIT program, which in combination with the feasibility findings, suggest that a fully powered randomized controlled trial, comparing HIIT to usual-care supervised exercise programs is warranted.
Intermittent claudication (IC) is a classic symptom of peripheral artery disease, with first line treatment being supervised exercise therapy (SET). Despite this, SET is frequently underutilised, and ...adherence is often poor. An alternative option are home-based exercise programmes (HBEP). Although HBEPs are well tolerated, to the authors’ knowledge, no research has assessed their safety. The aim of this review was to assess the safety of HBEPs in people living with IC. We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library databases. The main parameter of interest was complication rate, calculated as the number of related adverse events per patient-hours. Subanalysis was undertaken to determine differences in safety for studies that did and did not include pre-exercise cardiac screening, and for studies with exercise at low, moderate, and high levels of claudication pain. Our search strategy identified 8693 results, of which 27 studies were included for full review. Studies included 1642 participants completing 147,810 patient-hours of home-based exercise. Four related adverse events were reported, three of which were cardiac in origin, giving an all-cause complication rate of one event per 36,953 patient-hours. Three of these events occurred following exercise to high levels of claudication pain, and one occurred with pain-free exercise. One event occured in a study without cardiac screening. Based on the low number of related adverse events, HBEPs appear to be a safe method of exercise prescription for people with IC. Our results strengthen the rationale for providing alternative exercise options for this population. PROSPERO Registration No.: CRD42021254581
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