Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.202300242
Jornal Vascular Brasileiro
Original Article

Effects of aerobic and combined training on pain-free walking distance and health-related quality of life in patients with peripheral artery disease: a randomized clinical trial

Efeitos do treinamento aeróbico e combinado na distância percorrida sem dor e na qualidade de vida relacionada à saúde em pacientes com doença arterial periférica: um ensaio clínico randomizado

Eduardo Lima Garcia; Adamastor Humberto Pereira; Marcio Garcia Menezes; Alexandre Araújo Pereira; Ricardo Stein; Leandro Tolfo Franzoni; Luiz Claudio Danzmann; Antônio Cardoso dos Santos

Downloads: 3
Views: 631

Abstract

Background: Decreased walking ability in patients with peripheral arterial disease is often a clinical problem and limits the quality of life and daily activities of these subjects. physical exercise is important in this scenario, as it improves both the daily walking distance and the ability to withstand intermittent claudication related to the limitations of the peripheral disease.

Objectives: Our aim was to compare the effects of two types of exercise training (aerobic training and aerobic training combined with resistance exercises) on pain-free walking distance (PFWD) and health-related quality of life (HRQoL) in a sample composed of patients with peripheral artery disease (PAD).

Methods: Twenty patients with claudication symptoms were randomized to either aerobic control (AC) N= 9, or combined training (CT) N= 8, (24 sixty-minute sessions, twice a week). The total walking distance until onset of pain due to claudication was assessed using the 6-minute walk test and HRQoL was measured using the WHOQOL-bref questionnaire (general and specific domains) at baseline and after training. We used generalized estimating equations (GEE) to assess the differences between groups for the PFWD and HRQoL domains, testing the main group and time effects and their respective interaction effects. P values < 0.05 were considered statistically significant.

Results: Seventeen patients (mean age 63±9 years; 53% male) completed the study. Both groups experienced improvement in claudication, as reflected by a significant increase in PFWD: AC, 149 m to 299 m (P<0.001); CT, 156 m to 253 m (P<0.001). HRQoL domains also improved similarly in both groups (physical capacity, psychological aspects, and self-reported quality of life; P=0.001, P=0.003, and P=0.011 respectively).

Conclusions: Both aerobic and combined training similarly improved PFWD and HRQoL in PAD patients. There are no advantages in adding strength training to conventional aerobic training. This study does not support the conclusion that combined training is a good strategy for these patients when compared with classic training.

Keywords

peripheral artery disease, pain-free walking distance, health-related quality of life, exercise, intermittent claudication

Resumo

Contexto: A diminuição da capacidade de marcha em pacientes com doença arterial periférica é frequentemente um problema clínico e limita a qualidade de vida e as atividades diárias desses indivíduos. O exercício físico é importante nesse cenário, pois melhora tanto a distância caminhada diária quanto a capacidade de suportar a claudicação intermitente relacionada às limitações da doença periférica.

Objetivos: Comparar os efeitos do treinamento aeróbico (TA) e do treinamento aeróbico combinado com exercícios de resistência (TC) na distância percorrida livre de dor (DPLD) e na qualidade de vida relacionada à saúde (QVRS) em pacientes com doença arterial periférica (DAP).

Métodos: Vinte pacientes com sintomas de claudicação foram randomizados para TA ou TC. Os treinamentos foram realizados em 24 sessões, duas vezes por semana. A DPLD foi avaliada por meio do teste de caminhada de 6 minutos, e a QVRS foi medida pelo instrumento da avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-BREF), no início e após o treinamento. Para avaliar as diferenças entre os grupos para DPLD e os domínios da QVRS, foi utilizado o modelo de equações de estimativa generalizada, testando os efeitos principais do grupo e tempo, bem como os respectivos efeitos de interação. Valores de p < 0,05 foram considerados estatisticamente significativos.

Resultados: Dezessete pacientes (idade média: 63±9 anos; 53% do sexo masculino) completaram o estudo. Ambos os grupos apresentaram melhora na claudicação, refletida por um aumento significativo na DPLD: grupo controle aeróbico - de 149 m para 299 m (P < 0,001); grupo de treinamento combinado - de 156 m para 253 m (P < 0,001). Os domínios da QVRS também melhoraram de forma semelhante em ambos os grupos (capacidade física, aspectos psicológicos e qualidade de vida autorreferida; P = 0,001, P = 0,003 e P = 0,011, respectivamente).

Conclusões: Ambos os treinamentos melhoraram de forma semelhante a DPLD e a QVRS em pacientes com DAP. Não há vantagens em associar o treinamento de força ao treinamento aeróbico convencional. O estudo não permite concluir que o TC é uma boa estratégia para esses pacientes quando comparado ao treinamento clássico.
 

Palavras-chave

doença arterial periférica, distância percorrida livre de dor, qualidade de vida relacionada à saúde, exercício, claudicação intermitente

References

1 Haga M, Hoshina K, Koyama H, et al. Bicycle exercise training improves ambulation in patients with peripheral artery disease. J Vasc Surg. 2020;71(3):979-87. http://dx.doi.org/10.1016/j.jvs.2019.06.188. PMid:31495679.

2 McDermott MM, Ades P, Guralnik JM, et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA. 2009;301(2):165-74. http://dx.doi.org/10.1001/jama.2008.962. PMid:19141764.

3 Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Vasc Med. 2017;22(3):NP1-NP43. http://dx.doi.org/10.1177/1358863X17701592. PMid:28494710.

4 Novaković M, Krevel B, Rajkovic U, et al. Moderate-pain versus pain-free exercise, walking capacity, and cardiovascular health in patients with peripheral artery disease. J Vasc Surg. 2019;70(1):148-56. http://dx.doi.org/10.1016/j.jvs.2018.10.109. PMid:30922760.

5 Gardner AW, Montgomery PS, Scott KJ, Afaq A, Blevins SM. Patterns of ambulatory activity in subjects with and without intermittent claudication. J Vasc Surg. 2007;46(6):1208-14. http://dx.doi.org/10.1016/j.jvs.2007.07.038. PMid:17919876.

6 Aragão JA, Santos RM, Neves OMG, et al. Qualidade de vida em pacientes com doença arterial periférica. J Vasc Bras. 2018;17(2):117-21. http://dx.doi.org/10.1590/1677-5449.009017 PMid:30377420.

7 Allen JD, Giordano T, Kevil CG. Nitrite and nitric oxide metabolism in peripheral artery disease. Nitric Oxide. 2012;26(4):217-22. http://dx.doi.org/10.1016/j.niox.2012.03.003. PMid:22426034.

8 Shibata D. Improvement of dynamic postural stability by an exercise program. Gait Posture. 2020;80:178-84. http://dx.doi.org/10.1016/j.gaitpost.2020.05.044. PMid:32521472.

9 Machado I, Sousa N, Paredes H, Ferreira J, Abrantes C. Combined aerobic and resistance exercise in walking performance of patients with intermittent claudication: systematic review. Front Physiol. 2020;10:1538. http://dx.doi.org/10.3389/fphys.2019.01538. PMid:31969830.

10 Wilson JM, Marin PJ, Rhea MR, Wilson SMC, Loenneke JP, Anderson JC. Concurrent training: a meta-analysis examining interference of aerobic and resistance exercises. J Strength Cond Res. 2012;26(8):2293-307. http://dx.doi.org/10.1519/JSC.0b013e31823a3e2d PMid:22002517.

11 ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7. http://dx.doi.org/10.1164/ajrccm.166.1.at1102. PMid:12091180.

12 Gift AG. Visual analogue scales: measurement of subjective phenomena. Nurs Res. 1989;38(5):286-8. http://dx.doi.org/10.1097/00006199-198909000-00006. PMid:2678015.

13 Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81. http://dx.doi.org/10.1249/00005768-198205000-00012. PMid:7154893.

14 Fleck MP, Louzada S, Xavier M, et al. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica. 2000;34(2):178-83. http://dx.doi.org/10.1590/S0034-89102000000200012. PMid:10881154.

15 Brawner CA, Keteyian SJ, Ehrman JK. The relationship of heart rate reserve to VO2 reserve in patients with heart disease. Med Sci Sports Exerc. 2002;34(3):418-22. http://dx.doi.org/10.1097/00005768-200203000-00006. PMid:11880804.

16 Robertson RJ, Goss FL, Rutkowski J, et al. Concurrent validation of the OMNI perceived exertion scale for resistance exercise. Med Sci Sports Exerc. 2003;35(2):333-41. http://dx.doi.org/10.1249/01.MSS.0000048831.15016.2A. PMid:12569225.

17 McDermott MM, Kibbe MR, Guralnik JM, et al. Durability of benefits from supervised treadmill exercise in people with peripheral artery disease. J Am Heart Assoc. 2019;8(1):e009380. http://dx.doi.org/10.1161/JAHA.118.009380. PMid:30587066.

18 Reynolds MR, Apruzzese P, Galper BZ, et al. Cost-effectiveness of supervised exercise, stenting, and optimal medical care for claudication: results from the Claudication: Exercise versus Endoluminal Revascularization (CLEVER) trial. J Am Heart Assoc. 2014;3(6):e001233. http://dx.doi.org/10.1161/JAHA.114.001233. PMid:25389284.

19 McGuigan MR, Bronks R, Newton RU, et al. Resistance training in patients with peripheral arterial disease: effects on myosin isoforms, fiber type distribution, and capillary supply to skeletal muscle. J Gerontol A Biol Sci Med Sci. 2001;56(7):B302-10. http://dx.doi.org/10.1093/gerona/56.7.B302. PMid:11445595.

20 Mosti MP, Wang E, Wiggen ON, Helgerud J, Hoff J. Concurrent strength and endurance training improves physical capacity in patients with peripheral arterial disease. Scand J Med Sci Sports. 2011;21(6):e308-14. http://dx.doi.org/10.1111/j.1600-0838.2011.01294.x. PMid:21410546.

21 Kraemer WJ, Patton JF, Gordon SE, et al. Compatibility of high-intensity strength and endurance training on hormonal and skeletal muscle adaptations. J Appl Physiol. 1995;78(3):976-89. http://dx.doi.org/10.1152/jappl.1995.78.3.976 PMid:7775344.

22 Marzolini S, Oh PI, Thomas SG, Goodman JM. Aerobic and resistance training in coronary disease: single versus multiple sets. Med Sci Sports Exerc. 2008;40(9):1557-64. http://dx.doi.org/10.1249/MSS.0b013e318177eb7f. PMid:18685538.

23 Gardner AW, Montgomery PS, Parker DE. Optimal exercise program length for patients with claudication. J Vasc Surg. 2012;55(5):1346-54. http://dx.doi.org/10.1016/j.jvs.2011.11.123. PMid:22459748.

24 Gardner AW, Montgomery PS, Parker DE. Metabolic syndrome impairs physical function, health-related quality of life, and peripheral circulation in patients with intermittent claudication. J Vasc Surg. 2006;43(6):1191-6, discussion 1197. http://dx.doi.org/10.1016/j.jvs.2006.02.042. PMid:16765237.

25 Lane R, Harwood A, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2017;12(12):CD000990. PMid:29278423.

26 Kruidenier LM, Viechtbauer W, Nicolai SP, Buller H, Prins MH, Teijink JA. Treatment for intermittent claudication and the effects on walking distance and quality of life. Vascular. 2012;20(1):20-35. http://dx.doi.org/10.1258/vasc.2011.ra0048. PMid:22271802.

27 Gardner AW, Montgomery PS, Wang M, Xu C. Predictors of health-related quality of life in patients with symptomatic peripheral artery disease. J Vasc Surg. 2018;68(4):1126-34. http://dx.doi.org/10.1016/j.jvs.2017.12.074. PMid:29615353.

28 Liles DR, Kallen MA, Petersen LA, Bush RL. Quality of life and peripheral arterial disease. J Surg Res. 2006;136(2):294-301. http://dx.doi.org/10.1016/j.jss.2006.06.008. PMid:17046794.

29 Wu A, Coresh J, Selvin E, et al. Lower extremity peripheral artery disease and quality of life among older individuals in the community. J Am Heart Assoc. 2017;6(1):e004519. http://dx.doi.org/10.1161/JAHA.116.004519. PMid:28108464.

30 Parmenter BJ, Dieberg G, Phipps G, Smart NA. Exercise training for health-related quality of life in peripheral artery disease: a systematic review and meta-analysis. Vasc Med. 2015;20(1):30-40. http://dx.doi.org/10.1177/1358863X14559092. PMid:25432991.

31 Andrade Lima AH, Farah BQ, Rodrigues LB, et al. Low-intensity resistance exercise does not affect cardiac autonomic modulation in patients with peripheral artery disease. Clinics (São Paulo). 2013;68(5):632-7. http://dx.doi.org/10.6061/clinics/2013(05)09. PMid:23778414.
 


Submitted date:
04/03/2023

Accepted date:
05/22/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
64e7b797a95395785b4d65b4 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections