H.J.P Fokkenrood

Innovative strategies for
intermittent claudication

towards a stepped care approach and new outcome measures

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ABSTRACT


Objectives

 Intermittent claudication (IC) is associated with a reduction in physical activity (PA) and a more rapid functional decline leading to a higher mortality rate compared to healthy individuals. Supervised exercise therapy (SET) is known to increase the walking capacity of IC patients. However, it is unclear whether SET increases PA. The aim of this study was to investigate the effect of SET on PA levels and ambulatory activities in patients with IC.


Design

 Newly diagnosed IC patients were requested to wear an activity monitor one week prior to and one week immediately following 3 months of SET. Primary outcome was the percentage of patients meeting the minimum recommendations of PA (ACSM/AHA public health, =67 METs·min·day, in bouts of =10 min) at baseline and after 3 months of SET. Additionally, daily PA level (metabolic equivalents, METs·min), duration of ambulatory activities, daily number of steps, pain free walking distance (PFWD), maximal walking distance (MWD) and SF-36 health surveys were compared before and after SET.


Results

 Data of 41 participants were available for analysis. A higher number of participants met the ACSM minimum recommendation for PA at the 3 months follow up (baseline: 43%; 3 months: 63%, p= .003). Despite significant increases in PFWD (baseline: 210m; 3 months: 390m, p=.001), MWD (baseline: 373m; 3 months: 555m, p=.002) and physical functioning score (SF-36) following SET, no increase in mean daily PA level was found (395 ± 220 vs. 411 ± 228 METs?min, p=.43). Furthermore, total number of steps and time spent in ambulatory activities did not change following SET.


Conclusion

 Three months of SET for intermittent claudication leads to more patients meeting the ACSM/AHA public health minimum recommendations of PA. Assessment of PA may be incorporated as outcome parameter in future research comparing different treatment modalities for peripheral arterial disease.