H.J.P Fokkenrood

Innovative strategies for
intermittent claudication

towards a stepped care approach and new outcome measures

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ABSTRACT


Introduction

 Reduced physical activity (PA) is associated with a higher mortality rate and more rapid functional decline in patients with intermittent claudication (IC). The newest generation of accelerometers can assess both direction and intensity of activities three-dimensionally and may also adequately calculate energy expenditure in daily life. The aim of this study was to quantify daily PA level and energy expenditure of newly diagnosed patients with IC and healthy controls. PA outcomes are compared with contemporary public health physical activity guidelines.


Materials

 Before initiating treatment, 94 patients with newly diagnosed IC and 36 healthy controls were instructed to wear a tri-axial seismic accelerometer for 1 week. Daily PA levels (in metabolic equivalents, METs) were compared to the ACSM/AHA public health PA minimum recommendations (=64 METs·min·day, in bouts of =10 min). A subgroup analysis assessed the effect of functional impairment on daily PA levels.

 

Results

 Data of 56 IC patients and 27 healthy controls were available for analysis. Patients with IC demonstrated significantly lower mean daily PA levels (± S.D.) compared to controls (387 ± 198 METs?min vs. 500 ± 156 METs?min, p=0.02). This difference was solely attributable to a subgroup of IC patients with the largest functional impairment (WIQ-score <0.4). Only 45% of IC patients met the public health physical activity guidelines compared to 74% of the healthy controls (p=0.01).


Conclusion

 More than half of patients with intermittent claudication (IC) do not meet recommended standards of physical activity (PA). Considering the serious health risks associated with low PA levels, these findings underscore the need for more awareness to improve physical exercise in patients with IC.