Aims: Investigate whether a Home-based Exercise Therapy (HBET) program for patients with Peripheral Arterial Disease (PAD) and Intermittent Claudication (IC) with a behavior change intervention, supported by a smartphone application, is effective in improving walking distances and performance, and quality of life (QoL) over 6 months.Methods and results: This was a single-center, prospective, two-arm, single-blinded randomized controlled trial including 73 patients with PAD and IC, and three assessment moments: baseline, 3, and 6 months. Participants were randomized to receive a walking exercise prescription, with the support (n = 38) or without the support (n = 35) of the WalkingPad app, between January 2021 and July 2022. Both groups received two face-to-face behavior change sessions and 12 structured and targeted reinforcement phone calls over 6 months. Primary outcomes were between-group differences in pain-free walking distance (PFWD), functional walking distance (FWD), maximal walking distance (MWD), and 6-min walk distance (6 MWD) at 3 and 6 months. Secondary outcomes were QoL and walking impairment. Seventy-three patients (mean age 64 ± 7.2 years, 88% men) participated in this study, 60 of whom completed the three assessment moments. The whole sample significantly improved all primary outcomes in the first 3 months; that is, the average PFWD (151.1 m), FWD (175.2 m), MWD (171.1 m), and 6 MWD (30.8 m) increased from T1 to T2. Only MWD exhibited a significant average increase (35.0 m). Secondary outcomes also increased from baseline to 3 and 6 months. There were no between-group differences, except for MWD, which showed a greater increase at 6 months in the group that used the app, excluding patients with weak walking ability and extreme anxiety symptoms at baseline.Conclusion: The intervention improved distances and walking skills as well as the physical, mental, and disease-related quality of life among adults with PAD and IC. The group that used the WalkingPad app improved their MWD in 6 months compared to the control group, except for patients with poor walking ability and extreme anxiety symptoms, which suggests the effectiveness of the WalkingPad app for patients with high walking ability and no severe anxiety symptoms. More research is needed to determine the durability of these findings and to explore what app functionality might promote the other outcomes. Clinical Trial Registration: https://clinicaltrials.gov (NCT04749732).

The aim of this pilot study was to assess the effect of muscle contraction type on SmO₂ during a dynamic contraction protocol (DYN) and a holding isometric contraction protocol (ISO) in the back squat exercise. Ten voluntary participants (age: 26.6 ± 5.0 years, height: 176.8 ± 8.0 cm, body mass: 76.7 ± 8.1 kg, and one-repetition maximum (1RM): 112.0 ± 33.1 kg) with back squat experience were recruited. The DYN consisted of 3 sets of 16 repetitions at 50% of 1RM (56.0 ± 17.4 kg), with a 120-second rest interval between sets and 2 seconds per movement cycle. The ISO consisted of 3 sets of 1 isometric contraction with the same weight and duration as the DYN (32 seconds). Through near-infrared spectroscopy (NIRS) in the vastus lateralis (VL), soleus (SL), longissimus (LG), and semitendinosus (ST) muscles, the minimum SmO₂ (SmO_{2 min}), mean SmO₂ (SmO_{2 avg}), percent change from baseline (SmO_{2 Δdeoxy}) and time to recovery 50% of baseline value (t SmO_{2 50%reoxy}) were determined. No changes in SmO_{2 avg} were found in the VL, LG, and ST muscles, however the SL muscle had lower values in DYN, in the 1^st set (p = 0.002) and in the 2^nd set (p = 0.044). In terms of SmO_{2 min} and ΔSmO_{2 deoxy}, only the SL muscle showed differences (p≤0.05) and lower values in the DYN compared to ISO regardless of the set. The t SmO_{2 50%reoxy} was higher in the VL muscle after ISO, only in the 3^rd set. These preliminary data suggested that varying the type of muscle contraction in back squat with the same load and exercise time resulted in a lower SmO_{2 min} in the SL muscle in DYN, most likely because of a higher demand for specialized muscle activation, indicating a larger oxygen supply-consumption gap.

Background: Exercise therapy is a recognized non-pharmacological intervention for peripheral arterial disease (PAD); however, the effects of combined exercise remain under investigation. This study aimed to compare the effects of a 6-month combined supervised exercise program (SUP) with a usual care (UC) approach on walking ability, physical fitness, and peripheral blood flow in people with PAD and claudication. Methods: Twenty-three male participants (Age = 64.1 +/- 6.2years and ABI = 0.58 +/- 0.07) with PAD and claudication were assigned to either the SUP group ( n = 10), engaging in structured supervised treadmill walking combined with three resistance exercises, three times a week, or the UC group ( n = 13), receiving advice to walk. The primary outcome measure was walking ability, with assessments conducted at baseline (M0), after 3 months (M3), and 6 months (M6). Results: After the 6-month intervention, the SUP group exhibited significant improvements in absolute claudication time (ACT, p = 0.045), maximal walking time (MWT, p = 0.045), maximal walking distance (MWD, p = 0.027), and pause duration ( p = 0.045) during the 6-minute walk test (6MWT), when compared to the UC group. Over time, a significant increase in walking speed during the 6MWT (Speed6MWT , p = 0.001) and walking speed without claudication (SpeedNoC , p < 0.001) was found, although no significant differences were found between the groups. The SUP group increased by 0.8 km/h in both Speed6MWT and SpeedNoC , while the UC group increased by 0.3 km/h and 0.6 km/h, respectively. Despite claudication consistently occurring at the same time, the SUP group demonstrated an improved tolerance to pain or a better understanding of pain, enabling them to walk longer distances at higher speeds. A positive effect of SUP was found for chair sit-and-reach test ( p = 0.023), percentage of fat mass ( p = 0.048), fat-free mass ( p = 0.040), and total body water ( p = 0.026), suggesting potential benefits attributed to the resistance strength exercises. Conclusion: A 6-month combined treadmill and resistance exercise program improved walking ability, walking speed, lower body and lower back flexibility, and body composition in people with PAD and claudication. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of Society for Vascular Nursing, Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Article: Six-month effects of supervised exercise on walking ability and health-related factors in peripheral arterial disease: a pilot study - International Angiology 2023 Oct 23 - Minerva Medica - Journals

Adequate exercise prescription requires a deep understanding of the body’s response to exercise. This study explored the responses of heart rate (HR), muscle oxygen saturation (SmO₂), and perceived exertion (RPE) during six body-weight squat exercise variations. A total of 15 recreationally active participants (age: 28.2 ± 8.0 years; body mass: 71.1 ± 11.2 kg; height: 1.73 ± 0.08 m) were recruited. Six body-weight squat variations (deep, jumping, single-leg, uneven, unstable, and wall-sit) were randomly performed for 90 s. Results revealed that the jumping squat promoted a higher average and peak HR (165.3 ± 14.5 and 146.1 ± 14.8 bpm, respectively), and a lower average SmO₂ and higher deoxygenation SmO₂ in the soleus muscle (40.3 ± 15.4 and 46.0 ± 11.4%, accordingly). No differences were observed in recovery time or in the same SmO₂ derived-parameters in the vastus lateralis muscle. The jumping variation promoted a greater response at a physiological level, both centrally, related to cardiovascular response, and peripherally, related to soleus SmO₂. It was also the more demanding variation at both the overall and lower limb muscular level of RPE. This holistic view allows a precise identification of the response patterns in body-weight squat exercise variations to an acute session, with a training intervention providing additional information.

This study presents the development and assessment of a mobile application - the WalkingPAD app - aimed at promoting adherence to physical exercise among patients with Peripheral Arterial Disease (PAD). The assessment of adherence, acceptability, and usability was performed using mixed methods. Thirty-eight patients participated in the study with a mean age of 63.4 years (SD = 6.8). Thirty patients used the application for three months, responded to a semi-structured interview, and completed a task test and the System Usability Scale (SUS, ranging from 0 to 100). The application's adherence rate was 73%. When patients were asked about their reasons for using the app, the main themes that emerged were motivation, self-monitoring, and support in fulfilling a commitment. The average SUS score was 82.82 (SD = 18.4), indicating high usability. An upcoming version of the WalkingPAD app is expected to redesign both tasks - opening the app and looking up the walking history - which were rated as the most difficult tasks to accomplish. The new version of the WalkingPAD app will incorporate participants' comments and suggestions to enhance usability for this population.