Mary M McDermott1. 1. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: mdm608@northwestern.edu.
Abstract
OBJECTIVE: The objective of this study was to provide an overview of evidence regarding exercise therapies for patients with lower extremity peripheral artery disease (PAD). METHODS: This manuscript summarizes the content of a lecture delivered as part of the 2016 Crawford Critical Issues Symposium. RESULTS: Multiple randomized clinical trials demonstrate that supervised treadmill exercise significantly improves treadmill walking performance in people with PAD and intermittent claudication symptoms. A meta-analysis of 25 randomized trials demonstrated a 180-meter increase in treadmill walking distance in response to supervised exercise interventions compared with a nonexercising control group. Supervised treadmill exercise has been inaccessible to many patients with PAD because of lack of medical insurance coverage. However, in 2017, the Centers for Medicare and Medicaid Services issued a decision memorandum to support health insurance coverage of 12 weeks of supervised treadmill exercise for patients with walking impairment due to PAD. Recent evidence also supports home-based walking exercise to improve walking performance in people with PAD. Effective home-exercise programs incorporate behavioral change interventions such as a remote coach, goal setting, and self-monitoring. Supervised treadmill exercise programs preferentially improve treadmill walking performance, whereas home-based walking exercise programs preferentially improve corridor walking, such as the 6-minute walk test. Clinical trial evidence also supports arm or leg ergometry exercise to improve walking endurance in people with PAD. Treadmill walking exercise appears superior to resistance training alone for improving walking endurance. CONCLUSIONS: Supervised treadmill exercise significantly improves treadmill walking performance in people with PAD by approximately 180 meters compared with no exercise. Recent evidence suggests that home-based exercise is also effective and preferentially improves over-ground walking performance, such as the 6-minute walk test.
OBJECTIVE: The objective of this study was to provide an overview of evidence regarding exercise therapies for patients with lower extremity peripheral artery disease (PAD). METHODS: This manuscript summarizes the content of a lecture delivered as part of the 2016 Crawford Critical Issues Symposium. RESULTS: Multiple randomized clinical trials demonstrate that supervised treadmill exercise significantly improves treadmill walking performance in people with PAD and intermittent claudication symptoms. A meta-analysis of 25 randomized trials demonstrated a 180-meter increase in treadmill walking distance in response to supervised exercise interventions compared with a nonexercising control group. Supervised treadmill exercise has been inaccessible to many patients with PAD because of lack of medical insurance coverage. However, in 2017, the Centers for Medicare and Medicaid Services issued a decision memorandum to support health insurance coverage of 12 weeks of supervised treadmill exercise for patients with walking impairment due to PAD. Recent evidence also supports home-based walking exercise to improve walking performance in people with PAD. Effective home-exercise programs incorporate behavioral change interventions such as a remote coach, goal setting, and self-monitoring. Supervised treadmill exercise programs preferentially improve treadmill walking performance, whereas home-based walking exercise programs preferentially improve corridor walking, such as the 6-minute walk test. Clinical trial evidence also supports arm or leg ergometry exercise to improve walking endurance in people with PAD. Treadmill walking exercise appears superior to resistance training alone for improving walking endurance. CONCLUSIONS: Supervised treadmill exercise significantly improves treadmill walking performance in people with PAD by approximately 180 meters compared with no exercise. Recent evidence suggests that home-based exercise is also effective and preferentially improves over-ground walking performance, such as the 6-minute walk test.
Authors: Irena Zwierska; Richard D Walker; Sohail A Choksy; Jonathan S Male; A Graham Pockley; John M Saxton Journal: J Vasc Surg Date: 2005-12 Impact factor: 4.268
Authors: Mary M McDermott; Jack M Guralnik; Michael H Criqui; Kiang Liu; Melina R Kibbe; Luigi Ferrucci Journal: Circulation Date: 2014-07-01 Impact factor: 29.690
Authors: Michael S Conte; Frank B Pomposelli; Daniel G Clair; Patrick J Geraghty; James F McKinsey; Joseph L Mills; Gregory L Moneta; M Hassan Murad; Richard J Powell; Amy B Reed; Andres Schanzer; Anton N Sidawy Journal: J Vasc Surg Date: 2015-01-28 Impact factor: 4.268
Authors: Mary M McDermott; Kiang Liu; Jack M Guralnik; Michael H Criqui; Bonnie Spring; Lu Tian; Kathryn Domanchuk; Luigi Ferrucci; Donald Lloyd-Jones; Melina Kibbe; Huimin Tao; Lihui Zhao; Yihua Liao; W Jack Rejeski Journal: JAMA Date: 2013-07-03 Impact factor: 56.272
Authors: Julie R Menard; Hadley E Smith; Deborah Riebe; Christina M Braun; Bryan Blissmer; Robert B Patterson Journal: J Vasc Surg Date: 2004-06 Impact factor: 4.268
Authors: Mary McGrae McDermott; Kiang Liu; Philip Greenland; Jack M Guralnik; Michael H Criqui; Cheeling Chan; William H Pearce; Joseph R Schneider; Luigi Ferrucci; Lillian Celic; Lloyd M Taylor; Ed Vonesh; Gary J Martin; Elizabeth Clark Journal: JAMA Date: 2004-07-28 Impact factor: 56.272
Authors: Jacob C Monroe; Chen Lin; Susan M Perkins; Yan Han; Brett J Wong; Raghu L Motaganahalli; Bruno T Roseguini Journal: J Appl Physiol (1985) Date: 2020-10-01
Authors: Anna Spannbauer; Maciej Chwała; Tomasz Ridan; Arkadiusz Berwecki; Piotr Mika; Anita Kulik; Małgorzata Berwecka; Maria T Szewczyk Journal: Biomed Res Int Date: 2019-09-18 Impact factor: 3.411
Authors: Zainali Chunawala; Patricia P Chang; Andrew P DeFilippis; Michael E Hall; Kunihiro Matsushita; Melissa C Caughey Journal: J Am Heart Assoc Date: 2020-10-26 Impact factor: 5.501