Kruti Patel1, Tamar S Polonsky2, Melina R Kibbe3, Jack M Guralnik4, Lu Tian5, Luigi Ferrucci6, Michael H Criqui7, Robert Sufit8, Christiaan Leeuwenburgh9, Dongxue Zhang10, Lihui Zhao11, Mary M McDermott12. 1. University of Illinois College of Medicine, Chicago, Ill. 2. Department of Medicine, University of Chicago, Chicago. 3. Department of Surgery, University of North Carolina, Chapel Hill, NC. 4. Department of Epidemiology, University of Maryland, Baltimore, Md. 5. Department of Biomedical Data Science, Stanford University, Stanford, Calif. 6. Division of Intramural Research, National Institute on Aging, Bethesda, Md. 7. Department of Family Medicine and Public Health, University of California San Diego, San Diego, Calif. 8. Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill. 9. Department of Aging and Geriatric Research, University of Florida, Gainesville, Fla. 10. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. 11. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. 12. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: mdm608@northwestern.edu.
Abstract
BACKGROUND: Among people with lower extremity peripheral artery disease (PAD), little is known about variation in response to supervised exercise therapy (SET). Clinical characteristics associated with greater responsiveness to SET have not been identified. METHODS: Data from participants with PAD in two randomized clinical trials comparing SET vs nonexercising control were combined. The exercise intervention consisted of three times weekly supervised treadmill exercise. The control groups received lectures on health-related topics. RESULTS:Of 309 unique participants randomized (mean age, 67.9 years [standard deviation, 9.3 years]; 132 [42.7%] women; 185 [59.9%] black), 285 (92%) completed 6-month follow-up. Compared with control, those randomized to SET improved 6-minute walk distance by 35.6 meters (95% confidence interval, 21.4-49.8; P < .001). In the 95 (62.1%) participants who attended at least 70% of SET sessions, change in 6-minute walk distance varied from -149.4 to +356.0 meters. Thirty-four (35.8%) had no 6-minute walk distance improvement. Among all participants, age, sex, race, body mass index, prior lower extremity revascularization, and other clinical characteristics did not affect the degree of improvement in 6-minute walk distance after SET relative to the control group. Participants with 6-minute walk distance less than the median of 334 meters at baseline had greater percentage improvement in 6-minute walk distance compared with those with baseline 6-minute walk distance above the median (+20.5% vs +5.3%; P for interaction = .0107). CONCLUSIONS: Among people with PAD, substantial variability exists in walking improvement after SET. Shorter 6-minute walk distance at baseline was associated with greater improvement after SET, but other clinical characteristics, including age, sex, prior lower extremity revascularization, and disease severity, did not affect responsiveness to exercise therapy.
RCT Entities:
BACKGROUND: Among people with lower extremity peripheral artery disease (PAD), little is known about variation in response to supervised exercise therapy (SET). Clinical characteristics associated with greater responsiveness to SET have not been identified. METHODS: Data from participants with PAD in two randomized clinical trials comparing SET vs nonexercising control were combined. The exercise intervention consisted of three times weekly supervised treadmill exercise. The control groups received lectures on health-related topics. RESULTS: Of 309 unique participants randomized (mean age, 67.9 years [standard deviation, 9.3 years]; 132 [42.7%] women; 185 [59.9%] black), 285 (92%) completed 6-month follow-up. Compared with control, those randomized to SET improved 6-minute walk distance by 35.6 meters (95% confidence interval, 21.4-49.8; P < .001). In the 95 (62.1%) participants who attended at least 70% of SET sessions, change in 6-minute walk distance varied from -149.4 to +356.0 meters. Thirty-four (35.8%) had no 6-minute walk distance improvement. Among all participants, age, sex, race, body mass index, prior lower extremity revascularization, and other clinical characteristics did not affect the degree of improvement in 6-minute walk distance after SET relative to the control group. Participants with 6-minute walk distance less than the median of 334 meters at baseline had greater percentage improvement in 6-minute walk distance compared with those with baseline 6-minute walk distance above the median (+20.5% vs +5.3%; P for interaction = .0107). CONCLUSIONS: Among people with PAD, substantial variability exists in walking improvement after SET. Shorter 6-minute walk distance at baseline was associated with greater improvement after SET, but other clinical characteristics, including age, sex, prior lower extremity revascularization, and disease severity, did not affect responsiveness to exercise therapy.
Authors: Hafizur Rahman; Iraklis I Pipinos; Jason M Johanning; George Casale; Mark A Williams; Jonathan R Thompson; Yohanis O'Neill-Castro; Sara A Myers Journal: J Vasc Surg Date: 2021-05-31 Impact factor: 4.268