Top

Published in:

01-03-2020 | Arterial Diseases | IM - ORIGINAL

Changes in exercise capacity and risk of all-cause mortality in patients with peripheral artery disease: a 10-year retrospective cohort study

Authors: Nicola Lamberti, Pablo Jesùs López-Soto, Franco Guerzoni, Nicola Napoli, Vincenzo Gasbarro, Paolo Zamboni, Elpiniki Tsolaki, Maria Cristina Taddia, Maria Aurora Rodríguez-Borrego, Roberto Manfredini, Nino Basaglia, Fabio Manfredini

Published in: Internal and Emergency Medicine | Issue 2/2020

Abstract

We retrospectively studied the association between changes in exercise capacity at discharge from a home-based exercise program and the risk of all-cause mortality among patients with peripheral artery disease (PAD) and claudication. The records of 1076 consecutive PAD patients were assessed between 2003 and 2013. The exercise program was prescribed during a few visits and executed at home at symptom-free walking speed. Ankle–Brachial Index (ABI) and maximal speed (S_max) on an incremental treadmill test were recorded at baseline and discharge. The number and date of deaths and hospitalizations for a 10-year period were collected from the regional registry. A total of 865 PAD patients completed the program (completers), while 221 left the program for health reasons (n = 128, diseased) or for nonhealth reasons (n = 83, quitters). Among the completers, the mortality rate (27%) was significantly lower (p < 0.001) than that of both the diseased (49 deaths, 38%) and the quitters (45 deaths, 54%). The completers (71 ± 9 years; 88% exercise sessions completed) showed significant improvements in the lowest ABI (from 0.62 ± 0.18 to 0.67 ± 0.19) and S_max (from 3.3 ± 1.1 to 3.8 ± 1.1 km h⁻¹) at discharge. The completers who reached the clinically important difference of S_max ≥ 0.4 km h⁻¹ at follow-up showed a significantly lower mortality risk (25% vs. 30%; HR 0.72; 95% CI 0.55–0.93) as well a lower rate of hospitalizations (p < 0.001). In conclusion, in PAD patients, active participation in a home-based exercise program was associated with a lower rate of death and better long-term clinical outcomes, particularly for those who attained a moderate increase in exercise capacity.

Available only for authorised users

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45(Suppl S):S5–67CrossRef

Hamburg NM, Balady GJ (2011) Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation 123(1):87–97. https://doi.org/10.1161/CIRCULATIONAHA.109.881888 CrossRefPubMedPubMedCentral

Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, Chambless LE, Folsom AR, Hirsch AT, Dramaix M, deBacker G, Wautrecht JC, Kornitzer M, Newman AB, Cushman M, Sutton-Tyrrell K, Fowkes FG, Lee AJ, Price JF, D'Agostino RB, Murabito JM, Norman PE, Jamrozik K, Curb JD, Masaki KH, Rodriguez BL, Dekker JM, Bouter LM, Heine RJ, Nijpels G, Stehouwer CD, Ferrucci L, McDermott MM, Stoffers HE, Hooi JD, Knottnerus JA, Ogren M, Hedblad B, Witteman JC, Breteler MM, Hunink MG, Hofman A, Criqui MH, Langer RD, Fronek A, Hiatt WR, Hamman R, Resnick HE, Guralnik J, McDermott MM (2008) Ankle Brachial Index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 300:197–208CrossRef

Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, Browner D (1992) Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381–386CrossRef

Murabito JM, Evans JC, Larson MG, Nieto K, Levy D, Wilson PW (2003) The Ankle-Brachial Index in the elderly and risk of stroke, coronary disease, and death: the Framingham Study. Arch Intern Med 163:1939–1942CrossRef

Steg PG, Bhatt DL, Wilson PW, D'Agostino R Sr, Ohman EM, Rother J, Liau CS, Hirsch AT, Mas JL, Ikeda Y, Pencina MJ, Goto S (2007) One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 297:1197–1206CrossRef

McDermott MM, Greenland P, Liu K, Guralnik JM, Celic L, Criqui MH, Chan C, Martin GJ, Schneider J, Pearce WH, Taylor LM, Clark E (2002) The Ankle Brachial Index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med 136:873–883CrossRef

Writing Committee Members, Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME, ACC/AHA Task Force Members, Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis J, Joglar J, Pressler SJ, Wijeysundera DN (2017) 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Vasc Med 22(3):NP1–NP43. https://doi.org/10.1177/1358863X17701592 CrossRef

Hageman D, Fokkenrood HJ, Gommans LN, van den Houten MM, Teijink JA (2018) Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication. Cochrane Database Syst Rev 4:CD005263. https://doi.org/10.1002/14651858.CD005263.pub4 CrossRefPubMed

10.

Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I, ESC Scientific Document Group (2017) ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS) (2018) document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39(9):763–816. https://doi.org/10.1093/eurheartj/ehx095 CrossRef

11.

Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, Gardner AW, Hiatt WR, Regensteiner JG, Rich K, American Heart Association Council on Peripheral Vascular Disease, Council on Quality of Care, and Outcomes Research, Council on Cardiovascular, and Stroke Nursing (2019) Optimal exercise programs for patients with peripheral artery disease: a scientific statement from the American Heart Association. Circulation 139(4):e10–e33. https://doi.org/10.1161/CIR.0000000000000623 CrossRefPubMed

12.

McDermott MM (2018) Exercise rehabilitation for peripheral artery disease: a review. J Cardiopulm Rehabil Prev 38(2):63–69. https://doi.org/10.1097/HCR.0000000000000343 CrossRefPubMedPubMedCentral

13.

Gielen S, Schuler G, Adams V (2010) Cardiovascular effects of exercise training: molecular mechanisms. Circulation 122(12):1221–1238. https://doi.org/10.1161/CIRCULATIONAHA.110.939959 CrossRefPubMed

14.

Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor RS (2016) Exercise-based cardiac rehabilitation for coronary heart disease: cochrane systematic review and meta-analysis. J Am Coll Cardiol 67(1):1–12. https://doi.org/10.1016/j.jacc.2015.10.044 CrossRefPubMed

15.

Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, Dalal H, Rees K, Singh SJ, Taylor RS (2019) Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev 1:CD003331. https://doi.org/10.1002/14651858.CD003331.pub5 CrossRefPubMed

16.

Manfredini F, Conconi F, Malagoni AM, Manfredini R, Basaglia N, Mascoli F, Liboni A, Zamboni P (2004) Training guided by pain threshold speed. Effects of a home-based program on claudication. Int Angiol 23(4):379–387PubMed

17.

Manfredini F, Malagoni AM, Mascoli F, Mandini S, Taddia MC, Basaglia N, Manfredini R, Conconi F, Zamboni P (2008) Training rather than walking: the test in-train out program for home-based rehabilitation in peripheral arteriopathy. Circ J 72(6):946–952CrossRef

18.

Malagoni AM, Vagnoni E, Felisatti M, Mandini S, Heidari M, Mascoli F, Basaglia N, Manfredini R, Zamboni P, Manfredini F (2011) Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication. Circ J 75(9):2128–2134CrossRef

19.

Lamberti N, Straudi S, Lissia E, Cavazzini L, Buja S, Manfredini R, Basaglia N, Manfredini F (2018) Home-based exercise for elderly patients with intermittent claudication limited by osteoarticular disorders—feasibility and effectiveness of a low-intensity programme. Vasa 47(3):227–234. https://doi.org/10.1024/0301-1526/a000692 CrossRefPubMed

20.

Malagoni AM, Cavazza S, Ferraresi G, Grassi G, Felisatti M, Lamberti N, Basaglia N, Manfredini F (2016) Effects of a "test in-train out" walking program versus supervised standard rehabilitation in chronic stroke patients: a feasibility and pilot randomized study. Eur J Phys Rehabil Med 52(3):279–287PubMed

21.

Lamberti N, Straudi S, Malagoni AM, Argirò M, Felisatti M, Nardini E, Zambon C, Basaglia N, Manfredini F (2017) Effects of low-intensity endurance and resistance training on mobility in chronic stroke survivors: a pilot randomized controlled study. Eur J Phys Rehabil Med 53(2):228–239. https://doi.org/10.23736/S1973-9087.16.04322-7 CrossRefPubMed

22.

Manfredini F, Mallamaci F, D'Arrigo G, Baggetta R, Bolignano D, Torino C, Lamberti N, Bertoli S, Ciurlino D, Rocca-Rey L, Barillà A, Battaglia Y, Rapanà RM, Zuccalà A, Bonanno G, Fatuzzo P, Rapisarda F, Rastelli S, Fabrizi F, Messa P, De Paola L, Lombardi L, Cupisti A, Fuiano G, Lucisano G, Summaria C, Felisatti M, Pozzato E, Malagoni AM, Castellino P, Aucella F, Abd ElHafeez S, Provenzano PF, Tripepi G, Catizone L, Zoccali C (2017) Exercise in patients on dialysis: a multicenter, randomized clinical trial. J Am Soc Nephrol 28(4):1259–1268. https://doi.org/10.1681/ASN.2016030378 CrossRefPubMed

23.

Malagoni AM, Catizone L, Mandini S, Soffritti S, Manfredini R, Boari B, Russo G, Basaglia N, Zamboni P, Manfredini F (2008) Acute and long-term effects of an exercise program for dialysis patients prescribed in hospital and performed at home. J Nephrol 21(6):871–878PubMed

24.

Pomidori L, Lamberti N, Malagoni AM, Manfredini F, Pozzato E, Felisatti M, Catizone L, Barillà A, Zuccalà A, Tripepi G, Mallamaci F, Zoccali C, Cogo A (2016) Respiratory muscle impairment in dialysis patients: can minimal dose of exercise limit the damage? A preliminary study in a sample of patients enrolled in the EXCITE trial. J Nephrol 29(6):863–869CrossRef

25.

Manfredini F, Lamberti N, Malagoni AM, Felisatti M, Zuccalà A, Torino C, Tripepi G, Catizone L, Mallamaci F, Zoccali C (2015) The role of deconditioning in the end-stage renal disease myopathy: physical exercise improves altered resting muscle oxygen consumption. Am J Nephrol 41(4–5):329–336. https://doi.org/10.1159/000431339 CrossRefPubMed

26.

Manfredini F, Lamberti N, Guerzoni F, Napoli N, Gasbarro V, Zamboni P, Mascoli F, Manfredini R, Basaglia N, Rodríguez-Borrego MA, López-Soto PJ (2019) Rehabilitative exercise reduced the impact of peripheral artery disease on vascular outcomes in elderly patients with claudication: a three-year single center retrospective study. J Clin Med 8(2):E210. https://doi.org/10.3390/jcm8020210 CrossRefPubMed

27.

Manfredini F, Conconi F, Malagoni AM, Manfredini R, Mascoli F, Liboni A, Zamboni P (2004) Speed rather than distance: a novel graded treadmill test to assess claudication. Eur J Vasc Endovasc Surg 28(3):303–309CrossRef

28.

McDermott MM, Spring B, Berger JS, Treat-Jacobson D, Conte MS, Creager MA, Criqui MH, Ferrucci L, Gornik HL, Guralnik JM, Hahn EA, Henke P, Kibbe MR, Kohlman-Trighoff D, Li L, Lloyd-Jones D, McCarthy W, Polonsky TS, Skelly C, Tian L, Zhao L, Zhang D, Rejeski WJ (2018) Effect of a home-based exercise intervention of wearable technology and telephone coaching on walking performance in peripheral artery disease: the HONOR randomized clinical trial. JAMA 319(16):1665–1676. https://doi.org/10.1001/jama.2018.3275 CrossRefPubMedPubMedCentral

29.

Bohannon RW, Glenney SS (2014) Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract 20(4):295–300. https://doi.org/10.1111/jep.12158 CrossRefPubMed

30.

Sakamoto S, Yokoyama N, Tamori Y, Akutsu K, Hashimoto H, Takeshita S (2009) Patients with peripheral artery disease who complete 12-week supervised exercise training program show reduced cardiovascular mortality and morbidity. Circ J 73(1):167–173CrossRef

31.

Leeper NJ, Myers J, Zhou M, Nead KT, Syed A, Kojima Y, Caceres RD, Cooke JP (2013) Exercise capacity is the strongest predictor of mortality in patients with peripheral arterial disease. J Vasc Surg 57(3):728–733. https://doi.org/10.1016/j.jvs.2012.07.051 CrossRefPubMed

32.

American College of Sports Medicine (2019) Metabolic equations handbook. Lippincott, Williams, & Wilkins, Baltimore, pp 25–30

33.

Hardy SE, Perera S, Roumani YF, Chandler JM, Studenski SA (2007) Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc 55(11):1727–1734CrossRef

34.

Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, Brach J, Chandler J, Cawthon P, Connor EB, Nevitt M, Visser M, Kritchevsky S, Badinelli S, Harris T, Newman AB, Cauley J, Ferrucci L, Guralnik J (2011) Gait speed and survival in older adults. JAMA 305(1):50–58. https://doi.org/10.1001/jama.2010.1923 CrossRefPubMedPubMedCentral

35.

Chui K, Hood E, Klima D (2012) Meaningful change in walking speed. Top Geriatr Rehabil 28(2):97–103. https://doi.org/10.1097/TGR.0b013e3182510195 CrossRef

36.

Torino C, Manfredini F, Bolignano D, Aucella F, Baggetta R, Barillà A, Battaglia Y, Bertoli S, Bonanno G, Castellino P, Ciurlino D, Cupisti A, D'Arrigo G, De Paola L, Fabrizi F, Fatuzzo P, Fuiano G, Lombardi L, Lucisano G, Messa P, Rapanà R, Rapisarda F, Rastelli S, Rocca-Rey L, Summaria C, Zuccalà A, Tripepi G, Catizone L, Zoccali C, Mallamaci F, EXCITE Working Group (2014) Physical performance and clinical outcomes in dialysis patients: a secondary analysis of the EXCITE trial. Kidney Blood Press Res 39(2–3):205–211. https://doi.org/10.1159/000355798 CrossRefPubMed

37.

McDermott MM, Tian L, Liu K, Guralnik JM, Ferrucci L, Tan J, Pearce WH, Schneider JR, Criqui MH (2008) Prognostic value of functional performance for mortality in patients with peripheral artery disease. J Am Coll Cardiol 51(15):1482–1489. https://doi.org/10.1016/j.jacc.2007.12.034 CrossRefPubMedPubMedCentral

38.

McDermott MM, Liu K, Ferrucci L, Tian L, Guralnik JM, Liao Y, Criqui MH (2011) Decline in functional performance predicts later increased mobility loss and mortality in peripheral arterial disease. J Am Coll Cardiol 57:962–970. https://doi.org/10.1016/j.jacc.2010.09.053 CrossRefPubMedPubMedCentral

39.

Afilalo J, Sharma A, Zhang S, Brennan JM, Edwards FH, Mack MJ, McClurken JB, Cleveland JC Jr, Smith PK, Shahian DM, Peterson ED, Alexander KP (2018) Gait speed and 1-year mortality following cardiac surgery: a landmark analysis from the society of thoracic surgeons adult cardiac surgery database. J Am Heart Assoc 7(23):e010139. https://doi.org/10.1161/JAHA.118.010139 CrossRefPubMedPubMedCentral

40.

Swank AM, Horton J, Fleg JL, Fonarow GC, Keteyian S, Goldberg L, Wolfel G, Handberg EM, Bensimhon D, Illiou MC, Vest M, Ewald G, Blackburn G, Leifer E, Cooper L, Kraus WE, Investigators HF-ACTION (2012) Modest increase in peak VO₂ is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training. Circ Heart Fail 5(5):579–585CrossRef

41.

Kokkinos P, Myers J, Faselis C, Panagiotakos DB, Doumas M, Pittaras A, Manolis A, Kokkinos JP, Karasik P, Greenberg M, Papademetriou V, Fletcher R (2010) Exercise capacity and mortality in older men: a 20-year follow-up study. Circulation 122(8):790–797. https://doi.org/10.1161/CIRCULATIONAHA.110.938852 CrossRefPubMed

42.

Manfredini R, Lamberti N, Manfredini F, Straudi S, Fabbian F, Rodriguez Borrego MA, Carmona Torres JM, Lopez Soto PJ (2018) Gender differences in outcomes following a pain-free, home-based exercise program for claudication. J Womens Health (Larchmt). https://doi.org/10.1089/jwh.2018.7113(Epub ahead of print) CrossRef

43.

Manfredini F, Malagoni AM, Felisatti M, Mandini S, Mascoli F, Manfredini R, Basaglia N, Zamboni P (2009) A dynamic objective evaluation of peripheral arterial disease by near-infrared spectroscopy. Eur J Vasc Endovasc Surg 38(4):441–448. https://doi.org/10.1016/j.ejvs.2009.06.011 CrossRefPubMed

44.

Manfredini F, Malagoni AM, Mandini S, Felisatti M, Mascoli F, Basaglia N, Manfredini R, Mikhailidis DP, Zamboni P (2012) Near-infrared spectroscopy assessment following exercise training in patients with intermittent claudication and in untrained healthy participants. Vasc Endovascular Surg 46(4):315–324. https://doi.org/10.1177/1538574412443318 CrossRefPubMed

45.

Murrow JR, Brizendine JT, Djire B, Young HJ, Rathbun S, Nilsson KR Jr, McCully KK (2019) Near infrared spectroscopy-guided exercise training for claudication in peripheral arterial disease. Eur J Prev Cardiol 26(5):471–480. https://doi.org/10.1177/2047487318795192 CrossRefPubMed

Title: Changes in exercise capacity and risk of all-cause mortality in patients with peripheral artery disease: a 10-year retrospective cohort study
Authors: Nicola Lamberti
Pablo Jesùs López-Soto
Franco Guerzoni
Nicola Napoli
Vincenzo Gasbarro
Paolo Zamboni
Elpiniki Tsolaki
Maria Cristina Taddia
Maria Aurora Rodríguez-Borrego
Roberto Manfredini
Nino Basaglia
Fabio Manfredini
Publication date: 01-03-2020
Publisher: Springer International Publishing
Keyword: Arterial Diseases
Published in: Internal and Emergency Medicine / Issue 2/2020
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-019-02176-3

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2020

Hyperchloremia and acute kidney injury: a spurious association or a worrisome reality?

High-dose lormetazepam dependence: strange case of Dr. Jekyll and Mr. Hyde—comment

Female sex and stroke in atrial fibrillation: an intriguing relationship

Two different techniques of ultrasound-guided peripheral venous catheter placement versus the traditional approach in the pre-hospital emergency setting: a randomized study

An unusual cause of intestinal obstruction: phlebosclerotic colitis

Handling shock in idiopathic systemic capillary leak syndrome (Clarkson's disease) less is more: reply

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage