# Exercise as it relates to Disease/The Effect of Exercise Training on Patients With Peripheral Arterial Disease (PAD)

This is a review of the article 'Exercise training improves functional status in patients with peripheral arterial disease' by Judith G. Regensteiner, published in 1996

## What is the background to this research?

Peripheral arterial disease (PAD) is a disease in which your arteries begin to narrow. PAD is often caused by atherosclerosis which is a build up of fatty deposits (plaques) in your artery walls which reduce blood flow.

##### Symptoms

One of the first symptoms of PAD is that the patient will experience pain and ache in the lower leg muscles particularly in the calf muscle. The patient can also experience pain and ache in the thighs and the buttocks. This symptom is called Intermittent claudication (IC).

##### Risk Factors

When considering the risk factors for developing PAD, they can be broken in to two categories:
| Modifiable | Non-Modifiable |
| Smoking | Age (especially >50) |
| Diabetes | Family History |
| Obesity (BMI >30) | |
| High blood pressure | |
| High cholesterol | |
Approximately 8.5 million people in the United States have PAD. Within that 8.5 million 12-20% of individuals are older than age 60.

## Where is this research from?

This study was carried out by Judith G. Regensteiner along with John F. Steiner and William R. Hiatt in Denver, Colorado. USA. The research was conducted in collaboration with the University of Colorado, Denver. The university has a good reputation in regards to health and medicine with each area having top ranked programs. With the author's PHD qualifications and Dr. Hiatt being a recipient of an NIH Academic Award in Vascular Disease; demonstrates that reliability and validity of this article. The research was supported by a grant from the National Institute on Disability and Rehabilitation Research.

## What kind of research is this?

The study was performed as a Randomised Control Trial (RCT) analysis. This involved groups operating under different circumstances to then later compare the results. This sort of analysis is used by medical professionals to ensure that the results are free from a specific type of selection bias. Safety protocols were undertaken, patients would be excluded from the study if they had the following: ischemic rest pain, arthritis and angina as well as other limiting factors. Informed consent was obtained from all enrolled subjects.

## What did the research involve?

The study involved twenty-nine men with disabling Intermittent claudication (IC). They were randomised to twelve weeks of either supervised treadmill training, strength training, or to a non exercising control group. Each group was given a specific set of guidelines they had to follow in regards to their training. If the patient was in the treadmill group then they must do 3 hr/wk at a work intensity sufficient to produce claudication, while if they were in the strength group they must do 3 hr/wk of resistive training of six muscle groups in each leg. All programs began with 5 minutes warm up and 5 minutes cool down. All training programs were supervised and were conducted in 1 hr sessions for 3 days each week. During treadmill training heart rate and blood pressure were monitored constantly
In order to evaluate the patients functional status, questioners and activity monitors were used to help with this study. instruments such as the Walking Impairment Questionnaire (WIQ), the Physical Activity Recall (PAR), the Medical Outcomes Study questionnaire (MOS) and the Vitalog activity monitor were used throughout the study. All questionnaires were administered from the onset and after 12 and 24 weeks. The study hypothesised that a supervised exercise training program would improve functional status in patients with IC, with 24 weeks of training being more beneficial than 12 weeks.

## What were the basic results?

The researchers for this study had found out that after twelve weeks of treadmill training there was an improvement in scores in most questionnaires. PAR scores increased by 48 metabolic equivalent hr/wk, the MOS score increased by 24 percentage points, and the number of walking activity bouts measured by the Vitalog to 4.5 bouts/hr. The WIQ scores showed no change. Strength training increased scores in the WIQ walking speed and stair climbing category as well as an increase in MOS well being scores. There was no other changes in functional status. twelve weeks of extra treadmill training resulted in scores being maintained for the group who did treadmill training the first 12 weeks, and improved activity levels as defined by Vitalog in patients who did strength training for the first 12 weeks.

## Conclusions

This study explains the relationship between exercise training and patients with PAD. A supervised exercise training program can help improve functional status in patients with PAD. The study also found that training for 24 weeks was more effective than training for 12 weeks. Looking at the results we can conclude that treadmill training is an effective way to help functional status in patients with PAD. Treadmill training is found to be more effective in improving functional status compared to strength training or a combination of both.

## Practical Advice

If you suffer from leg pain, numbness or other symptoms please refer to a doctor immediately so as you will be at risk of developing coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke. If you know you have PAD this article recommends you should do some supervised exercise program training. Treadmill training will be beneficial as it will help your body use oxygen more efficiently.

## Further Information and Resources

For further reading regarding Peripheral arterial Disease please visit the following links:
* http://www.medicinenet.com/peripheral_vascular_disease/article.htm
* http://www.heart.org/HEARTORG/Conditions/VascularHealth/PeripheralArteryDisease/About-Peripheral-Artery-Disease-PAD_UCM_301301_Article.jsp
* https://www.medicalnewstoday.com/articles/188939.php

## References

* ↑ Regensteiner J, Steiner J, Hiatt W. Exercise training improves functional status in patients with peripheral arterial disease. Journal of Vascular Surgery. 1996;23(1):104-115.
* ↑ Peripheral artery disease - legs: MedlinePlus Medical Encyclopedia [Internet]. Medlineplus.gov. 2017 [cited 24 September 2017]. Available from: https://medlineplus.gov/ency/article/000170.htm
* ↑ Peripheral artery disease (PAD) - Symptoms and causes [Internet]. Mayo Clinic. 2017 [cited 24 September 2017]. Available from: http://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/symptoms-causes/dxc-20167421
* ↑ Roger VL, Go AS, Lloyd-Jones DM, et. al. Heart Disease and Stroke Statistics 2011 Update: A Report From the American Heart Association. Circulation 2011;123:e18-e209
* ↑ Regensteiner J, Steiner J, Hiatt W. Exercise training improves functional status in patients with peripheral arterial disease. Journal of Vascular Surgery. 1996;23(1):104-115.
* ↑ Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice guidelines for the management of patients withi peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): Circulation. 2006;113:e463-654.
* ↑ Peripheral artery disease (PAD) - Treatment [Internet]. Mayo Clinic. 2017 [cited 24 September 2017]. Available from: http://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/diagnosis-treatment/treatment/txc-20167509