Effect of a monitored home-based exercise program combined with a behavior change intervention and a smartphone app on walking distances and quality of life in adults with peripheral arterial disease: the WalkingPad randomized clinical trial.

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).

Six-month effects of supervised exercise on walking ability and health-related factors in peripheral arterial disease: a pilot study.

BACKGROUND: In peripheral arterial disease (PAD) patients with intermittent claudication (IC), the combination of aerobic and resistance exercises could counteract muscle loss and attenuate disease progression. This study analyzed the effects of six months of a combined exercise program on walking ability, lower limb body composition, cardiovascular risk factors, and Ankle-Brachial Index (ABI). METHODS: Twenty-three patients (age 63.2±1.5 years and ABI 0.58±0.07) with PAD and IC were allocated to a control group (CG) or a supervised exercise group (SUP). Ten patients underwent six months of treadmill walking combined with resistance exercises, three times a week. The CG (N.=13) received a recommendation for walking. All patients were measured at baseline (M0), after three months (M3), and six months (M6). RESULTS: During constant treadmill protocol, the claudication onset time/distance (COT/COD), absolute claudication time/distance (ACT/ACD), and number of pauses of overall patients significantly improved at M3 and M6. Between groups were found significant differences in COT and COD at M6 (P=0.005 and P=0.007, respectively); and in ACT and ACD at M3 (P=0.003 for both) and at M6 (P=0.005 and P=0.005, respectively), with major improvements in the SUP. Over the six months, a significant group effect was found in fat-free mass (P=0.041) and predicted muscle mass (P=0.039) of the lower ABI leg, with greater improvements in the SUP. CONCLUSIONS: A supervised exercise program that combines aerobic and resistance training improves PAD symptoms and has additional benefits for patients. Patients in the program showed improvements in walking ability, lower-limb body composition, perceived exertion, and heart rate during treadmill walking.

Comparing the effects of dynamic and holding isometric contractions on cardiovascular, perceptual, and near-infrared spectroscopy parameters: A pilot study.

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 (SmO2 min), mean SmO2 (SmO2 avg), percent change from baseline (SmO2 Δdeoxy) and time to recovery 50% of baseline value (t SmO2 50%reoxy) were determined. No changes in SmO2 avg were found in the VL, LG, and ST muscles, however the SL muscle had lower values in DYN, in the 1st set (p = 0.002) and in the 2nd set (p = 0.044). In terms of SmO2 min and ΔSmO2 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 SmO2 50%reoxy was higher in the VL muscle after ISO, only in the 3rd 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 SmO2 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.