Supervised walking exercise therapy improves gait biomechanics in patients with peripheral artery disease

Molly N. Schieber, Iraklis I. Pipinos, Jason M. Johanning, George P. Casale, Mark A. Williams, Holly K. DeSpiegelaere, Benjamin Senderling, Sara A. Myers

Research output: Contribution to journalArticle

Abstract

Objective: In patients with peripheral artery disease (PAD), supervised exercise therapy is a first line of treatment because it increases maximum walking distances comparable with surgical revascularization therapy. Little is known regarding gait biomechanics after supervised exercise therapy. This study characterized the effects of supervised exercise therapy on gait biomechanics and walking distances in claudicating patients with PAD. Methods: Forty-seven claudicating patients with PAD underwent gait analysis before and immediately after 6 months of supervised exercise therapy. Exercise sessions consisted of a 5-minute warmup of mild walking and stretching of upper and lower leg muscles, 50 minutes of intermittent treadmill walking, and 5 minutes of cooldown (similar to warmup) three times per week. Measurements included self-perceived ambulatory limitations measured by questionnaire, the ankle-brachial index (ABI), walking distance measures, maximal plantar flexor strength measured by isometric dynamometry, and overground gait biomechanics trials performed before and after the onset of claudication pain. Paired t-tests were used to test for differences in quality of life, walking distances, ABI, and maximal strength. A two-factor repeated measures analysis of variance determined differences for intervention and condition for gait biomechanics dependent variables. Results: After supervised exercise therapy, quality of life, walking distances, and maximal plantar flexor strength improved, although the ABI did not significantly change. Several gait biomechanics parameters improved after the intervention, including torque and power generation at the ankle and hip. Similar to previous studies, the onset of claudication pain led to a worsening gait or a gait that was less like healthy individuals with a pain-free gait. Conclusions: Six months of supervised exercise therapy produced increases in walking distances and quality of life that are consistent with concurrent improvements in muscle strength and gait biomechanics. These improvements occurred even though the ABI did not improve. Future work should examine the benefits of supervised exercise therapy used in combination with other available treatments for PAD.

Original languageEnglish (US)
JournalJournal of vascular surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Exercise Therapy
Peripheral Arterial Disease
Gait
Biomechanical Phenomena
Walking
Ankle Brachial Index
Quality of Life
Pain
Torque
Muscle Strength
Ankle
Hip
Leg
Analysis of Variance
Therapeutics
Exercise

Keywords

  • Arterial disease
  • Claudication
  • Joint kinetics
  • Vascular disease
  • Walking performance

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Supervised walking exercise therapy improves gait biomechanics in patients with peripheral artery disease. / Schieber, Molly N.; Pipinos, Iraklis I.; Johanning, Jason M.; Casale, George P.; Williams, Mark A.; DeSpiegelaere, Holly K.; Senderling, Benjamin; Myers, Sara A.

In: Journal of vascular surgery, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objective: In patients with peripheral artery disease (PAD), supervised exercise therapy is a first line of treatment because it increases maximum walking distances comparable with surgical revascularization therapy. Little is known regarding gait biomechanics after supervised exercise therapy. This study characterized the effects of supervised exercise therapy on gait biomechanics and walking distances in claudicating patients with PAD. Methods: Forty-seven claudicating patients with PAD underwent gait analysis before and immediately after 6 months of supervised exercise therapy. Exercise sessions consisted of a 5-minute warmup of mild walking and stretching of upper and lower leg muscles, 50 minutes of intermittent treadmill walking, and 5 minutes of cooldown (similar to warmup) three times per week. Measurements included self-perceived ambulatory limitations measured by questionnaire, the ankle-brachial index (ABI), walking distance measures, maximal plantar flexor strength measured by isometric dynamometry, and overground gait biomechanics trials performed before and after the onset of claudication pain. Paired t-tests were used to test for differences in quality of life, walking distances, ABI, and maximal strength. A two-factor repeated measures analysis of variance determined differences for intervention and condition for gait biomechanics dependent variables. Results: After supervised exercise therapy, quality of life, walking distances, and maximal plantar flexor strength improved, although the ABI did not significantly change. Several gait biomechanics parameters improved after the intervention, including torque and power generation at the ankle and hip. Similar to previous studies, the onset of claudication pain led to a worsening gait or a gait that was less like healthy individuals with a pain-free gait. Conclusions: Six months of supervised exercise therapy produced increases in walking distances and quality of life that are consistent with concurrent improvements in muscle strength and gait biomechanics. These improvements occurred even though the ABI did not improve. Future work should examine the benefits of supervised exercise therapy used in combination with other available treatments for PAD.",
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AU - Pipinos, Iraklis I.

AU - Johanning, Jason M.

AU - Casale, George P.

AU - Williams, Mark A.

AU - DeSpiegelaere, Holly K.

AU - Senderling, Benjamin

AU - Myers, Sara A.

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KW - Arterial disease

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KW - Joint kinetics

KW - Vascular disease

KW - Walking performance

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