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

Internal and Emergency Medicine - Tập 15 - Trang 289-298 - 2019
Nicola Lamberti1, Pablo Jesùs López-Soto2, Franco Guerzoni3, Nicola Napoli3, Vincenzo Gasbarro4, Paolo Zamboni5, Elpiniki Tsolaki4, Maria Cristina Taddia4, Maria Aurora Rodríguez-Borrego2, Roberto Manfredini6, Nino Basaglia7, Fabio Manfredini1,7
1Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy
2Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain
3Department of Medical Statistics, University Hospital of Ferrara, Ferrara, Italy
4Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Ferrara, Italy
5Unit of Translational Surgery, University Hospital of Ferrara, Ferrara, Italy
6Department of Medical Sciences, University of Ferrara, Ferrara, Italy
7Unit of Physical and Rehabilitation Medicine, University Hospital of Ferrara, Ferrara, Italy

Tóm tắt

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 (Smax) 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 Smax (from 3.3 ± 1.1 to 3.8 ± 1.1 km h−1) at discharge. The completers who reached the clinically important difference of Smax ≥ 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.

Tài liệu tham khảo

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):S5–67 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 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 300:197–208 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 326:381–386 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 163:1939–1942 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 297:1197–1206 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 136:873–883 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 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 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 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 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 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 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 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 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):379–387 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):946–952 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):2128–2134 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 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):279–287 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 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 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):871–878 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):863–869 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 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 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):303–309 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 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 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):167–173 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 American College of Sports Medicine (2019) Metabolic equations handbook. Lippincott, Williams, & Wilkins, Baltimore, pp 25–30 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):1727–1734 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 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 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 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 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 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 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):579–585 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 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) 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 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 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