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

Authors

Molly Schieber, University of Nebraska at OmahaFollow
Iraklis Pipinos, Department of Surgery, Veterans Affairs Medical Center and University of Nebraska Medical Center, Omaha, NE USAFollow
Jason M. Johanning, University of Nebraska Medical CenterFollow
George P. Casale, University of Nebraska Medical Center
Mark A. Williams
Holly DeSpiegelaere, Omaha and Western Iowa Veterans Affairs Medical CenterFollow
Ben Senderling, University of Nebraska at OmahaFollow
Sara A. Myers, University of Nebraska at OmahaFollow

Author ORCID Identifier

Myers - https://orcid.org/0000-0002-2934-2624

Pipinos - https://orcid.org/0000-0001-6873-6346

Document Type

Article

Publication Date

8-20-2019

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.

Comments

This is an Accepted Manuscript of an article published by Elsevier in Journal of Vascular Surgery on August 20, 2019, available online: https://doi.org/10.1016/j.jvs.2019.05.044

Journal Title

Journal of Vascular Surgery

Volume

71

Issue

2

First Page

575

Last Page

583

Recommended Citation

Schieber, MN, Pipinos, II, Johanning, JM, Casale, GP, Williams, MA, DeSpiegelaere, HK, Senderling, B, Myers, SA. Supervised walking exercise therapy improves gait biomechanics in patients with peripheral artery disease. Journal of Vascular Surgery. 2019 Aug 20. https://doi.org/10.1016/j.jvs.2019.05.044

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.