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Association between home-based exercise using a pedometer and clinical prognosis after endovascular treatment in patients with peripheral artery disease

Published:October 04, 2022DOI:https://doi.org/10.1016/j.jjcc.2022.09.005

      Highlights

      • Pedometer is useful to confirm activity of patients with peripheral artery disease.
      • Good self-recording of pedometers was related with favorable prognosis.
      • Poor recording group had severe comorbidities and poor baseline walking ability.
      • Early recognition of poor recording may lead to risk stratification.

      Abstract

      Background

      Exercise therapy following endovascular treatment (EVT) is important for patients with peripheral artery disease (PAD); however, continuous exercise therapy is difficult to be performed in clinical practice. This study aimed to investigate the association between the implementation of home-based exercise using pedometers after EVT and 1-year clinical outcomes.

      Methods

      This multicenter observational prospective cohort registry included patients with PAD complaining of intermittent claudication who underwent EVT for aortoiliac and/or femoropopliteal artery lesions between January 2016 and March 2019. Patients were instructed to perform home-based exercises using a specific pedometer after EVT. The study population was divided into good and poor recording groups according to the frequency of the pedometer measurements. The good recording group was defined as those who completed ≥50 % of the prescribed daily pedometer recording during the follow-up period. The poor recording group was defined as those with an inability to use a pedometer and/or who completed <50 % of the prescribed daily pedometer recordings. The primary outcome was 1-year major adverse events (MAE), defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, target vessel revascularization, and major amputation of the target limb.

      Results

      The mean age was 74.4 years; 78 % were male. A total of 623 lesions were analyzed (58.7 % aortoiliac, 41.3 % femoropopliteal). At 1 year, a lower cumulative incidence of MAE was observed in the good recording group compared to that in the poor recording group [10/233 (4.3 %) vs. 35/267 (13.7 %) patients, respectively; p < 0.001]. Multivariate Cox regression analysis showed that patients in the good recording group had a lower hazard ratio for 1-year MAE (0.33; 95 % confidence interval, 0.16–0.68; p = 0.004) than that in the poor recording group.

      Conclusions

      Good self-recording of pedometer measurements was associated with favorable prognosis in patients with PAD following EVT.

      Graphical abstract

      Keywords

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      References

        • Fowkes F.G.
        • Rudan D.
        • Rudan I.
        • Aboyans V.
        • Denenberg J.O.
        • McDermott M.M.
        • et al.
        Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis.
        Lancet. 2013; 382: 1329-1340https://doi.org/10.1016/S0140-6736(13)61249-0
        • Criqui M.H.
        • Langer R.D.
        • Fronek A.
        • Feigelson H.S.
        • Klauber M.R.
        • McCann T.J.
        • et al.
        Mortality over a period of 10 years in patients with peripheral arterial disease.
        N Engl J Med. 1992; 326: 381-386https://doi.org/10.1056/NEJM199202063260605
        • McDermott M.M.
        • Tian L.
        • Liu K.
        • Guralnik J.M.
        • Ferrucci L.
        • Tan J.
        • et al.
        Prognostic value of functional performance for mortality in patients with peripheral artery disease.
        J Am Coll Cardiol. 2008; 51: 1482-1489https://doi.org/10.1016/j.jacc.2007.12.034
        • Criqui M.H.
        • Aboyans V.
        Epidemiology of peripheral artery disease.
        Circ Res. 2015; 116: 1509-1526https://doi.org/10.1161/CIRCRESAHA.116.303849
        • Murphy T.P.
        • Cutlip D.E.
        • Regensteiner J.G.
        • Mohler E.R.
        • Cohen D.J.
        • Reynolds M.R.
        • et al.
        Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study.
        J Am Coll Cardiol. 2015; 65: 999-1009https://doi.org/10.1016/j.jacc.2014.12.043
        • Mazari F.A.
        • Khan J.A.
        • Carradice D.
        • Samuel N.
        • Abdul Rahman M.N.
        • Gulati S.
        • et al.
        Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease.
        Br J Surg. 2012; 99: 39-48https://doi.org/10.1002/bjs.7710
        • Aboyans V.
        • Ricco J.B.
        • Bartelink M.E.L.
        • Björck M.
        • Brodmann M.
        • Cohnert T.
        • et al.
        ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesendorsed 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. 2018; 39: 763-816
        • Gerhard-Herman M.D.
        • Gornik H.L.
        • Barrett C.
        • Barshes N.R.
        • Corriere M.A.
        • Drachman D.E.
        • et al.
        2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines.
        Circulation. 2017; 135: e686-e725https://doi.org/10.1161/CIR.0000000000000470
        • Vandenbroucke J.P.
        • von Elm E.
        • Altman D.G.
        • Gøtzsche P.C.
        • Mulrow C.D.
        • Pocock S.J.
        • et al.
        Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.
        Epidemiology. 2007; 18: 805-835https://doi.org/10.1097/EDE.0b013e3181577511
        • Patel M.R.
        • Conte M.S.
        • Cutlip D.E.
        • Dib N.
        • Geraghty P.
        • Gray W.
        • et al.
        Evaluation and treatment of patients with lower extremity peripheral artery disease: consensus definitions from Peripheral Academic Research Consortium (PARC).
        J Am Coll Cardiol. 2015; 65: 931-941https://doi.org/10.1016/j.jacc.2014.12.036
      1. Guidelines for the management of peripheral arterial occlusive diseases (JCS 2015).
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Simoons M.L.
        • Chaitman B.R.
        • White H.D.
        • et al.
        Third universal definition of myocardial infarction.
        Eur Heart J. 2012; 33: 2551-2567https://doi.org/10.1093/eurheartj/ehs184
        • Sacco R.L.
        • Kasner S.E.
        • Broderick J.P.
        • Caplan L.R.
        • Connors J.J.
        • Culebras A.
        • et al.
        An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2013; 44: 2064-2089https://doi.org/10.1161/STR.0b013e318296aeca
        • Rubin D.B.
        Multiple imputation for nonresponse in surveys.
        John Wiley & Sons, New York2004
        • Gardner A.W.
        • Parker D.E.
        • Montgomery P.S.
        • Blevins S.M.
        Step-monitored home exercise improves ambulation, vascular function, and inflammation in symptomatic patients with peripheral artery disease: a randomized controlled trial.
        J Am Heart Assoc. 2014; 3e001107https://doi.org/10.1161/JAHA.114.001107
        • Chang V.Y.
        • Handa K.K.
        • Fernandes M.
        • Yacoub C.
        • Pastana A.
        • Caramelli B.
        • et al.
        Improving cardiovascular prevention through patient awareness.
        Rev Assoc Med Bras. 1992; 2012: 550-556
        • Gardner A.W.
        • Parker D.E.
        • Montgomery P.S.
        • Scott K.J.
        • Blevins S.M.
        Efficacy of quantified home-based exercise and supervised exercise in patients with intermittent claudication: a randomized controlled trial.
        Circulation. 2011; 123: 491-498https://doi.org/10.1161/CIRCULATIONAHA.110.963066
        • Menard J.R.
        • Smith H.E.
        • Riebe D.
        • Braun C.M.
        • Blissmer B.
        • Patterson R.B.
        Long-term results of peripheral arterial disease rehabilitation.
        J Vasc Surg. 2004; 39: 1186-1192https://doi.org/10.1016/j.jvs.2004.01.034
        • Nicolaï S.P.
        • Teijink J.A.
        • Prins M.H.
        • Exercise Therapy in Peripheral Arterial Disease Study Group
        Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication.
        J Vasc Surg. 2010; 52: 348-355https://doi.org/10.1016/j.jvs.2010.02.022
        • McDermott M.M.
        • Ades P.
        • Guralnik J.M.
        • Dyer A.
        • Ferrucci L.
        • Liu K.
        • et al.
        Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial.
        JAMA. 2009; 301: 165-174https://doi.org/10.1001/jama.2008.962
        • Bø E.
        • Bergland A.
        • Stranden E.
        • Jørgensen J.J.
        • Sandbaek G.
        • Grøtta O.J.
        • et al.
        Effects of 12 weeks of supervised exercise after endovascular treatment: a randomized clinical trial.
        Physiother Res Int. 2015; 20: 147-157https://doi.org/10.1002/pri.1608
        • Kruidenier L.M.
        • Nicolaï S.P.
        • Rouwet E.V.
        • Peters R.J.
        • Prins M.H.
        • Teijink J.A.
        Additional supervised exercise therapy after a percutaneous vascular intervention for peripheral arterial disease: a randomized clinical trial.
        J Vasc Interv Radiol. 2011; 22: 961-968https://doi.org/10.1016/j.jvir.2011.02.017
        • Fanari Z.
        • Weintraub W.S.
        Cost-effectiveness of medical, endovascular and surgical management of peripheral vascular disease.
        Cardiovasc Revasc Med. 2015; 16: 421-425https://doi.org/10.1016/j.carrev.2015.06.006
        • Harwood A.E.
        • Broadbent E.
        • Totty J.P.
        • Smith G.E.
        • Chetter I.C.
        ‘Intermittent claudication a real pain in the calf’- patient experience of diagnosis and treatment with a supervised exercise program.
        J Vasc Nurs. 2017; 35: 131-135https://doi.org/10.1016/j.jvn.2017.03.001
        • El Morr C.
        • AlHamzah M.
        • Ng P.
        • Purewal A.
        • Al-Omran M.
        Knowledge of peripheral arterial disease: results of an intervention to measure and improve PAD knowledge in Toronto.
        Vascular. 2017; 25: 479-487https://doi.org/10.1177/1708538116689355