The impact of peripheral arterial disease on exercise tolerance and quality of life in the elderly and the role of cardiovascular physiotherapy: review article

Lourenço, Ana Leticia Gonçalves; Silva, Josicléia Leôncio da; Leite, Jéssica Costa

doi:10.1590/1677-5449.200117

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REVIEW ARTICLE • J. Vasc. Bras. 20 • 2021 • https://doi.org/10.1590/1677-5449.200117 linkcopy

The impact of peripheral arterial disease on exercise tolerance and quality of life in the elderly and the role of cardiovascular physiotherapy: review article

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The primary symptom of peripheral arterial its intermittent claudication; a condition that causes functional disabilities, compromising quality of life. This review aimed to survey the impacts of this disease on the elderly, investigating possible contributions that cardiovascular physiotherapy has to offer. Searches were run on the MEDLINE, LILACS, SciELO, Scopus, Science Direct, and PEDro databases, identifying 7,587 studies. Seven of these met the eligibility criteria and were grouped and analyzed according evidence level, recommendation grade, and methodological quality. It was observed that this disease is responsible for considerable impact on exercise tolerance and quality of life. Regarding the therapeutic approach to these outcomes, the studies reported that there were improvements in walking and quality of life, increased functional capacity, and reduced pain. With regard to the treatment modality, most research included aerobic exercises.

Keywords:
peripheral arterial disease; exercise tolerance; quality of life

Authors, country	Type of study	Population	Assessments	Interventions
Langbein et al.,⁹ United States	Controlled RCT	n = 52 (51 M and 1 W), mean age: 67.05±7.95 years	Exercise tolerance: incremental load treadmill test, constant load treadmill test, and VO₂max analysis	G1: Nordic walking 3x per week for 24 weeks.
Langbein et al.,⁹ United States	Controlled RCT	n = 52 (51 M and 1 W), mean age: 67.05±7.95 years		G2: control group, no exercise.
Tew et al.,¹⁰ United Kingdom	Controlled RCT	n = 57 (57 M and 0 W), mean age: 70±8 years	Exercise tolerance: test on cycle ergometer with electronic break, hand crank, VO₂max analysis_, blood lactate concentration, and incremental treadmill test	G1: intermittent aerobic exercise (2 min exercise and 2 min rest) on hand crank ergometer, 2x per week, from 20 to 40 min per day, for 12 weeks.
Tew et al.,¹⁰ United Kingdom	Controlled RCT	n = 57 (57 M and 0 W), mean age: 70±8 years		G2: control group, no exercises.
Malagoni et al.,¹⁴ Italy	Uncontrolled RCT	n = 289 (210 M and 79 W), mean age: 71±10.1 years	Exercise tolerance: constant load treadmill test.	All participants: 10 min walk 2x per day, 6 days per week, for 2 years. Afterwards, analysis of variables compared participants with good compliance, 13±2months (G1) with those with poor compliance, 12±2 months (G2).
Malagoni et al.,¹⁴ Italy	Uncontrolled RCT	n = 289 (210 M and 79 W), mean age: 71±10.1 years	Quality of life: with SF-36 questionnaire.
Collins et al.,¹¹ United States	Controlled RCT	n = 103 (89 M and 14 W), mean age: 69.7±8.9 years	Exercise tolerance: incremental load treadmill test, constant load treadmill test (before and after 6, 12, and 24 weeks) and WIQ. Tissue oxygenation: with NIRS.	Interval exercises (low and high intensity) 3x per week for 24 weeks.
				G1: Nordic walking.
				G2: traditional walking.
			Quality of life: with SF-36 questionnaire.
Dziubek et al.,¹⁵ Poland	Cross-sectional case-control study	n = 135 (83 M and 52 W), G1: 85 seniors with PAD and G2: 50 seniors without PAD, mean age: 70.35±7.7 years	Exercise tolerance: 6WT, plus assessment of lower limb dynamic muscle strength and peak torque with an isokinetic dynamometer	NA
Lamberti et al.,¹² Italy	Controlled RCT	n = 27 (21 M and 6 W), mean age: 67±7 years	Exercise tolerance and claudication: constant load treadmill test and 6WT.	G1: home exercise, intermittent walking (1 min of exercise and 1 min of rest) 10 min per day, 6x per week, for 16 weeks.
Lamberti et al.,¹² Italy	Controlled RCT	n = 27 (21 M and 6 W), mean age: 67±7 years	Quality of life: with SF-36 questionnaire. Also analyzed the cost/effectiveness of treatment and compliance.	G2: open surgery or revascularization or both, plus instructed to remain active.
Akerman et al.,¹³ New Zealand	Controlled RCT	n = 22 (15 H and 7 W), mean of 75.3±8.9 years	Exercise tolerance: walking test, 6WT.	G1: heat therapy with immersions in a heated swimming pool (~39 °C) from 3 to 5x per week, plus resistance exercises and calisthenics wearing warm clothes, for 15 to 30 min.
			Internal temperature during physical activity: telemetry capsule.
			Oxygenation and volume of blood, vascular function: with FMD, NIRS, PWV, venous occlusion plethysmography, and CO re-breathing.	G2: walking for 30 to 60 min, 2x per week.
				Both groups exercised for 12 weeks.
			Quality of life: with SF-36 questionnaire.
			Also analyzed compliance with program.

Authors	Evidence level –recommendation grade	Methodological quality
Langbein et al.⁹	1b – A	6/10
Tew et al.¹⁰	1c – A	3/10
Malagoni et al.¹⁴	1b – A	5/10
Collins et al.¹¹	1b – A	5/10
Dziubek et al.¹⁵	1b – A	5/10
Lamberti et al.¹²	3b – B	NA
Akerman et al.¹³	1b – A	6/10

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Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Rua Estela, 515, bloco E, conj. 21, Vila Mariana, CEP04011-002 - São Paulo, SP, Tel.: (11) 5084.3482 / 5084.2853 - Porto Alegre - RS - Brazil
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[1] CO = carbon monoxide; RCT = randomized clinical trial; FMD = flow-mediated dilation; G1 = group one; G2 = group two; M = men; W = women; min = minutes; n = number of participants; NA = not applicable; NIRS = near-infrared spectroscopy; SF-36 = Medical Outcomes Short-Form Health Survey; 6WT = 6-minute walk test; VO₂max = maximum oxygen volume; PWV = pulse wave velocity; WIQ = Walking Impairment Questionnaire.