Supervised exercise training improves cardiorespiratory fitness and reduces perioperative risk in peripheral artery disease patients with intermittent claudication

Introduction: This study examined to what extent supervised aerobic and resistance exercise combined with continued unsupervised exercise training improves cardiorespiratory fitness and corresponding perioperative risk in peripheral artery disease (PAD) patients with intermittent claudication.

Materials and Methods: A total of 106 patients (77% male) were enrolled into the study, alongside 155 healthy non-PAD control participants. Patients completed supervised exercise therapy (aerobic and resistance exercises of the upper and lower limbs) twice a week for 10 weeks. Thereafter, 52 patients completed 12-weeks of an unsupervised tailored homebased exercise. Pain free walking distance (PWD), maximum walking distance (MWD), peak oxygen uptake (V̇O2PEAK) and perioperative risk were assessed before and after both exercise interventions.

Results: Patients were highly unconditioned relative to healthy controls ( ̇VO2PEAK=11.9 vs 24.2ml/kg/min,p=<0.001) with 91% classified ashigh perioperative risk (peak oxygen uptake <15ml/kg/min). Supervised exercise increased PWD (+44±81m,p=<0.001), MWD (+44±71m,p=<0.001) and ̇VO2PEAK(+1.01±1.63ml/kg/min,p=<0.001) and lowered perioperative risk (91% to 85%,p=<0.001). When compared withsupervised exercise, the improvements in PWD were maintained following unsupervised exercise (+11±91m vs supervised exercise,p=0.572);however, MWD and ̇VO2PEAKdecreased (−15±48m,p=0.030 and−0.34±1.11ml/kg/min,p=0.030, respectively) and perioperative risk increased(+3%,p=<0.001) although still below baseline (p=<0.001)

Conclusions: Supervised aerobic and resistance exercise training and, to a lesser extent, unsupervised tailored exercise improves walking capacity andcardiorespiratory fitness and reduces perioperative risk in PAD patients with intermittent claudication.