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Andrew W. Gardner - One of the best experts on this subject based on the ideXlab platform.
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barriers to physical activity in patients with intermittent Claudication
International Journal of Behavioral Medicine, 2015Co-Authors: Joao Paulo Dos Anjos Souza Barbosa, Andrew W. Gardner, Nelson Wolosker, Breno Quintella Farah, Marcel Da Rocha Chehuen, Gabriel Grizzo Cucato, Jose Cazuza De Farias, C L M Forjaz, Raphael Mendes RittidiasAbstract:The main barriers reported by the patients with Claudication are related to Claudication symptoms. However, it remains unclear whether these barriers are associated with physical activity levels in these patients. The aim of this study was to analyze the barriers to and the factors associated with physical activity (PA) in intermittent Claudication (IC) patients. The sample included 150 IC Brazilian patients and mean age 64 ± 9 years old. Sociodemographic factors, comorbid conditions and cardiovascular risk factors, personal and environmental barriers to PA, and walking capacity (Claudication onset distance-COD and peak walking distance-PWD) were obtained. PA was assessed using a pedometer over seven consecutive days. Patients performed 6,041 ± 3,166 steps/day. The most prevalent personal and environmental barriers to PAs were exercise-induced pain and the presence of obstacles that aggravate the leg pain. Multiple linear regression showed that level of PA was inversely associated with age (β = −81.13; p < 0.001), lack of green areas (β = −1363.54; p < 0.001), and positively associated with PWD (β = 3.07; p < 0.001). Older IC patients who live in neighborhoods that lack green areas to walk in, and who have poor walking capacity present lower levels of PA.
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barriers to physical activity in patients with intermittent Claudication
International Journal of Behavioral Medicine, 2015Co-Authors: Joao Paulo Dos Anjos Souza Barbosa, Andrew W. Gardner, Nelson Wolosker, Breno Quintella Farah, Marcel Da Rocha Chehuen, Gabriel Grizzo Cucato, Jose Cazuza De Farias, Claudia Lucia De Moraes Forjaz, Raphael Mendes RittidiasAbstract:Background The main barriers reported by the patients with Claudication are related to Claudication symptoms. However, it remains unclear whether these barriers are associated with physical activity levels in these patients.
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P 0.05). The changes in Claudication onset time and peak walking time were similar between the 2 exercise groups (P>0.05), whereas the change in daily average cadence was greater with home-based exercise (P<0.05). A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving Claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise. URL: http://www.ClinicalTrials.Gov. Unique identifier: NCT00618670.
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:Background—This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Methods and Results—Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P<0.001) and peak...
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patterns of ambulatory activity in subjects with and without intermittent Claudication
Journal of Vascular Surgery, 2007Co-Authors: Andrew W. Gardner, Kristy J Scott, Azhar Afaq, Polly S. Montgomery, Steve M BlevinsAbstract:Purpose This study compared the patterns of ambulatory activity in subjects with and without intermittent Claudication. Methods The study participants were 98 subjects limited by intermittent Claudication and 129 controls who were matched for age, gender, and race. Subjects were assessed on their ambulatory activity patterns for 1 week with a small, lightweight step activity monitor attached to the ankle using elastic Velcro (Velcro Industries BV, Manchester, NH) straps above the lateral malleolus of the right leg. The step activity monitor recorded the number of strides taken on a minute-to-minute basis, the time spent ambulating, and the time and number of strides measured at low ( 30 strides/min) cadences. Results Subjects with intermittent Claudication took fewer total strides each day than the controls (3149 ± 1557 strides/d vs 4230 ± 1708 strides/d; P P = .001) and high (766 ± 753 strides/day vs 1285 ± 1029 strides/day; P P P = .034), primarily at medium (58 ± 30 min/day vs 75 ± 32 min/day; P P = .001) cadences. Conclusion Intermittent Claudication is associated with lower total daily ambulatory activity owing both to less time ambulating and to fewer strides taken while ambulating, particularly at moderate and high cadences.
Polly S. Montgomery - One of the best experts on this subject based on the ideXlab platform.
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P 0.05). The changes in Claudication onset time and peak walking time were similar between the 2 exercise groups (P>0.05), whereas the change in daily average cadence was greater with home-based exercise (P<0.05). A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving Claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise. URL: http://www.ClinicalTrials.Gov. Unique identifier: NCT00618670.
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:Background—This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Methods and Results—Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P<0.001) and peak...
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the effect of metabolic syndrome components on exercise performance in patients with intermittent Claudication
Journal of Vascular Surgery, 2008Co-Authors: Andy Gardner, Polly S. MontgomeryAbstract:Purpose To determine the effect of metabolic syndrome components on intermittent Claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and to identify the metabolic syndrome components most predictive of each outcome measure. Methods Patients limited by intermittent Claudication with three (n = 48), four (n = 45), or five (n = 40) components of metabolic syndrome were studied. Patients were assessed on PAD-specific measures consisting of ankle-brachial index (ABI), initial Claudication distance, absolute Claudication distance, physical function measures, health-related quality of life, and calf blood flow and transcutaneous oxygen tension responses after 3 minutes of vascular occlusion. Results Initial Claudication distance (mean ± SD) progressively declined ( P = .019) in those with three (203 ± 167 m), four (124 ± 77 m), and five (78 ± 57 m) metabolic syndrome components, and absolute Claudication distance progressively declined ( P = .036) in these groups as well (414 ± 224 m vs 323 ± 153 m vs 249 ± 152 m, respectively). Furthermore, compared with patients with only three components of metabolic syndrome, those with all five components had impaired values ( P P P Conclusion PAD patients with more metabolic syndrome components have worsened intermittent Claudication, physical function, health-related quality of life, and peripheral circulation. Abdominal obesity and elevated fasting glucose are the metabolic syndrome components that are most predictive of these outcome measures. Aggressively treating these metabolic syndrome components may be particularly important in managing symptoms and long-term prognosis of PAD patients.
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patterns of ambulatory activity in subjects with and without intermittent Claudication
Journal of Vascular Surgery, 2007Co-Authors: Andrew W. Gardner, Kristy J Scott, Azhar Afaq, Polly S. Montgomery, Steve M BlevinsAbstract:Purpose This study compared the patterns of ambulatory activity in subjects with and without intermittent Claudication. Methods The study participants were 98 subjects limited by intermittent Claudication and 129 controls who were matched for age, gender, and race. Subjects were assessed on their ambulatory activity patterns for 1 week with a small, lightweight step activity monitor attached to the ankle using elastic Velcro (Velcro Industries BV, Manchester, NH) straps above the lateral malleolus of the right leg. The step activity monitor recorded the number of strides taken on a minute-to-minute basis, the time spent ambulating, and the time and number of strides measured at low ( 30 strides/min) cadences. Results Subjects with intermittent Claudication took fewer total strides each day than the controls (3149 ± 1557 strides/d vs 4230 ± 1708 strides/d; P P = .001) and high (766 ± 753 strides/day vs 1285 ± 1029 strides/day; P P P = .034), primarily at medium (58 ± 30 min/day vs 75 ± 32 min/day; P P = .001) cadences. Conclusion Intermittent Claudication is associated with lower total daily ambulatory activity owing both to less time ambulating and to fewer strides taken while ambulating, particularly at moderate and high cadences.
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metabolic syndrome impairs physical function health related quality of life and peripheral circulation in patients with intermittent Claudication
Journal of Vascular Surgery, 2006Co-Authors: Polly S. Montgomery, Andrew W. Gardner, Donald E ParkerAbstract:Purpose This study was conducted to (1) examine the effect of metabolic syndrome on intermittent Claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and (2) determine whether peripheral vascular function was predictive of intermittent Claudication and physical function in patients with metabolic syndrome. Methods Patients limited by intermittent Claudication and who had metabolic syndrome (n = 133) were compared with those without metabolic syndrome (n = 201). Patients were assessed on metabolic syndrome characteristics, PAD-specific measures consisting of ankle/brachial index and Claudication distances, physical function measures, health-related quality of life, and calf blood flow and transcutaneous oxygen tension responses after 3 minutes of vascular occlusion. Results Initial Claudication distance (mean ± SD) was 29% shorter ( P = .018) in patients with metabolic syndrome than in the controls (128 ± 121 meters vs 180 ± 166 meters), and absolute Claudication distance was 22% shorter ( P = .025) in those with metabolic syndrome (319 ± 195 meters vs 409 ± 255 meters). Furthermore, patients with metabolic syndrome had lower peak oxygen uptake ( P = .037), a shorter 6-minute walk distance ( P = .027), lower values on six domains of health-related quality of life ( P P = .028), and greater calf ischemia ( P r = 0.30, P = .004), absolute Claudication distance ( r = 0.40, P r = 0.52, P Conclusion Metabolic syndrome worsens intermittent Claudication, physical function, health-related quality of life, and peripheral circulation in patients with PAD. Calf ischemia in those with metabolic syndrome was predictive of intermittent Claudication and physical function. The additive burden of metabolic syndrome thus places patients who are limited by intermittent Claudication at an even greater risk for living a functionally dependent lifestyle. Aggressive risk-factor modification designed to treat components of metabolic syndrome should be evaluated for efficacy in modifying physical and vascular function in patients with intermittent Claudication.
Steve M Blevins - One of the best experts on this subject based on the ideXlab platform.
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:Background—This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Methods and Results—Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P<0.001) and peak...
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P 0.05). The changes in Claudication onset time and peak walking time were similar between the 2 exercise groups (P>0.05), whereas the change in daily average cadence was greater with home-based exercise (P<0.05). A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving Claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise. URL: http://www.ClinicalTrials.Gov. Unique identifier: NCT00618670.
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patterns of ambulatory activity in subjects with and without intermittent Claudication
Journal of Vascular Surgery, 2007Co-Authors: Andrew W. Gardner, Kristy J Scott, Azhar Afaq, Polly S. Montgomery, Steve M BlevinsAbstract:Purpose This study compared the patterns of ambulatory activity in subjects with and without intermittent Claudication. Methods The study participants were 98 subjects limited by intermittent Claudication and 129 controls who were matched for age, gender, and race. Subjects were assessed on their ambulatory activity patterns for 1 week with a small, lightweight step activity monitor attached to the ankle using elastic Velcro (Velcro Industries BV, Manchester, NH) straps above the lateral malleolus of the right leg. The step activity monitor recorded the number of strides taken on a minute-to-minute basis, the time spent ambulating, and the time and number of strides measured at low ( 30 strides/min) cadences. Results Subjects with intermittent Claudication took fewer total strides each day than the controls (3149 ± 1557 strides/d vs 4230 ± 1708 strides/d; P P = .001) and high (766 ± 753 strides/day vs 1285 ± 1029 strides/day; P P P = .034), primarily at medium (58 ± 30 min/day vs 75 ± 32 min/day; P P = .001) cadences. Conclusion Intermittent Claudication is associated with lower total daily ambulatory activity owing both to less time ambulating and to fewer strides taken while ambulating, particularly at moderate and high cadences.
Donald E Parker - One of the best experts on this subject based on the ideXlab platform.
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:Background—This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Methods and Results—Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P<0.001) and peak...
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efficacy of quantified home based exercise and supervised exercise in patients with intermittent Claudication a randomized controlled trial
Circulation, 2011Co-Authors: Andrew W. Gardner, Kristy J Scott, Donald E Parker, Polly S. Montgomery, Steve M BlevinsAbstract:This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent Claudication after a home-based exercise program, a supervised exercise program, and usual-care control. Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal Claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included Claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased Claudication onset time (P 0.05). The changes in Claudication onset time and peak walking time were similar between the 2 exercise groups (P>0.05), whereas the change in daily average cadence was greater with home-based exercise (P<0.05). A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving Claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise. URL: http://www.ClinicalTrials.Gov. Unique identifier: NCT00618670.
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metabolic syndrome impairs physical function health related quality of life and peripheral circulation in patients with intermittent Claudication
Journal of Vascular Surgery, 2006Co-Authors: Polly S. Montgomery, Andrew W. Gardner, Donald E ParkerAbstract:Purpose This study was conducted to (1) examine the effect of metabolic syndrome on intermittent Claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and (2) determine whether peripheral vascular function was predictive of intermittent Claudication and physical function in patients with metabolic syndrome. Methods Patients limited by intermittent Claudication and who had metabolic syndrome (n = 133) were compared with those without metabolic syndrome (n = 201). Patients were assessed on metabolic syndrome characteristics, PAD-specific measures consisting of ankle/brachial index and Claudication distances, physical function measures, health-related quality of life, and calf blood flow and transcutaneous oxygen tension responses after 3 minutes of vascular occlusion. Results Initial Claudication distance (mean ± SD) was 29% shorter ( P = .018) in patients with metabolic syndrome than in the controls (128 ± 121 meters vs 180 ± 166 meters), and absolute Claudication distance was 22% shorter ( P = .025) in those with metabolic syndrome (319 ± 195 meters vs 409 ± 255 meters). Furthermore, patients with metabolic syndrome had lower peak oxygen uptake ( P = .037), a shorter 6-minute walk distance ( P = .027), lower values on six domains of health-related quality of life ( P P = .028), and greater calf ischemia ( P r = 0.30, P = .004), absolute Claudication distance ( r = 0.40, P r = 0.52, P Conclusion Metabolic syndrome worsens intermittent Claudication, physical function, health-related quality of life, and peripheral circulation in patients with PAD. Calf ischemia in those with metabolic syndrome was predictive of intermittent Claudication and physical function. The additive burden of metabolic syndrome thus places patients who are limited by intermittent Claudication at an even greater risk for living a functionally dependent lifestyle. Aggressive risk-factor modification designed to treat components of metabolic syndrome should be evaluated for efficacy in modifying physical and vascular function in patients with intermittent Claudication.
Jonathan Golledge - One of the best experts on this subject based on the ideXlab platform.
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relationship between requirement to stop during a six minute walk test and health related quality of life physical activity and physical performance amongst people with intermittent Claudication
Annals of Vascular Surgery, 2021Co-Authors: Jonathan Golledge, Lisan Yip, Malindu E Fernando, Jenna Pinchbeck, Sophie E Rowbotham, Jason Jenkins, Anthony S LeichtAbstract:Aim A simple objective test is required to identify people with impaired physical aspects of health-related quality of life (QOL) due to intermittent Claudication. This study assessed the relationship of QOL, function and physical activity to the need to stop during a six-minute walking test (6MWT) amongst people with intermittent Claudication. Method This was a prospective case-control study conducted at two centers in Australia. 173 participants with a history of intermittent Claudication and peripheral artery disease diagnosed by ankle brachial pressure index Results Participants that had to stop at least once during the two 6MWTs (46; 26.6%) had significantly lower scores for three of the domains (physical functioning, role-physical and bodily pain) and the physical component summary (PCS) measure of the SF-36 compared to those who did not need to stop (n = 127; 73.4%). After adjusting for the risk factor co-variates (diabetes, hypertension and ankle brachial pressure index) which were significantly unequally distributed, needing to stop during the 6MWTs was significantly associated with a lower PCS score (adjusted mean 36.5, standard error 0.8 vs. 30.5, standard error 1.3; F = 14.0; P Conclusions Needing to stop during a 6MWT identified participants with intermittent Claudication with poorer QOL and less physical activity compared to those that do not need to stop.
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lower plasma testosterone or dihydrotestosterone but not estradiol is associated with symptoms of intermittent Claudication in older men
Clinical Endocrinology, 2013Co-Authors: Jonathan Golledge, Bu B Yeap, Helman Alfonso, S Paul A Chubb, David J Handelsman, Graeme J Hankey, Leon Flicker, Paul NormanAbstract:Objective: In men, testosterone (T) levels decline with age, and lower T predicts all-cause and cardiovascular mortality. However, the associations of T and its metabolites, dihydrotestosterone (DHT) and estradiol (E2), with symptomatic peripheral arterial disease remain unclear. We assessed associations of T, DHT and E2 with lower limb intermittent Claudication in older men. Design: Cross-sectional study. Participants: Community-dwelling men aged 70–89 years resident in Perth, Western Australia. Measurements:Intermittent Claudication was ascertained by the Edinburgh Claudication Questionnaire. Early morning, plasma T, DHT and E2 were assayed using liquid chromatography–tandem mass spectrometry. Results: There were 268 men with intermittent Claudication and 2435 without Claudication or any leg pain. Men with nonspecific leg pain (n = 986) were excluded. After adjusting for age, smoking, BMI, waist/hip ratio, hypertension, dyslipidaemia, diabetes, creatinine and prevalent cardiovascular disease (CVD), higher T was associated with reduced risk of having Claudication (per 1 SD increase, odds ratio [OR] = 0·80, 95% confidence interval [CI] = 0·69–0·94, P = 0·006; quartiles, Q4/Q1, OR = 0·54, 95% CI = 0·36–0·81). Higher DHT was associated with reduced risk of having Claudication (per 1 SD increase, OR = 0·86, 95% CI = 0·73–1·00, P = 0·048; Q4/Q1, OR = 0·64, 95% CI = 0·43–0·95). E2 was not associated with Claudication (per 1 SD increase, OR = 0·96, 95% CI = 0·83–1·11, P = 0·565; Q4/Q1, OR = 0·88, 95% CI = 0·60–1·29). Conclusions: Lower T or DHT levels, but not E2, are associated with symptoms of intermittent Claudication in older men. Reduced exposure to androgens may represent a causal factor or biomarker for symptomatic peripheral arterial disease. Further studies are needed to examine underlying mechanisms and evaluate therapeutic options in ageing men.
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a meta analysis of the outcome of endovascular and noninvasive therapies in the treatment of intermittent Claudication
Journal of Vascular Surgery, 2011Co-Authors: Anna A Ahimastos, Elise Pappas, Petra Buttner, P J Walker, Bronwyn A Kingwell, Jonathan GolledgeAbstract:Purpose Intermittent Claudication is a common symptom of peripheral arterial disease. Currently, there is a lack of consensus on the most effective therapies for this problem. We conducted a meta-analysis of randomized trials assessing the efficacy of endovascular therapy (EVT) compared with noninvasive therapies for the treatment of intermittent Claudication. Methods Randomized trials comparing the efficacy of EVT and noninvasive therapies, such as medical therapy (MT) and supervised exercise (SVE) in patients with intermittent Claudication were identified by a systematic search. Data were pooled, and combined overall effect sizes (standardized differences of mean values) were calculated for a random effect model in terms of ankle-brachial index (ABI) and treadmill walking for initial Claudication distance (ICD) and maximum walking distance (MWD). Nine eligible trials (873 participants) were included: two compared EVT and MT alone, four compared EVT and SVE, and three trials compared EVT plus SVE vs SVE alone. Results Heterogeneity between studies was marked. Quantitative data analysis suggested that EVT improved outcomes over MT alone at early follow-up evaluations. Outcomes of EVT plus SVE were better than those of SVE alone in terms of both ABI and treadmill walking at immediate, early, and intermediate follow-up. No substantial differences in outcomes of EVT alone compared with SVE alone were found. Conclusion In patients with intermittent Claudication, current evidence supports improved ABI and treadmill walking when EVT is added to MT or SVE during early and intermediate follow-up. There is no evidence that EVT alone provides improved outcome over SVE alone. There is low confidence in these findings for a number of reasons, including the small number of trials, the small size of these studies, the heterogeneity in study design, and the limited use of quality of life tools in assessing outcomes. More consistent data from larger, more homogenous studies, including longer follow-up, are required.
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association of obesity and metabolic syndrome with the severity and outcome of intermittent Claudication
Journal of Vascular Surgery, 2007Co-Authors: Jonathan Golledge, Anthony S Leicht, Robert G Crowther, Paula Clancy, Warwick L Spinks, Francis QuigleyAbstract:Background Obesity is recognized as an independent predictor of coronary artery disease; however, its importance in peripheral arterial disease is less clear. The aim of this study was to assess the association between obesity and the severity and outcome of intermittent Claudication. Methods This study was a prospective cohort study based at a tertiary referral center. Sixty patients with intermittent Claudication selected for conservative treatment were assessed for obesity and metabolic syndrome by using the International Diabetes Federation definition. Other risk factors, including diabetes, hypertension, smoking history, serum lipids, adipocytokines, and C-reactive protein, were measured by clinical and blood assessment. Obesity and metabolic syndrome were related to the severity of peripheral arterial disease, defined by ankle-brachial pressure index and graded treadmill measured maximum walking distance (MWD) and initial Claudication distance, by using multiple linear regression analysis allowing for traditional atherosclerotic risk factors. Patients were followed up for 24 months, and combined outcome was reported in terms of death, cardiovascular events, or requirement for revascularization. The effect of obesity and metabolic syndrome on outcome was investigated by using Kaplan-Meier and Cox proportional hazard analysis. Results Obesity and serum adiponectin were independently associated with the severity of peripheral arterial disease measured by ankle-brachial pressure index (P = .03 and .001), initial Claudication distance (P = .009 and .03), and MWD (P = .001 and .04). Metabolic syndrome was independently associated only with MWD (P = .02). By 24 months, outcome events occurred in 37% ± 7% and 43% ± 9% of patients with metabolic syndrome or obesity, respectively, compared with 0% and 11% ± 6% of those without these diagnoses. Waist circumference independently predicted the likelihood of outcome events (relative risk, 1.16; 95% confidence interval, 1.08-1.26; P < .001). Conclusions These findings, if confirmed in other cohorts, suggest the importance of treating obesity in patients with intermittent Claudication. Serum adiponectin concentrations may be an important guide to the efficacy of treatment in patients with intermittent Claudication and obesity.