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Jonathan Golledge - One of the best experts on this subject based on the ideXlab platform.
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association of lower extremity performance with cardiovascular and all cause mortality in patients with peripheral artery disease a systematic review and meta analysis
Journal of the American Heart Association, 2014Co-Authors: Dylan R Morris, Jonathan Golledge, Alexander J Rodriguez, Joseph V Moxon, Margaret Cunningham, Mary M Mcdermott, Jonathan Myers, Nicholas J Leeper, R E JonesAbstract:Background Peripheral artery disease (PAD) is associated with impaired mobility and a high rate of mortality. The aim of this systematic review was to investigate whether reduced lower extremity performance was associated with an increased incidence of cardiovascular and all-cause mortality in people with PAD. Methods and Results A systematic search of the MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library databases was conducted. Studies assessing the association between measures of lower extremity performance and cardiovascular or all-cause mortality in PAD patients were included. A meta-analysis was conducted combining data from commonly assessed performance tests. The 10 identified studies assessed lower extremity performance by strength tests, treadmill walking performance, 6-minute walk, walking velocity, and walking impairment questionnaire (WIQ). A meta-analysis revealed that shorter maximum walking Distance was associated with increased 5-year cardiovascular (unadjusted RR=2.54, 95% CI 1.86 to 3.47, P <10−5, n=1577, fixed effects) and all-cause mortality (unadjusted RR=2.23 95% CI 1.85 to 2.69, P <10−5, n=1710, fixed effects). Slower 4-metre walking velocity, a lower WIQ stair-climbing Score, and poor hip extension, knee flexion, and plantar flexion strength were also associated with increased mortality. No significant associations were found for hip flexion strength, WIQ Distance Score, or WIQ speed Score with mortality. Conclusions A number of lower extremity performance measures are prognostic markers for mortality in PAD and may be useful clinical tools for identifying patients at higher risk of death. Further studies are needed to determine whether interventions that improve measures of lower extremity performance reduce mortality.
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effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication a randomized controlled trial
The Journal of Antibiotics, 2013Co-Authors: Anna Agnes Ahimastos, P J Walker, Christopher D Askew, Anthony S Leicht, Elise Pappas, Peter Blombery, Christopher M Reid, Jonathan Golledge, Bronwyn A KingwellAbstract:Importance Approximately one-third of patients with peripheral artery disease experience intermittent claudication, with consequent loss of quality of life. Objective To determine the efficacy of ramipril for improving walking ability, patient-perceived walking performance, and quality of life in patients with claudication. Design, Setting, and Patients Randomized, double-blind, placebo-controlled trial conducted among 212 patients with peripheral artery disease (mean age, 65.5 [SD, 6.2] years), initiated in May 2008 and completed in August 2011 and conducted at 3 hospitals in Australia. Intervention Patients were randomized to receive 10 mg/d of ramipril (n = 106) or matching placebo (n = 106) for 24 weeks. Main Outcome Measures Maximum and pain-free walking times were recorded during a standard treadmill test. The Walking Impairment Questionnaire (WIQ) and Short-Form 36 Health Survey (SF-36) were used to assess walking ability and quality of life, respectively. Results At 6 months, relative to placebo, ramipril was associated with a 75-second (95% CI, 60-89 seconds) increase in mean pain-free walking time (P < .001) and a 255-second (95% CI, 215-295 seconds) increase in maximum walking time (P < .001). Relative to placebo, ramipril improved the WIQ median Distance Score by 13.8 (Hodges-Lehmann 95% CI, 12.2-15.5), speed Score by 13.3 (95% CI, 11.9-15.2), and stair climbing Score by 25.2 (95% CI, 25.1-29.4) (P < .001 for all). The overall SF-36 median Physical Component Summary Score improved by 8.2 (Hodges-Lehmann 95% CI, 3.6-11.4; P = .02) in the ramipril group relative to placebo. Ramipril did not affect the overall SF-36 median Mental Component Summary Score. Conclusions and Relevance Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 Score. Trial Registration clinicaltrials.gov Identifier: NCT00681226
William R Hiatt - One of the best experts on this subject based on the ideXlab platform.
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effect of cilostazol on treadmill walking community based walking ability and health related quality of life in patients with intermittent claudication due to peripheral arterial disease meta analysis of six randomized controlled trials
Journal of the American Geriatrics Society, 2002Co-Authors: Judith G Regensteiner, John E Ware, Walter J Mccarthy, Peter Zhang, William P Forbes, Jeffrey Heckman, William R HiattAbstract:OBJECTIVES: To assess whether cilostazol, a phosphodiesterase III inhibitor, improves treadmill and community-based walking ability and health-related quality of life (HQL) in patients with intermittent claudication resulting from peripheral arterial disease (PAD). DESIGN: Retrospective meta-analysis of data pooled from six Phase 3, multicenter, double-blind, placebo-controlled, parallel-group, randomized studies. SETTING: Patients were recruited from outpatient ambulatory medical care facilities. PARTICIPANTS: Patients' (n = 1,751) mean age ± standard deviation was 65 ± 9, and they had a history of PAD for 6 months or longer and an ankle brachial index (ABI) of 0.90 or less. INTERVENTION: Cilostazol 50 mg bid or 100 mg bid for 12, 16, or 24 weeks. MEASUREMENTS: ABI; maximal walking Distance (MWD); pain-free walking Distance on a graded and constant-load treadmill; and HQL, measured using the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study Short Form-36 (SF-36). RESULTS: Maximal treadmill walking Distance improved more in both cilostazol groups than in the placebo group (both P < .0001). WIQ and SF-36 physical summary Scores improved significantly more with cilostazol than with placebo (for instance, WIQ Distance Score, P < .0001 and SF-36 physical summary Score, P < .0001, comparing persons taking cilostazol with controls). Improved MWD correlated with improvements in WIQ (correlation with Distance Score, r = 0.34, P < .0001) and SF-36 physical summary Scores (r = 0.29, P < .0001). CONCLUSIONS: Treatment with cilostazol was associated with greater improvements in community-based walking ability and HQL in patients with intermittent claudication than treatment with placebo. These improvements correlated with increased MWD. This analysis of effects of cilostazol on improving walking ability in persons with claudication is the first cilostazol study focused on community-based measures of functional status and HQL. Questionnaires assessing walking ability and HQL provide important patient-based information about clinical outcomes of claudication therapy.
Mary M Mcdermott - One of the best experts on this subject based on the ideXlab platform.
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meaningful change in 6 minute walk in people with peripheral artery disease
Journal of Vascular Surgery, 2021Co-Authors: Mary M Mcdermott, Luigi Ferrucci, Lu Tian, Michael H Criqui, Michael S Conte, Lihui Zhao, Robert L Sufit, Tamar S Polonsky, Melina R Kibbe, Philip GreenlandAbstract:Abstract Objective The 6-minute walk test is a common outcome measure in clinical trials of people with lower extremity peripheral artery disease (PAD). However, what constitutes a meaningful change in the 6-minute walk Distance has not been well defined for people with PAD. The present study related the change in the 6-minute walk Distance to the degree of participant-reported improvement or decline in the 6-minute walk Distance to define a meaningful change in the 6-minute walk Distance for those with PAD. Methods Participants with PAD from three observational longitudinal studies completed the walking impairment questionnaire (WIQ) Distance Score and 6-minute walk at baseline and 1 year later. The WIQ Distance Score measures participants' perceived difficulty walking seven different Distances without stopping (ranging from walking around the home to walking 5 blocks) on a 0 to 4 Likert scale, with 0 representing an inability to walk the Distance and 4 representing no difficulty. The mean changes in the 6-minute walk Distance corresponding to the participants' report of no change, 1-unit change, or 2-unit change, respectively, in the Likert scale Score between the baseline and 1-year follow-up measures were calculated for each WIQ Distance. Results A total of 777 participants with PAD (mean age, 71.2 ± 8.8 years; mean baseline 6-minute walk Distance, 350.1 ± 118.1 meters) completed 5439 questions about their difficulty walking each WIQ Distance at baseline and follow-up. Participants with PAD who reported no change in their difficulty in walking each WIQ Distance between baseline and follow-up had a decline of 7.2 meters (95% confidence interval [CI], −11.6 to −2.8 meters) in the 6-minute walk test. Relative to those reporting no change in difficulty walking, the participants reporting 1- and 2-point improvements in walking ability showed 6-minute walk Distance improvements of 7.8 meters (95% CI, −0.3 to 15.9 meters) and 20.1 meters (95% CI, 1.1-39.2 meters), respectively. Relative to those reporting no change in walking difficulty, those reporting 1- and 2-point declines in perceived walking difficulty showed declines of −11.2 meters (95% CI, −19.0 to −3.4 meters) and −23.8 meters (95% CI, −37.4 to −10.3 meters) in the 6-minute walk Distance. Conclusions Among people with PAD, ∼8- and ∼20-meter improvements in the 6-minute walk Distance represent small and large improvements in walking ability, respectively. People with PAD who reported no change in their ability to walk Distances over 1 year simultaneously declined by a mean of 7 meters in the 6-minute walk test. These findings will be useful for interpreting the results from randomized trials of interventions to improve the walking performance of people with PAD.
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association of lower extremity performance with cardiovascular and all cause mortality in patients with peripheral artery disease a systematic review and meta analysis
Journal of the American Heart Association, 2014Co-Authors: Dylan R Morris, Jonathan Golledge, Alexander J Rodriguez, Joseph V Moxon, Margaret Cunningham, Mary M Mcdermott, Jonathan Myers, Nicholas J Leeper, R E JonesAbstract:Background Peripheral artery disease (PAD) is associated with impaired mobility and a high rate of mortality. The aim of this systematic review was to investigate whether reduced lower extremity performance was associated with an increased incidence of cardiovascular and all-cause mortality in people with PAD. Methods and Results A systematic search of the MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library databases was conducted. Studies assessing the association between measures of lower extremity performance and cardiovascular or all-cause mortality in PAD patients were included. A meta-analysis was conducted combining data from commonly assessed performance tests. The 10 identified studies assessed lower extremity performance by strength tests, treadmill walking performance, 6-minute walk, walking velocity, and walking impairment questionnaire (WIQ). A meta-analysis revealed that shorter maximum walking Distance was associated with increased 5-year cardiovascular (unadjusted RR=2.54, 95% CI 1.86 to 3.47, P <10−5, n=1577, fixed effects) and all-cause mortality (unadjusted RR=2.23 95% CI 1.85 to 2.69, P <10−5, n=1710, fixed effects). Slower 4-metre walking velocity, a lower WIQ stair-climbing Score, and poor hip extension, knee flexion, and plantar flexion strength were also associated with increased mortality. No significant associations were found for hip flexion strength, WIQ Distance Score, or WIQ speed Score with mortality. Conclusions A number of lower extremity performance measures are prognostic markers for mortality in PAD and may be useful clinical tools for identifying patients at higher risk of death. Further studies are needed to determine whether interventions that improve measures of lower extremity performance reduce mortality.
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home based walking exercise intervention in peripheral artery disease a randomized clinical trial
JAMA, 2013Co-Authors: Mary M Mcdermott, Luigi Ferrucci, Lu Tian, Michael H Criqui, Kiang Liu, Jack M Guralnik, Bonnie Spring, Kathryn Domanchuk, Donald M Lloydjones, Melina R KibbeAbstract:Importance Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease (PAD) to participate in a home-based walking exercise program. Objective To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention, incorporating both group support and self-regulatory skills, can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication. Design, Setting, and Patients Randomized controlled clinical trial of 194 patients with PAD, including 72.2% without classic symptoms of intermittent claudication, performed in Chicago, Illinois between July 22, 2008, and December 14, 2012. Interventions Participants were randomized to 1 of 2 parallel groups: a home-based group-mediated cognitive behavioral walking intervention or an attention control condition. Main Outcomes and Measures The primary outcome was 6-month change in 6-minute walk performance. Secondary outcomes included 6-month change in treadmill walking, physical activity, the Walking Impairment Questionnaire (WIQ), and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey. Results Participants randomized to the intervention group significantly increased their 6-minute walk Distance ([reported in meters] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5 [95% CI, 33.2 to 73.8]; P P = .04), accelerometer-measured physical activity over 7 days (intervention, 778.0 to 866.1 vs control, 671.6 to 645.0; mean difference, 114.7 activity units [95% CI, 12.82 to 216.5]; P = .03), WIQ Distance Score (intervention, 35.3 to 47.4 vs control, 33.3 to 34.4; mean difference, 11.1 [95% CI, 3.9 to 18.1]; P = .003), and WIQ speed Score (intervention, 36.1 to 47.7 vs control, 35.3-36.6; mean difference, 10.4 [95% CI, 3.4 to 17.4]; P = .004). Conclusion and Relevance A home-based walking exercise program significantly improved walking endurance, physical activity, and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms. These findings have implications for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs. Trial Registration clinicaltrials.gov Identifier:NCT00693940
Bronwyn A Kingwell - One of the best experts on this subject based on the ideXlab platform.
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effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication a randomized controlled trial
The Journal of Antibiotics, 2013Co-Authors: Anna Agnes Ahimastos, P J Walker, Christopher D Askew, Anthony S Leicht, Elise Pappas, Peter Blombery, Christopher M Reid, Jonathan Golledge, Bronwyn A KingwellAbstract:Importance Approximately one-third of patients with peripheral artery disease experience intermittent claudication, with consequent loss of quality of life. Objective To determine the efficacy of ramipril for improving walking ability, patient-perceived walking performance, and quality of life in patients with claudication. Design, Setting, and Patients Randomized, double-blind, placebo-controlled trial conducted among 212 patients with peripheral artery disease (mean age, 65.5 [SD, 6.2] years), initiated in May 2008 and completed in August 2011 and conducted at 3 hospitals in Australia. Intervention Patients were randomized to receive 10 mg/d of ramipril (n = 106) or matching placebo (n = 106) for 24 weeks. Main Outcome Measures Maximum and pain-free walking times were recorded during a standard treadmill test. The Walking Impairment Questionnaire (WIQ) and Short-Form 36 Health Survey (SF-36) were used to assess walking ability and quality of life, respectively. Results At 6 months, relative to placebo, ramipril was associated with a 75-second (95% CI, 60-89 seconds) increase in mean pain-free walking time (P < .001) and a 255-second (95% CI, 215-295 seconds) increase in maximum walking time (P < .001). Relative to placebo, ramipril improved the WIQ median Distance Score by 13.8 (Hodges-Lehmann 95% CI, 12.2-15.5), speed Score by 13.3 (95% CI, 11.9-15.2), and stair climbing Score by 25.2 (95% CI, 25.1-29.4) (P < .001 for all). The overall SF-36 median Physical Component Summary Score improved by 8.2 (Hodges-Lehmann 95% CI, 3.6-11.4; P = .02) in the ramipril group relative to placebo. Ramipril did not affect the overall SF-36 median Mental Component Summary Score. Conclusions and Relevance Among patients with intermittent claudication, 24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo. This was associated with a significant increase in the physical functioning component of the SF-36 Score. Trial Registration clinicaltrials.gov Identifier: NCT00681226
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brief communication ramipril markedly improves walking ability in patients with peripheral arterial disease a randomized trial
Annals of Internal Medicine, 2006Co-Authors: Anna Agnes Ahimastos, Peter Blombery, Christopher M Reid, Adam Lawler, Bronwyn A KingwellAbstract:Background: Peripheral arterial disease (PAD) affects up to 12% of adults older than 50 years of age. Conventional therapies have only modest effects in improving symptoms. Objective: To examine the effects of angiotensin-converting enzyme inhibition on walking ability in patients with PAD. Design: Randomized, double-blind, placebo-controlled trial initiated in March 2003 and completed in January 2005. Setting: The Alfred Hospital, Melbourne, Australia. Participants: 40 older adults with symptomatic PAD and no history of diabetes or hypertension. Intervention: 10 mg of ramipril (n = 20) or placebo (n = 20) once daily for 24 weeks. All patients completed the trial. Measurements: Pain-free and maximum walking time were recorded during a standard treadmill test, and the standard Walking Impairment Questionnaire was administered. Results: After adjustment for the baseline pain-free walking time, mean pain-free walking time after ramipril treatment was 227 seconds (95% Cl, 175 seconds to 278 seconds; P < 0.001) longer than that after placebo treatment. Similarly, maximum walking time improved by 451 seconds in the ramipril group (Cl, 367 seconds to 536 seconds; P < 0.001) but did not change in the placebo group. Ramipril improved the Walking Impairment Questionnaire median Distance Score from 5% (range, 1% to 39%) to 21% (range, 12% to 58%; P < 0.001), speed Score from 3% (range, 3% to 39%) to 18% (range, 8% to 50%; P< 0.001), and stair-climbing Score from 17% (range, 4% to 80%) to 67% (range, 38% to 88%; P < 0.001). No adverse events were reported. Limitations: The sample size is modest, and the strict inclusion criteria limit the applicability of the results to patients with claudication and infrainguinal disease and those without diabetes. Conclusion: Ramipril improved pain-free and maximum walking time in some adults with symptomatic PAD.
Benedicte Nourydesvaux - One of the best experts on this subject based on the ideXlab platform.
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measurement of walking Distance and speed in patients with peripheral arterial disease a novel method using a global positioning system
Circulation, 2008Co-Authors: Alexis Le Faucheur, Pierre Abraham, Vincent Jaquinandi, Philippe Bouye, Jean Louis Saumet, Benedicte NourydesvauxAbstract:Background— The maximal walking Distance (MWD) performed on a treadmill test remains the “gold standard” in estimating the walking capacity of patients who have peripheral arterial disease with intermittent claudication, although treadmills are not accessible to most physicians. We hypothesized that global positioning system (GPS) recordings could monitor community-based outdoor walking and provide valid information on walking capacity in patients with peripheral arterial disease. Methods and Results— We studied 24 patients (6 women) with arterial claudication (median [25th to 75th percentile] values: 57 years old [48 to 67 years], 169 cm tall [164 to 172 cm], weight 81 kg [71 to 86 kg], and ankle-brachial index 0.64 [0.56 to 0.74]). MWD on the treadmill was 184 m (144 to 246 m), which was compared with the results of self-reported MWD, the Distance Score from the Walking Impairment Questionnaire, MWD observed during a 6-minute walking test, and MWD measured over a GPS-recorded unconstrained outdoor walk ...