Document Detail


The effect of exercise on haemodynamics in intermittent claudication: a systematic review of randomized controlled trials.
MedLine Citation:
PMID:  20433214     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Changes in lower limb haemodynamics such as arterial pressure and/or flow have often been, and continue to be, cited as possible mechanisms for the improvement in walking performance that occurs with exercise training in individuals with peripheral arterial disease (PAD), but data are conflicting in this regard. There are a small number of literature reviews examining the effects of exercise on PAD, however, there has been insufficient analysis synthesizing possible mechanisms of effect, overall benefits and limitations of these trials. Our objective was therefore to systematically review the evidence for the effect of exercise on lower limb haemodynamic measures of resting and post-exercise ankle brachial index (ABI), resting toe pressure, and resting and reactive hyperaemic calf blood flow in PAD. A systematic search of studies published between 1934 and March 2010 was conducted using MEDLINE, EMBASE, AMED, SportDiscus, CINAHL, PEDro, Premedline, Google Scholar and Web of Knowledge databases. Eligible studies included randomized controlled trials using an exercise intervention for the treatment of intermittent claudication with haemodynamic measures of disease severity as outcomes. Relative effect sizes (ESs) and 95% confidence intervals were calculated for outcomes. Correlation and regression analyses were performed to establish relationships between symptoms and haemodynamic outcomes. Thirty-three trials including 1237 subjects with mild to moderate claudication met the eligibility criteria. Exercise did not significantly change lower extremity haemodynamics in most trials; nor were clinical improvements related to changes in resting ABI (mean ES 0.09 +/- 0.26; r = 0.02; p = 0.94), post-exercise ABI (mean ES 0.18 +/- 0.3; r = -0.33; p = 0.52) or reactive hyperaemic calf blood flow (mean ES 0.38 +/- 0.67; r = 0.35; p = 0.26). A relationship may exist between a change in symptoms and changes in resting toe pressure (mean ES 0.22 +/- 0.22; r = 0.75; p = 0.25) and resting calf blood flow (mean ES 0.09 +/- 0.16; r = 0.59; p = 0.22). Changes in resting and post-exercise ABI and reactive hyperaemic calf blood flow do not appear to explain the clinical benefits of exercise in PAD. More study is required in the areas of resting toe pressure and resting calf blood flow.
Authors:
Belinda J Parmenter; Jacqueline Raymond; Maria A Fiatarone Singh
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Sports medicine (Auckland, N.Z.)     Volume:  40     ISSN:  1179-2035     ISO Abbreviation:  Sports Med     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-06-16     Revised Date:  2013-05-16    
Medline Journal Info:
Nlm Unique ID:  8412297     Medline TA:  Sports Med     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  433-47     Citation Subset:  IM    
Affiliation:
Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia. belinda.parmenter@sydney.edu.au
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MeSH Terms
Descriptor/Qualifier:
Ankle Brachial Index
Exercise Therapy*
Hemodynamics / physiology*
Humans
Intermittent Claudication / physiopathology,  therapy*
Lower Extremity / blood supply*,  physiopathology
Randomized Controlled Trials as Topic
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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