The aim of the study is to analyze the effect of 12 weeks of arm crank exercise (ACE) training on cardiovascular function in PAD patients, and compare it with treadmill exercise (TE), the actual recommendation for this patients. In this clinical trial, 45 patients will be allocated randomly in three experimental groups: ACE training, TE and control group. ACE and TE groups will perform exercises twice a week with the intensity equivalent to 13- 15 on Borg's Subjective Perception Exertion Scale. Patients in control group will meet twice a week, however only to perform diverse activities and group living, without any type of exercise involved. All groups will be encouraged to increase their levels of activity, as they are usually guided in medical consultations. Before and after 12 weeks of intervention, cardiovascular function, functional capacity, cognition, and quality of life will be assessed.
Arm-crank exercise (ACT) is an alternative exercise strategy for patients with symptomatic peripheral artery disease (PAD) due the benefits on functional capacity and quality of life, besides provoking less or no pain symptoms during the execution. This study sought to describe the protocol of a study that will analyse the effect of ACT exercise on walking capacity, cardiovascular function, cognition and quality of life in patients with symptomatic PAD. This is a three-armed randomized, prospective, single-blind data collection, single-center, controlled study enrolling 45 patients with symptomatic PAD which will be randomized into 3 intervention groups: walking training (WT), ACT (WT and AC: 15 to 10 sets of 2 to 5 minutes, Borg 13 to 15) and control group (CG). Before and after 12 weeks of intervention, cardiovascular function (ambulatory blood pressure , clinic blood pressure, central blood pressure, heart rate variability, arterial stiffness, vascular function), functional capacity (six-minute walking test, 2 minute step test \[2 MST\], Walking impairment questionnaire \[WIQ\], Walking estimated limitation calculated by history \[WELCH\], Baltimore activity scale for intermittent claudication, handgrip test and short physical performance battery \[SPPB\]), cognition (executive function and memory) and quality of life (short version of world health organization quality of life and vascular quality of life questionnaire \[VASCUQOL-6\]) will be assessed. This is the first trial to evaluate the effects of ACT on regulatory mechanisms of cardiovascular system in PAD patients. If the results are as expected, they will provide evidence of ACT in promoting cardiovascular benefits in symptomatic PAD population.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
45
Arm-crank exercise group will be performed twice a week for 12 weeks. In the first weeks of training, each session will consist of 15 bouts, two active minutes and two minutes of passive interval, consisting of 60 minutes of session (30 minutes of active exercise). After the first three weeks of training, the exercise time will progressively increase by one minute every 3 weeks and the recovery period will be decreased, completing, at the end, a maximum volume of 10 bouts of five minutes of exercise and one minute of passive interval. The intensity of the exercise will be determined by the load equivalent to the range of 13 - 15 of The Borg Rating of Perceived Exertion, considered as somewhat hard to hard
Walking exercise group will be performed twice a week for 12 weeks. In the first weeks of training, each session will consist of 15 bouts, two active minutes and two minutes of passive interval, consisting of 60 minutes of session (30 minutes of active exercise). After the first three weeks of training, the exercise time will progressively increase by one minute every 3 weeks and the recovery period will be decreased, completing, at the end, a maximum volume of 10 bouts of five minutes of exercise and one minute of passive interval. The intensity of the exercise will be determined by the load equivalent to the range of 13 - 15 of The Borg Rating of Perceived Exertion, considered as somewhat hard to hard.
Patients randomized to control group will attend to meetings with the researcher team twice a week during the 12 weeks. At these meetings, patients will perform manual tasks, with or without the use of artistic materials, cultural programs, cooking classes and home care, without any exercise component. This CG practice will be performed in order to minimize the effects of the patient's bi- weekly commitment and displacement to the training site, to minimize the influence of the patient- researcher contact and also minimize the convivial effect among the patients themselves, which will occur in the other two groups.
Hospital Israelita Albert Einstein
São Paulo, Brazil
RECRUITINGambulatory blood pressure
Systolic, diastolic and mean blood pressure will be measured before and after 12 weeks of intervention period on intervention and control group by an automatic ambulatory blood pressure monitor (Cardios, São Paulo, Brazil).
Time frame: Change from baseline in ambulatory blood pressure at 12 weeks
Clinic blood pressure
Systolic and diastolic brachial blood pressure will be measured before and after 12 weeks of intervention period on intervention and control group by an automatic blood pressure monitor (HEM-742, Omron Healthcare, Japan).
Time frame: Change from baseline in ambulatory blood pressure at 12 weeks
Central blood pressure
Systolic and diastolic central blood pressure will be measured before and after 12 weeks of intervention period on intervention and control group by an automatic blood pressure monitor (HEM-742, Omron Healthcare, Japan).
Time frame: Change from baseline in ambulatory blood pressure at 12 weeks
Heart rate variability
Heart rate variability will be measured before and after 12 weeks of intervention period on intervention and control group by heart rate monitor (Polar, RS 800, USA).
Time frame: Change from baseline in ambulatory blood pressure at 12 weeks
Arterial stiffness
Carotid femoral pulse wave velocity will be measured before and after 12 weeks of intervention period on intervention and control group by pulse wave velocity measurement with applanation tonometry (SphygmoCor, AtCor Medical, Australia).
Time frame: Change from baseline in arterial stiffness at 12 weeks
Vascular function
Flow-meadiated dilation will be measured before and after 12 weeks of intervention period on intervention and control group by a flow mediated dilation measurement with an ultrasound image (HDI 5000 Sono CT, Philips, The Netherlands).
Time frame: Change from baseline in flow-mediated vasodilation at 12 weeks
Walking capacity
Six-minute walking test will be measured before and after 12 weeks of intervention
Time frame: Change from baseline in walking distance at 12 weeks
March in place
Two-minute step test will be measured before and after 12 weeks of intervention
Time frame: Change from baseline in the number of the steps at 12 weeks
Subjective measurement of walking capacity
Walking impairment questionnaire will be measured before and after 12 weeks of intervention
Time frame: Change from baseline in the walking impairment questionnaire score after 12 weeks
Subjective measurement of walking capacity compared to healthy subjects
Walking estimated limitation calculated by history questionnaire will be measured before and after 12 weeks of intervention
Time frame: Change from baseline in the Walking estimated limitation calculated by history questionnaire score after 12 weeks
Overall strength test
Handgrip strength test will be measured before and after 12 weeks of intervention
Time frame: Change from baseline in kgf of the handgrip test after 12 weeks
Symptoms of intermittent claudication
The Baltimore Activity Scale for Intermittent Claudication is a questionnaire that will be measured before and after 12 weeks of intervention.
Time frame: Change from baseline in the Baltimore Activity Scale for Intermittent Claudication score after 12 weeks
General functional capacity
The Short Physical Performance Battery will be measured before and after 12 weeks of intervention.
Time frame: Change from baseline in the Short Physical Performance Battery score after 12 weeks
Specific quality of life of vascular patients
The Vascular quality of life questionnaire will be measured before and after 12 weeks of intervention.
Time frame: Change from baseline in the Vascular quality of life questionnaire score after 12 weeks
General quality of life
The World Health Organization Quality of Life questionnaire will be measured before and after 12 weeks of intervention
Time frame: Change from baseline in the World Health Organization Quality of Life score after 12 weeks
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