2016, Number 1
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CorSalud 2016; 8 (1)
Physical rehabilitation training program for peripheral artery disease in patients with ischemic heart disease
Negrín VT, Lage LLM, Hernández TC, Castellanos GL, Fardales RR, Santos PA, Valero HA
Language: Spanish
References: 43
Page: 29-37
PDF size: 299.10 Kb.
ABSTRACT
Introduction: The ankle-brachial index provides a simple method to diagnose peripheral artery disease; its use allows identifying patients with intermittent laudication of the lower limbs who do not successfully complete a cardiovascular stress test, which hinders their inclusion in rehabilitation programs.
Objective: To design a comprehensive rehabilitation program for patients with peripheral
artery disease and ischemic heart disease.
Method: An observational, descriptive, prospective and longitudinal study was carried out with 28 patients after an acute coronary syndrome and peripheral artery
disease. A training program was designed and after a three months follow up results were compared with those at the beginning of the investigation.
Results: Male predominance (67.8%), 17 of them (60.7%) had an ankle-brachial index less than 0.9 (p=0.002). The most affected age group was 55-59 years (35.7%). The primary diagnosis was acute coronary syndrome with ST segment elevation (42.85%). The most common risk factor was hypertriglyceridemia (82.1%). Smoking (75%; p=0.005) and diabetes mellitus (28.6%; p=0.001) were significantly associated with a ITB ≤ 0,9. After three months of supervised physical activity, the ankle-brachial index improved and increased time on exercise (4:21
vs. 10:9 minutes) and onset of pain (2:31
vs. 7:6 minutes).
Conclusions: The introduction of supervised training programs for peripheral artery disease improves functional capacity of patients and their comprehensive
evaluation, which favors joining cardiovascular rehabilitation programs.
REFERENCES
European Stroke Organization, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2851-906.
Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, et al. Guía de práctica clínica de la ESC sobre diagnóstico y tratamiento de las enfermedades arteriales periféricas. Rev Esp Cardiol. 2012;65:172.e1-57.
Kannel WB, McGee DL. Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc. 1985;33:13- 8.
Korhonen P, Kautiainen H, Aarnio P. Pulse pressure and subclinical peripheral artery disease. J Hum Hypertens. 2014;28:242-5.
Andreozzi GM, Arosio E, Martini R, Verlato F, Visonà A. Consensus document on intermittent claudication from the Central European Vascular Forum 1st edition - Abano Terme (Italy) - May 2005 2nd revision - Portroz (Slovenia) September 2007. Int Angiol. 2008;27:93-113.
Mancera-Romero J, Rodríguez-Morata A, SánchezChaparro MA, Sánchez-Pérez M, Paniagua-Gómez F, Hidalgo-Conde A, et al. Role of an intermittent claudication questionnaire for the diagnosis of PAD in ambulatory patients with type 2 diabetes. Int Angiol. 2013;32:512-7.
Achterberg S, Soedamah-Muthu SS, Cramer MJ, Kappelle LJ, van der Graaf Y, Algra A, et al. Prognostic value of the Rose questionnaire: a validation with future coronary events in the SMART study. Eur J Prev Cardiol. 2012;19:5-14.
Loprinzi PD, Abbott K. Association of diabetic peripheral arterial disease and objectively-measured physical activity: NHANES 2003-2004. J Diabetes Metab Disord. 2014;13:63. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4 070082/pdf/2251-6581-13-63.pdf
Wendel-Vos GC, Dutman AE, Verschuren WM, Ronckers ET, Ament A, van Assema P, et al. Lifestyle factors of a five-year community-intervention program: the Hartslag Limburg intervention. Am J Prev Med. 2009;37:50-6.
Valdés Ramos ER, Espinosa Benítez Y. Factores de riesgo asociados con la aparición de enfermedad arterial periférica en personas con diabetes mellitus tipo 2. Rev Cubana Med [Internet]. 2013 [citado 23 Ago 2015];52:4-13. Disponible en: http://www.bvs.sld.cu/revistas/med/vol52_1_13/ med02113.htm
Momsen AH, Jensen MB, Norager CB, Madsen MR, Vestersgaard-Andersen T, Lindholt JS, et al. Drug therapy for improving walking distance in intermittent claudication: a systematic review and meta-analysis of robust randomised controlled studies. Eur J Vasc Endovasc Surg. 2009;38:463-74.
Siablis D, Karnabatidis D, Katsanos K, Diamantopoulos A, Spiliopoulos S, Kagadis GC, et al. Infrapopliteal application of sirolimus-eluting versus bare metal stents for critical limb ischemia: analysis of long-term angiographic and clinical outcome. J Vasc Interv Radiol. 2009;20:1141-50.
Hooi JD, Stoffers HE, Kester AD, van RJ, Knottnerus JA. Peripheral arterial occlusive disease: prognostic value of signs, symptoms, and the ankle-brachial pressure index. Med Decis Making. 2002;22:99-107.
Lahoz C, Mostaza JM. La aterosclerosis como enfermedad sistémica. Rev Esp Cardiol. 2007;60:184- 95.
Vavra AK, Kibbe MR. Women and peripheral arterial disease. Womens Health (Lond Engl). 2009;5:669-83.
Ministerio de Salud Pública. Anuario Estadístico de Salud 2014. La Habana: Dirección Nacional de Registros Médicos y Estadísticas de Salud; 2015.
Guindo J, Martínez-Ruiz MD, Gusi G, Punti J, Bermúdez P, Martínez-Rubio A. Métodos diagnósticos de la enfermedad arterial periférica. Importancia del índice tobillo-brazo como técnica de criba. Rev Esp Cardiol. 2009;9:D11-7.
Abramson BL, Huckell V, Anand S, Forbes T, Gupta A, Harris K, et al. Canadian Cardiovascular Society Consensus Conference: peripheral arterial disease-executive summary. Can J Cardiol. 2005;21:997-1006.
Schroder F, Diehm N, Kareem S, Ames M, Pira A, Zwettler U, et al. A modified calculation of anklebrachial pressure index is far more sensitive in the detection of peripheral arterial disease. J Vasc Surg. 2006;44:531-6.
Stein R, Hriljac I, Halperin JL, Gustavson SM, Teodorescu V, Olin JW. Limitation of the resting ankle-brachial index in symptomatic patients with peripheral arterial disease. Vasc Med. 2006;11:29- 33.
McDermott MM, Liu K, Criqui MH, Ruth K, Goff D, Saad MF, et al. Ankle-brachial index and subclinical cardiac and carotid disease. The multiethnic study of atherosclerosis. Am J Epidemiol. 2005;162:33-41.
Espinola-Klein C, Rupprecht HJ, Bickel C, Lackner K, Savvidis S, Messow CM, et al. Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. Circulation. 2008;118:961-7.
Ouwendijk R, De Vries M, Stijnen T, Pattynama PM, Van Sambeek MR, Buth J, et al. Multicenter randomized controlled trial of the costs and effects of noninvasive diagnostic imaging in patients with peripheral arterial disease: the DIPAD trial. AJR. 2008;190:1349-57.
Bendermacher BL, Willigendael EM, Teijink JA, Prins MH. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev. 2006; (2):CD005263. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/14651 858.CD005263.pub2/epdf
Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47:1239-312.
Watson L, Ellis B, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2008;(4):CD000990. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/14651 858.CD000990.pub2/epdf
Stramba-Badiale M, Fox KM, Priori SG, Collins P, Daly C, Graham I, et al. Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology. Eur Heart J. 2006;27:994-1005.
Fowkes FG, Housley E, Riemersma RA, Macintyre CC, Cawood EH, Prescott RJ, et al. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol. 1992;135: 331-40.
Criqui MH. Peripheral artery disease - epidemiological aspects. Vasc Med. 2001;6(Suppl 1):3-7.
Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, et al. Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality. A meta-analysis. JAMA. 2008;300:197- 208.
Rodríguez Perón JM, Mora SR, Acosta Cabrera E, Menéndez López JR. Repercusión negativa del tabaquismo en la evolución clínica de la enfermedad cardiovascular aterosclerótica. Rev Cub Med Mil. 2004 [citado 15 Sep 2015];33. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext& pid=S0138- 65572004000200004&lng=es&nrm=iso&tlng=es
Dorado Morales G, Varela Martínez IJ, Cepero Guedes A, Barreiro Alberdi O. Hábito de fumar y alcoholismo en un consultorio médico. Rev Cubana Enfermer [Internet]. 2003 [citado 15 Sep 2015]; 19: Disponible en: http://scielo.sld.cu/scielo.php?pid=S0864- 03192003000200004&script=sci_arttext
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35(Suppl 1):S64-71.
American Diabetes Association. Standards of medical care in diabetes - 2009. Diabetes Care. 2009;32:513-6.
Jiménez Navarrete MF. Diabetes mellitus: actualización. Acta Méd Costarric. 2000;42:53-65.
Rydén L, Grant P, Anker S, Berne C, Cosentino F, Danchin N, et al. ESC Guidelines on diabetes, prediabetes, and cardiovascular diseases developed in collaboration with the EASD. The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34: 3035-87.
Killewich LA, Macko RF, Montgomery PS, Wiley LA, Gardner AW. Exercise training enhances endogenous fibrinolysis in peripheral arterial disease. J Vasc Surg. 2004;40:741-5.
McGuigan MR, Bronks R, Newton RU, Sharman MJ, Graham JC, Cody DV, et al. Resistance training in patients with peripheral arterial disease: Effects on myosin isoforms, fiber type distribution, and capillary supply to skeletal muscle. J Gerontol A Biol Sci Med Sci. 2001;56:B302-10.
Brendle DC, Joseph LJ, Corretti MC, Gardner AW, Katzel LI. Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheral arterial disease. Am J Cardiol. 2001;87:324-9.
Comerota AJ, Throm RC, Kelly P, Jaff M. Tissue (muscle) oxygen saturation (StO2): a new measure of symptomatic lower-extremity arterial disease. J Vasc Surg. 2003;38:724-9.
Hou XY, Green S, Askew CD, Barker G, Green A, Walker PJ. Skeletal muscle mitochondrial ATP production rate and walking performance in peripheral arterial disease. Clin Physiol Funct Imaging. 2002:22:226-32.
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S): S5-67.
White C. Intermittent claudication. N Engl J Med. 2007;356:1241-50.