Resistance exercise intervention for lower leg vascular disease

Abstract

Implementation of a resistance exercise intervention into a healthy individuals daily routine is a challenge. The individual will undergo behavioural changes and will need to adapt or change their activities of daily living to compliment the new exercise intervention. Implementing an exercise intervention into the daily routine of an individual with a chronic progressive disease, such as intermittent claudication or chronic venous insufficiency, is more challenging. Continuous coaching, motivation and encouragement are needed particularly when participation in regular exercise may elicit painful or uncomfortable symptoms. This PhD thesis aims to highlight the importance of exercise intervention for lower leg vascular disease and to perform an in-depth and extensive review of existing exercise intervention protocols and devise a new evidence-based approach testing resistance (strength) exercise intervention for this population.

The majority of individuals with moderate intermittent claudication are given the ‘Go Home and Walk Advice’ (GHWA) which is also known as usual care. The ‘Go Home and Walk Advice’ encourages the patient to participate in regular daily walking to improve pain free walking distances by reaching their claudication pain point and walking a bit further past the pain threshold. This can result in reduced motivation and exercise participation because it is unenjoyable and painful for the patient. Therefore, there is a need for an alternative form of exercise for individuals with intermittent claudication to aid in improvement of health-related quality of life and functional walking ability.

The first phase of my PhD thesis is a detailed overview of systematic reviews focusing on the effect resistance exercise has on health-related quality of life in intermittent claudication; to date there has been no overview of systematic reviews observing this topic. From this overview I found that there is a gap in the current research regarding resistance exercise training and intermittent claudication and the effect it may have on health-related quality of life. I also concluded that there is a need for additional research observing the effect of alternative forms of exercise for individuals with moderate to severe intermittent claudication.

This led to the development of a vascular specific at home structured resistance exercise programme. The Strength From Within programme is a 12 week at home structured resistance exercise programme focusing on the improvement of whole-body strength. Included with the Strength From Within programme are walking protocols, range of motion exercises, warm-up, cool down and baseline measurements. Three subsequent clinical studies explored the acceptability, feasibility and physiological impact of the exercise intervention.

“Remote Ischemic Preconditioning in the Management of Intermittent Claudication: A Pilot Randomised Controlled Trial” was the initial study completed assessing the feasibility and acceptability of the Strength From Within exercise programme for individuals with moderate intermittent claudication when compared to remote ischemic preconditioning. From this I found that resistance training has the potential to be an effective method for symptom management for individuals with moderate intermittent claudication.

This led to “The Effect and Evaluation of Structured Resistance Exercise as a Treatment Option for Moderate Intermittent Claudication: A Pilot Study.” This focuses on the uptake, feasibility and acceptability of the Strength From Within programme for individuals with moderate intermittent claudication. The main findings from this present study was that the Strength From Within programme improved pain free walking distances and overall health status in individuals with moderate intermittent claudication.

The next phase explored comparing the Strength From Within exercise programme to a supervised walking programme. From this the clinical study “The Effect of Structured Resistance Exercise versus Supervised Walking for Patients with Intermittent Claudication: A Randomised Feasibility Trial” was conducted. This study focuses on the comparison of the Strength From Within programme to supervised walking. A walking programme was designed based on the recommended guidelines, such as Go Home and Walk advice, for individuals with moderate intermittent claudication. Two of the main findings from this present study was that the Strength From Within programme elicited similar results in improvement of functional walking ability when compared to supervised walking suggesting the Strength From Within programme has the potential to be an alternative form of exercise for individuals with moderate intermittent claudication.

The third study, “The Effect of Structured Resistance Exercise for Chronic Venous Insufficiency: A Feasibility Trial” implemented the Strength From Within programme in post-surgical individuals with chronic venous insufficiency or varicose veins. This present study assessed the feasibility and acceptability of the Strength From Within programme when implemented in a different lower leg vascular disease. Isokinetic testing was administered to assess lower leg strength after participation in the 12-week Strength From Within programme. The main finding of the present study was the improvement of upper muscular strength endurance and lower body muscular strength surrounding the knee and ankle in post-surgical individuals with chronic venous insufficiency.