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. 2019 Feb 7;8(2):210.
doi: 10.3390/jcm8020210.

Rehabilitative Exercise Reduced the Impact of Peripheral Artery Disease on Vascular Outcomes in Elderly Patients with Claudication: A Three-Year Single Center Retrospective Study

Fabio Manfredini  1   2   3 , Nicola Lamberti  4 , Franco Guerzoni  5 , Nicola Napoli  6 , Vincenzo Gasbarro  7 , Paolo Zamboni  8 , Francesco Mascoli  9 , Roberto Manfredini  10   11 , Nino Basaglia  12 , María Aurora Rodríguez-Borrego  13 , Pablo Jesús López-Soto  14
Affiliations

Rehabilitative Exercise Reduced the Impact of Peripheral Artery Disease on Vascular Outcomes in Elderly Patients with Claudication: A Three-Year Single Center Retrospective Study

Fabio Manfredini et al. J Clin Med. .

Abstract

The study retrospectively evaluated the association between rehabilitative outcomes and risk of peripheral revascularizations in elderly peripheral artery disease (PAD) patients with claudication. Eight-hundred thirty-five patients were enrolled. Ankle-brachial index (ABI) and maximal walking speed (Smax) were measured at baseline and at discharge from a structured home-based rehabilitation program. For the analysis, patients were divided according to a baseline ABI value (severe: ≤0.5; moderate: ≥0.5) and according to hemodynamic or functional rehabilitative response (responder: ABI ≥0.10 and/or Smax >0.5 km/h). Three-year outcomes were collected from the regional registry. According to the inclusion criteria (age 60⁻80, ABI <0.80; program completion) 457 patients, 146 severe and 311 moderate, were studied. The whole population showed significant functional and hemodynamic improvements at discharge, with 56 revascularizations and 69 deaths at follow-up. Compared to the moderate group, the severe group showed a higher rate of revascularizations (17% vs. 10%, p < 0.001) and deaths (29% and 8%, respectively; p < 0.001). However, patients with severe PAD who were ABI responders after rehabilitation showed less revascularizations than non-responders (13% vs. 21%; hazard ratio (HR): 0.52) and were not different from patients with moderate disease (9%). Superimposable rates were observed for Smax responders (13% vs. 21%; HR: 0.55; moderate 10%). In conclusion, elderly patients with severe PAD empowered by better rehabilitation outcomes showed lower rates of peripheral revascularizations and deaths that were comparable to patients with moderate PAD.

Keywords: exercise; mortality; peripheral artery disease; rehabilitation; vascular surgical procedures.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagrams of participants. Abbreviations: PAD, peripheral artery disease; ABI, ankle-brachial index.
Figure 2
Figure 2
Kaplan-Meier curves of revascularizations in the four patients’ subgroups according to disease severity and ABI (A), or maximal speed improvements (B), or both (C).
Figure 3
Figure 3
Kaplan-Meier curves of survival in the four patients’ subgroups according to disease severity and ABI (A), or maximal speed improvements (B).
Figure 4
Figure 4
Forest plot showing association between PAD-related revascularizations and study variables in the whole population.
See this image and copyright information in PMC

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