Effectiveness of a short duration program combining supervised exercises, nutritional advice and therapeutic education in patients with peripheral artery disease: A retrospective cohort study

Abstract

Objectives: Supervised exercise training (SET) for at least 3months is a cornerstone in the management of lower extremity peripheral artery disease (PAD). However, optimal duration of SET is discussed. This study aimed to evaluate the effectiveness of a short-duration program combining SET, nutritional advice and therapeutic education on maximal walking distance (MWD). Secondary objectives included assessing the impact of this program on smoking cessation, low-density lipoprotein cholesterol (LDL-c) levels, optimization of medical therapy, and to identify factors associated with MWD improvement.

Methods: We conducted a retrospective, monocentric study. Parameters assessed before and after the program included ankle-brachial index (ABI) at rest, MWD on treadmill, post-exercise ABI, and exercise transcutaneous oxygen pressure (TcPO2) using the Decrease from Rest of Oxygen Pressure (DROP). LDL-c levels, smoking status, and medical therapy were documented before and after the program.

Results: Forty-three patients (77% men, median age 67 [57-74]years) were included. The median program duration was 23.5 days [20.8-30.5], with 20.7h [16.8-25.1] of supervised physical activity. MWD increased significantly from 208m [139-294] to 251m [171-574] (P<0.001). Improvements in smoking status, LDL-c levels, and medical treatment optimization were also observed. Among all parameters, only the DROP TcPO2 before the program was significantly associated with MWD improvement (P<0.05).

Conclusion: A short-duration program effectively improved median MWD (+56% [10-159%]), cardiovascular risk management, and was associated with baseline ischemia severity. These findings support the utility of shorter combined programs and the potential value of exercise TcPO2 in selecting responsive patients.

Keywords: Ankle-brachial index; Maximal walking distance; Peripheral artery disease; Supervised exercise training; Transcutaneous oxygen pressure.