Trainability for cardiopulmonary fitness is low in patients with peripheral artery disease

Aims In patients with peripheral arterial disease (PAD), exercise therapy is recommended to relieve leg symptoms, as noted in the 2016 AHA/ACC and 2017 ESC/ESVS guidelines. We assessed the trainability for cardiopulmonary fitness (CPF) and quality of life (QOL); three distinct patient types, namely, PAD, heart failure (HF), and stroke, were compared. Methods and results This is a multicentre, retrospective analysis of prospectively collected data from three clinical studies. Data collected from 123 patients who completed 36 sessions of supervised aerobic training of moderate intensity were analysed, with 28 PAD, 55 HF, and 40 stroke patients totalling 123. Before and after training, cardiopulmonary exercise testing with non-invasive cardiac output monitoring and QOL evaluation using a 36-Item Short Form Survey (SF-36) were performed. Non-response was defined as a negative change in the post-training value compared with that in the pre-training value. The result showed an improvement in CPF in all three groups. However, cardiorespiratory fitness (CRF) increased by a lesser extent in the PAD group than in the HF and stroke groups; the physical and mental component scores (MCS) of SF-36 exhibited a similar pattern. Non-response rates of peak.VO2, oxygen uptake efficiency slope, and MCS were higher in the PAD group. In the PAD group, nonresponders regarding peak.VO2 had a higher pulse wave velocity than responders. Conclusion In patients with PAD following exercise therapy, CRF and QOL improved to a lesser extent on average; their non-response rate was also higher compared with that of HF or stroke patients. Therefore, a higher dose of exercise might be needed to elicit adaptation in PAD patients, especially those with high pulse wave velocity.

Automated summary

This study compared the effects of exercise training on cardiopulmonary fitness and quality of life in patients with peripheral arterial disease (PAD), heart failure (HF), and stroke. The results showed that although there was an improvement in cardiorespiratory fitness and quality of life in all three groups, the increase was smaller in PAD patients and they had a higher non-response rate, especially in terms of cardiorespiratory fitness and quality of life. Therefore, a higher dose of exercise may be needed to promote adaptation in PAD patients.