A Systematic Review of Exercise Prescription in Patients with Intermittent Claudication: Does Pain Matter?

Background: Current guidelines for intermittent claudication advocate exercise at moderate to maximal claudication pain. However, adherence rates to supervised exercise programmes (SEP) remain poor and claudication pain is a contributing factor. Limited evidence suggests that moderate or pain-free exercise may be just as beneficial and may be better tolerated. However, it remains unclear what ‘level’ of claudication pain is optimal for improving functional outcomes. We therefore conducted a systematic review to synthesise the evidence for exercise prescribed at different levels of claudication pain. Methods: The CENTRAL, MEDLINE, Embase and CINAHL databases were searched up to October 2020. Randomized controlled trials (RCTs) that directly compared at least 2 different intensities of claudication pain were included. Outcome measures included walking performance, adherence, quality of life and vascular function. Results: Of 1,543 search results, 2 studies were included. Maximal walking distance improved by 100–128% in the moderate-pain SEP groups, and by 77–90% in the pain-free SEP groups. Importantly, there were no significant differences between the moderate-pain and pain-free SEP groups in either study for improvements in walking performance, though comparison to a maximal-pain SEP group was not made. Conclusions: The efficacy of SEPs for patients with intermittent claudication is irrefutable, though there is no consensus on the optimal level of pain. Therefore, adequately powered RCTs are required to compare the effect of pain-free SEPs, moderate-pain SEPs and maximal-pain SEPs on functional outcomes. (PROSPERO ID: CRD42020213684)

A systematic review of exercise intervention reporting quality and dose in studies of intermittent claudication

Background: Exercise therapy is an important treatment option for people with intermittent claudication (IC). Appropriate reporting of exercise interventions in populations with IC within randomised controlled trials (RCTs) is important to ensure that research can be translated into clinical practice. Therefore, the purpose of our review is to evaluate the reporting of exercise interventions in RCTs of exercise therapy in patients with IC. Methods: A systematic search was performed to identify relevant trials in patients with IC published until May 2020. Studies including only participants with critical-limb ischemia or asymptomatic peripheral artery disease were excluded. Each trial was scored using the recently developed ‘Consensus on Exercise Reporting Template’ (CERT) which has a maximum obtainable score of 19. Results: Of 1489 unique records identified from the search, 73 trials were included reporting 107 exercise interventions. Overall, the average CERT score was 10/19. The exercise equipment used, the use of supervision and a description of whether the exercise prescription was tailored or generic were the most frequently reported intervention components. The motivational strategies used, intervention adherence, and intervention fidelity were the most under reported CERT components. There was no trend indicating that CERT scores were higher in more recent publications. Conclusions: We have identified that important details about exercise interventions are frequently missing from the published literature. These missing data hinder replication of research findings and limit the translation of evidence into clinical practice

A systematic review of exercise testing in patients with intermittent claudication: A focus on test standardisation and reporting quality in randomised controlled trials of exercise interventions

A systematic review was conducted to identify the range of terminology used in studies to describe maximum walking distance and the exercise testing protocols, and testing modalities used to measure it in patients with intermittent claudication. A secondary aim was to assess the implementation and reporting of the exercise testing protocols. CINAHL, Medline, EMBASE and Cochrane CENTRAL databases were searched. Randomised controlled trials whereby patients with intermittent claudication were randomised to an exercise intervention were included. The terminology used to describe maximal walking distance was recorded, as was the modality and protocol used to measure it. The implementation and reporting quality was also assessed using pre-specified criteria. Sixty-four trials were included in this review. Maximal walking distance was reported using fourteen different terminologies. Twenty-two different treadmill protocols and three different corridor tests were employed to assess maximal walking distance. No single trial satisfied all the implementation and reporting criteria for an exercise testing protocol. Evidence shows that between-study interpretation is difficult given the heterogenous nature of the exercise testing protocols, test endpoints and terminology used to describe maximal walking distance. This is further compounded by poor test reporting and implementation across studies. Comprehensive guidelines need to be provided to enable a standardised approach to exercise testing in patients with intermittent claudication

Integrating patients with intermittent claudication into an established cardiac rehabilitation programme: a feasibility study with embedded pilot

The Excel spreadsheet contains the raw data for the research project “Integrating patients with intermittent claudication into an established cardiac rehabilitation programme: a feasibility study with embedded pilot.”This study aimed to assess the feasibility of integrating patients with intermittent claudication (IC) into an established Cardiac Rehabilitation Programme (CRP), and to evaluate trial procedures, and to collect pilot data to guide the methodology for a future randomised control trial (RCT).A prospective, non-randomised controlled trial was conducted using two NHS hospitals. Feasibility was evaluated using a mixed methods approach, with quantitative measures including eligibility, consent, adherence, and adverse event rates, and qualitative interviews and focus groups assessed the acceptability among patients and service providers. Descriptive statistics, and thematic analysis was used to analyse the data.People with symptomatic peripheral artery disease (PAD) were considered for inclusion if they were aged 18 or over, diagnosed with PAD within the past 12 months, and had not had previous treatment for PAD. People with coronary artery disease (CAD) were considered for inclusion if they were aged 18 or over, diagnosed with CAD in the past 12 months, and had no previous diagnosis of PAD. Of eligible IC patients referred to the integrated CRP, 24% (n=17) consented to participate in the trial. A total of 10 IC and CAD patients from the integrated CRP, and 10 CRP staff members took part in the qualitative component of the study.Participants diagnosed with PAD were referred to either an IC only rehabilitation programme or a novel integrated cardiovascular rehabilitation programme (CRP). Both programmes consisted of once-a-week session for twelve weeks incorporating exercise and educations.The spreadsheet includes (on separate tabs):Participant demographicsParticipant anthropometricsParticipant activity dataExercise test resultsQuality of life questionnairesThere is a separate Word document which provides an overview of the individual tabs and details about abbreviations used.This project did not recieve any funding and was part of a Professional Doctorate.</p

The Effects of Exercise Prescribed at Different Levels of Claudication Pain on Walking Performance in Patients with Intermittent Claudication: A Protocol for a Randomised Controlled Trial

Peripheral artery disease affects over 236 million people globally and the classic symptom is intermittent claudication (IC) which is associated with reduction in physical activity. The evidence that supervised exercise programmes (SEPs) improve pain-free and maximal walking distance is irrefutable. However, adherence rates are low with exercise-related pain cited as a contributing factor. National and international guidelines recommend exercising at a moderate to maximal level of claudication pain to improve walking ability; however, exercising pain-free or at mild claudication pain has been shown to achieve this outcome. There is limited evidence that compares the relative effects of exercise prescribed at different levels of claudication pain. The objective of this study is to directly compare the effects of exercise prescribed at three different levels of claudication pain on walking performance. This study will be a single-centre randomised controlled trial. Based on an power calculation, 51 patients with IC will be allocated to 24 weeks of twice-weekly pain-free (PF), moderate pain (MOD-P) or maximal pain (MAX-P) exercise. The PF group will cease exercise at the onset of claudication (1 on the 0-4 IC rating scale), the MOD-P group will stop once moderate pain is reached (2 on the rating scale) and the MAX-P group will stop once maximal pain is reached (4 on the rating scale). Outcome measures will be assessed at baseline, 12 and 24 weeks adopting an analysis of covariance (ANCOVA) to compare MWD across three time points. The primary outcome for the trial will be change in maximal treadmill walking distance at 12 and 24 weeks. Trial registration number: NCT04370327

Effects of exercise prescribed at different levels of claudication pain on walking performance in patients with intermittent claudication: a protocol for a randomised controlled trial

Peripheral artery disease affects over 236 million people globally and the classic symptom is intermittent claudication (IC) which is associated with reduction in physical activity. The evidence that supervised exercise programmes (SEPs) improve pain-free and maximal walking distance is irrefutable. However, adherence rates are low with exercise-related pain cited as a contributing factor. National and international guidelines recommend exercising at a moderate to maximal level of claudication pain to improve walking ability; however, exercising pain-free or at mild claudication pain has been shown to achieve this outcome. There is limited evidence that compares the relative effects of exercise prescribed at different levels of claudication pain. The objective of this study is to directly compare the effects of exercise prescribed at three different levels of claudication pain on walking performance. This study will be a single-centre randomised controlled trial. Based on an power calculation, 51 patients with IC will be allocated to 24 weeks of twice-weekly pain-free (PF), moderate pain (MOD-P) or maximal pain (MAX-P) exercise. The PF group will cease exercise at the onset of claudication (1 on the 0-4 IC rating scale), the MOD-P group will stop once moderate pain is reached (2 on the rating scale) and the MAX-P group will stop once maximal pain is reached (4 on the rating scale). Outcome measures will be assessed at baseline, 12 and 24 weeks adopting an analysis of covariance (ANCOVA) to compare MWD across three time points. The primary outcome for the trial will be change in maximal treadmill walking distance at 12 and 24 weeks. Trial registration number: NCT04370327

Current trends in sample preparation for growth promoter and veterinary drug residue analysis

This research was part-funded under the Food Institutional Research Measure (project reference number: 06RDTAFRC479) and Food for Health Research Initiative (project reference number: 07FHRITAFRC5), which was administered under the Irish Department of Agriculture, Fisheries and Food.peer-reviewedA comprehensive review is presented on the current trends in sample preparation for isolation of veterinary drugs and growth promotors from foods. The objective of the review is to firstly give an overview of the sample preparation techniques that are applied in field. The review will focus on new techniques and technologies, which improve efficiency and coverage of residues. The underlying theme to the paper is the developments that have been made in multi-residue methods and particularly multi-class methods for residues of licensed animal health products, which have been developed in the last couple of years. The role of multi-class methods is discussed and how they can be accommodated in future residue surveillance.Department of Agriculture, Food and the Marin