Gait changes after supervised exercise training in patients with symptomatic lower extremity peripheral artery disease.

This study aimed to investigate the effects of supervised exercise training (SET) on walking performance and spatiotemporal gait changes in patients with symptomatic lower extremity peripheral artery disease (PAD). In this single-arm prospective nonrandomized cohort study, patients with Fontaine stage II PAD following a 3-month SET program were included. Before and after SET, a constant-load treadmill test was performed to determine the pain-free and maximal walking distances (PFWD and MWD, respectively). During this test, spatiotemporal gait parameters were assessed. The ankle-brachial index (ABI) and toe-brachial index (TBI) were also measured. Twenty-seven patients with PAD (64.0 ± 1.9 y, 74% men) were included. Following SET, the PFWD (+68%; p = 0.001) and MWD (+79%; p ⩽ 0.001) significantly increased. The ABI and TBI did not change significantly. Following SET, the stride duration, stride frequency, stride length, and double support phase duration did not change significantly. In contrast, subphases of stance showed significant changes: the loading response (+8%; p = 0.03) and foot-flat (+2%; p = 0.01) phases were significantly longer, whereas the push-off phase (-7%; p = 0.002) was significantly shorter. A significant positive correlation was found between changes in the foot-flat phase and changes in PFWD (r = 0.43, p = 0.03). A significant negative correlation was found between changes in the push-off phase and changes in PFWD (r = -0.39, p = 0.05). No significant correlations were found between changes in relative durations of the subphases of stance and MWD. These results indicate that changes in temporal gait parameters during the foot contact phase potentially constitute an underlying mechanism of delayed claudication distance in patients with symptomatic PAD.

Effect of bilateral lower limb strengthening exercise on balance and walking in hemiparetic patients after stroke: a randomized controlled trial.

[Purpose] To evaluate the effect of bilateral lower limb strengthening designed to improve balance and walking in stroke patients. [Subjects and Methods] Twenty hemiparetic stroke patients were divided into two groups: a unilateral therapy group (UTG) (n=10) and a bilateral therapy group (BTG) (n=10). The UTG completed strength training only in the paretic lower limb. The BTG completed strength training in the paretic and non-paretic lower limbs. Assessment tools included the functional reach test (FRT), the Berg balance scale (BBS), the timed up and go (TUG) test, and a 10-meter walk test (10MWT). [Results] In both groups, the lower limb strengthening exercise for balance and walking significantly improved the FRT, BBS, TUG, and 10MWT scores. Compared with UTG, the BTG attained significantly improved FRT and BBS scores. [Conclusion] Bilateral therapy using this lower limb strengthening exercise effectively promotes balance in hemiparetic stroke patients.

A SIX-WEEK SUPERVISED EXERCISE AND EDUCATIONAL INTERVENTION AFTER TOTAL HIP ARTHROPLASTY: A CASE SERIES.

BACKGROUND AND PURPOSE: Most rehabilitation interventions after total hip arthroplasty (THA) are not designed to return patients to high-levels of physical activity and, thus, low levels of physical activity and residual weakness are common. The purpose of this case series was to describe the feasibility and preliminary efficacy of an exercise and education intervention for patients after THA who have already completed formal outpatient physical therapy. STUDY DESIGN: Case series. CASE DESCRIPTION: Two participants underwent unilateral THA seven (case A) or eight (case B) months prior to the intervention. Individuals participated in 18 treatment sessions that included progressive aerobic and strengthening exercises and meetings with a health coach. Change in function, strength, and self-reported physical activity were measured. Outcomes 12 months after surgery were compared to a historical cohort of patients after THA. OUTCOME: There were no adverse events during the intervention. At the end of the intervention, hip and knee strength on the surgical side increased approximately 30% compared to baseline in both cases. Activity level, and recreational performance, including walking up stairs and hiking uphill (case A), and running and golfing (case B), improved by the end of the intervention. Most changes were maintained at follow-up, although hip strength for case B decreased 27% after discharge from the intervention. Outcomes for both cases exceeded historical averages for patients 12 months after THA, with the exception of strength in case B. DISCUSSION: The exercise intervention was well tolerated and without negative effects in two participants. Both participants increased their ability to complete demanding recreational and sports-related activities, physical activity, and demonstrated improved hip abductor and knee extensor strength. Further research is needed to evaluate the implementation and effectiveness of similar interventions after THA. LEVEL OF EVIDENCE: Level 4.