Long-term effects of supervised exercise in peripheral artery disease, associated risk factors, and physical fitness

• Autor(a) principal: Machado, Isabel Maria Luís
• Data de Publicação: 2023
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10348/12290
• topic: peripheral arterial disease; claudication

The respective thesis aims to investigate the chronic responses of a supervised physical exercise program that combines walking training with resistance strength exercises in claudication, physical fitness, health, and disease progression in patients with Fontaine stage II peripheral arterial disease. The first article consisted of a systematic review that aimed to investigate the effects of combined aerobic and resistance strength exercise programs on walking ability, compared to isolated aerobic exercise or usual care, in patients with claudication caused by peripheral arterial disease. The review included seven studies with a total of 337 participants. The results demonstrated that combined aerobic and strength exercise was effective in improving walking ability compared to usual care. In addition to the improvements observed in walking ability, combined exercise may also show improvements in other indicators. In this context, the intervention program - PASSUS saudáveis na doença arterial periférica - was designed, resulting in the second and third articles that demonstrate the effect of a six-month intervention of a supervised exercise program, that included treadmill walking and three resistance strength exercises for the lower limbs, performed three times a week for approximately one hour for each session. The studies reported improvements in walking ability, overall and segmental body composition of the lower limbs, walking speed, lower limb and back mobility, as well as a reduction in subjective perception of effort and heart rate during exercise. To the best of our knowledge, this was one of the first supervised exercise programs in a hospital setting in Portugal, accompanied by a multidisciplinary team. It is worth noting that this thesis presents exercise progression strategies to address existing gaps. The fourth article aimed to understand the acute effect of exercise performed in different modes and using specific execution techniques, at a more peripheral level, namely muscle oxygen saturation in muscles important for peripheral arterial disease. In this latter study, it was possible to observe that, in an apparently healthy population, the choice of exercise mode, as well as the execution technique performed in each mode, promotes different peripheral changes, which should be taken into consideration for a more appropriate exercise prescription. Together, these studies provide a comprehensive understanding of the positive effects of a supervised exercise program that combines walking training with resistance strength exercises on various indicators of physical fitness and health. They identify new walking progression strategies, the need for personalized load progression, as well as shed light on the impact of exercise mode and technical execution on peripheral tissue changes during exercise, contributing to a more effective and personalized exercise prescription.