Alternative exercise programmes for the treatment of intermittent claudication - from unsupervised home-based walking to supervised high-intensity interval cycling

Pymer, Sean

Abstract

Supervised exercise programmes (SEP) for intermittent claudication (IC) suffer from low provision and uptake rates. As such, alternative interventions should be explored, such as home-based exercise programmes (HEP) and high-intensity interval training (HIIT). This thesis aimed to synthesise the current evidence for HEPs and provide evidence-based recommendations for practitioners. A second systematic review was performed to synthesise the evidence for HIIT, designed to inform a cohort study considering the safety, tolerability, feasibility, efficacy and acceptability of HIIT for patients with IC.

Evidence from this thesis suggests that HEPs are potentially efficacious as long as they are sufficiently structured and include appropriate; frequency (≥3x week), intensity (moderate-maximal claudication), time (20 increasing to 60 minutes) and type (walking) principles. They also need to be supported by including education, feedback, goal setting, action planning and monitoring. However, this HEP structure is currently untested, meaning further adequately powered research is required.

Evidence for HIIT was limited but suggested that low-volume, short-duration protocols were efficacious. This informed the first cohort study which identified that a large proportion of patients were unable to achieve a maximal effort cardiopulmonary exercise test, likely due to deconditioning. This meant that conventional HIIT was not feasible for these patients and as such, they were excluded, leading to a low completion rate. However, these deconditioned patients may accrue the most benefit. As such, the exclusion criteria were altered, and these patients were included and provided with a personalised, submaximal HIIT programme. A second cohort study was performed to consider the feasibility of this slightly altered programme. The findings suggest that the exclusion criteria are now appropriate and that the HIIT protocol is feasible, tolerable and acceptable, whilst also being potentially safe and efficacious. These findings should be confirmed before larger randomised trials of HIIT versus SEPs are performed.

Citation

Pymer, S. Alternative exercise programmes for the treatment of intermittent claudication - from unsupervised home-based walking to supervised high-intensity interval cycling. (Thesis). Hull York Medical School, the University of Hull and the University of York. https://hull-repository.worktribe.com/output/4223166

• Thesis Type: Thesis
• Deposit Date: May 11, 2021
• Publicly Available Date: Feb 23, 2023
• Keywords: Medicine
• Public URL: https://hull-repository.worktribe.com/output/4223166
• Additional Information: Hull York Medical School, The University of Hull and the University of York
• Award Date: Jan 1, 2021