Peripheral arterial disease (PAD) is characterized by lower limb atherosclerosis impairing blood supply and causing walking-induced leg pain or claudication. Adherence to traditional exercise training programs is poor due to these symptoms despite exercise being a mainstay of conservative treatment. Heat therapy improves many cardiovascular health outcomes, so this study tested if this was a viable alternative cardiovascular therapy for PAD patients. Volunteers with PAD were randomized to 12 wk of heat ( n = 11; mean age 76 ± 8 yr, BMI 28.7 ± 3.5 kg/m2, 4 females) or exercise ( n = 11; 74 ± 10 yr, 28.5 ± 6.8 kg/m2, 3 females). Heat involved spa bathing at ∼39°C, 3–5 days/wk for ≤30 min, followed by ≤30 min of callisthenics. Exercise involved ≤90 min of supervised walking and gym-based exercise, 1–2 days/wk. Following the interventions, total walking distance during a 6-min walk test increased (from ∼350 m) by 41 m (95% CI: [13, 69], P = 0.006) regardless of group, and pain-free walking distance increased (from ∼170 m) by 43 m ([22, 63], P < 0.001). Systolic blood pressure was reduced more following heat (−7 mmHg, [−4, −10], P < 0.001) than following exercise (−3 mmHg, [0, −6], P = 0.078), and diastolic and mean arterial pressure decreased by 4 mmHg in both groups ( P = 0.002). There were no significant changes in blood volume, ankle-brachial index, or measures of vascular health. There were no differences in the improvement in functional or blood pressure outcomes between heat and exercise in individuals with PAD. NEW & NOTEWORTHY Heat therapy via hot-water immersion and supervised exercise both improved walking distance and resting blood pressure in peripheral arterial disease (PAD) patients over 12 wk. Adherence to heat therapy was excellent, and the heat intervention was well tolerated. The results of the current study indicate that heat therapy can improve functional ability and has potential as an effective cardiovascular conditioning tool for individuals with PAD. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/heat-therapy-vs-exercise-in-peripheral-arterial-disease/ .

Supplementary material for manuscript "Heat therapy vs. supervised exercise therapy for peripheral arterial disease: a 12-week randomized, controlled trial." AJP - Heart and Circulatory Physiology (https://doi.org/10.1152/ajpheart.00151.2019)

Purpose: To compare exercise capacity and cardiovascular response to exercise in elderly individuals with coronary artery disease (CAD) who attend ongoing community-based maintenance cardiac rehabilitation (CR) versus age- and gender-matched healthy "very active" (HVA; >= 2000 kcal/week) and healthy "less active" (HLA; <2000 kcal/week) individuals. Method: Sixty-three participants (age: 72.3 +/- 5.1 years; 62% men; n = 21 per group) completed the following assessments: (1) symptom-limited graded exercise test with expired gas analysis and bioimpedance assessment of cardiovascular function during exercise; (2) walking tests; (3) physical function; (4) anthropometry and (5) 12-month physical activity recall. Results: The CR group achieved 98% (range: 73-154%) of age- and gender-predicted peak oxygen consumption for healthy individuals. Peak oxygen consumption was lower in CR compared to HVA but not HLA group (VO2peak: CR: 19.0 +/- 4.5, HVA: 23.7 +/- 2.9, HLA: 20.7 +/- 4.7 ml center dot kg(-1)cmin(-1), p = 0.001 versus HVA; p = 0.390 versus HLA). Peak heart rate was lower in CR compared to both HVA and HLA. Walking test results and cardiovascular and physical function were not different between the groups. Conclusions: Elderly individuals with CAD participating in maintenance CR have similar exercise capacity and cardiorespiratory response to exercise compared to their age- and gender-matched less active healthy peers. The findings support referral of elderly patients to community-based CR.Implications for RehabilitationFitness benefits of long-term maintenance cardiac rehabilitation (CR) programs remain unknown.Elderly individuals with coronary artery disease participating in maintenance CR have exercise capacity and cardiorespiratory response to exercise similar to their less active healthy peers.Maintenance CR may play an important role prolonging independent living in elderly individuals.

Background Cardiac rehabilitation (CR) graduates are encouraged to attend maintenance programs to promote long-term physical activity and preserve gains in function. This study describes the characteristics, attendance and physical function of community-based maintenance CR participants, compared to primary prevention participants.Methods In this cross-sectional study, participants from two programs in New Zealand completed an interview, anthropometry, functional assessments (walking tests, chair stand test, handgrip strength), a 12-month physical activity recall, and a cardiopulmonary exercise test (subsample only). Attendance was ascertained from club records.Results Participants (n=101, 55.4% Secondary Prevention) attended 37.4 +/- 27.9% of sessions annually. Participants were predominately New Zealand-European (93.5%), retired (80.2%), married (68.3%) elderly individuals, with musculoskeletal problems (60.0%), who lived proximate to the clubs. In Secondary but not Primary Prevention participants, first-year attendance was strongly correlated with attendance in subsequent years (p<0.001). In all participants, greater attendance in the previous 12 months was significantly associated with lower waist circumference, and greater shuttle walk test duration, chair stands and balance (p<.05). Session attendance was positively correlated to peak oxygen consumption (p=0.041) in Secondary Prevention participants only.Conclusion Participation in community-based CR maintenance programs is associated with health benefits but these programs are not accessed by a diversity of patients.

Purpose: Compared with symptom-limited cardiopulmonary exercise test (CPET), timed walking tests are cheaper, well-tolerated and simpler alternative for assessing exercise capacity in coronary artery disease (CAD) patients. We developed multivariate models for predicting peak oxygen consumption (VO2peak) from 6-minute walk test (6MWT) distance and peak shuttle walk speed for elderly stable CAD patients. Methods: Fifty-eight CAD patients (72 SD 6 years, 66% men) completed: (1) CPET with expired gas analysis on a cycle ergometer, (2) incremental 10-meter shuttle walk test, (3) two 6MWTs, (4) anthropometric assessment and (5) 30-second chair stands. Linear regression models were developed for estimating VO2peak from 6MWT distance and peak shuttle walk speed as well as demographic, anthropometric and functional variables. Results: Measured VO2peak was significantly related to 6MWT distance (r = 0.719, p<0.001) and peak shuttle walk speed (r = 0.717, p<0.001). The addition of demographic (age, gender), anthropometric (height, weight, body mass index, body composition) and functional characteristics (30-second chair stands) increased the accuracy of predicting VO2peak from both 6MWT distance and peak shuttle walk speed (from 51% to 73% of VO2peak variance explained). Conclusions: Addition of demographic, anthropometric and functional characteristics improves the accuracy of VO2peak estimate based on walking tests in elderly individuals with stable CAD.

Objective. To examine long-term changes in physical function and body composition in coronary artery disease (CAD) patients participating in ongoing community-based cardiac rehabilitation (CR). Design. Thirty-four individuals (69.7±8.2 years; 79% men) participated in this longitudinal observational study. Baseline and follow-up assessments included incremental shuttle walk, short physical performance battery, handgrip strength, chair stands, body composition, last year physical activity, and CR attendance. Results. Participants attended 38.5±30.3% sessions during 1.6±0.2 year followup. A significant increase in 30-second chair stands (17.0±4.7 to 19.6±6.4, P<0.001), body weight (75.8±11.1 to 77.2±12.1 kg, P=0.001), and body fat (27.0±9.5 to 29.1±9.6%, P<0.001) and a decline in handgrip strength (36.4±9.4 to 33.0±10.6 kg·f, P<0.001) and muscle mass (40.8±5.6 to 39.3±5.8%, P<0.001) were observed during followup. There was no significant change in shuttle walk duration. CR attendance was not correlated to observed changes. Conclusions. Elderly CAD patients participating in a maintenance CR program improve lower-body muscle strength but experience a decline in handgrip strength and unfavourable changes in body composition, irrespective of CR attendance.

Background: Despite significant benefits, cardiac rehabilitation remains an underutilised intervention and long-term effects of such programs remain unknown. This study compared exercise capacity and cardiovascular function in elderly individuals with coronary artery disease (CAD) attending ongoing community-based cardiac rehabilitation (CR) versus age- and gender-matched healthy active (HA) and sedentary (HS) individuals.

Background: Short duration of outpatient cardiac rehabilitation (CR) programs, poor attendance and high drop-out rates present a challenge in examining long-term effects of CR in coronary artery disease (CAD) patients. This study examined changes in physical function and body composition over a 1.5-year follow-up in CAD patients participating in ongoing community-based CR programs.