Discrepancy between Angina and Ischemia Repeats in Peripheral Artery Disease

Three randomized studies showed exercising significantly improves 6-minute walk outcomes in patients with peripheral artery disease (PAD). However, many participants randomized to exercise did not perceive changes, and sometimes even got worse. 

La discrepancia entre angina e isquemia se repiten en enfermedad periférica

These findings suggest a significant discrepancy between objective and perceived change in walking ability among PAD patients.  

400 patients with peripheral artery disease randomized to exercise (n=205) vs control (n=199) completed a 6-minute walk test and a questionnaire about perceived claudication. Both tests were repeated 6 months after randomization.

Exercising improved significantly 6-minute walking distance almost 40 meters vs. baseline (p<0.001). 

Many patients perceived no improvement in walking ability after 6 months. This was true for the control group, with – 6.5 meters vs baseline (p<0.001), as opposed to the exercise group, which added 26.8 meters (p<0.001).

Another group perceived their situation had significantly worsened vs. baseline. Again, this was true for the control group, with – 27.3 meters, but not for the exercise group, with + 18.4 meters vs. baseline. 


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Having set a walking pace, PAD patients will often report no improvement at follow up, which might tilt the scales for revascularization. It seems important to be able to objectively measure walking ability at baseline and follow up to be able to make objective decisions. 

The coronaries have shown angina and ischemia do not walk hand in hand. Now peripheral vascular disease shows similar discrepancy between symptoms and objective test outcomes. 

Conclusion

Exercising significantly improves walking distance in PAD patients. However, many patients do not perceive this change, and some even feel they get worse. 

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Original Title: Perceived Versus Objective Change in Walking Ability in Peripheral Artery Disease: Results from 3 Randomized Clinical Trials of Exercise Therapy.

Reference: Mary M. McDermott et al. J Am Heart Assoc. 2021;10:e017609. DOI: 10.1161/JAHA.120.017609.


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