Exercise as it relates to Disease/Effects of upper body strength training, dynamic training and advice to train at home on peripheral arterial disease

This is a critique of the original research article Parr, B. M., Noakes, T. D., & Derman, E. W. (2009). Peripheral arterial disease and intermittent claudication: efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home. South African Medical Journal, 99(11).

What is the background to this research?
Peripheral arterial disease is quite a common circulatory issue. It involves the narrowing of arteries which in turn reduces blood flow to muscle groups around the body. Peripheral arterial disease is usually associated with intermittent claudication. Intermittent claudication is another consequence of artherosclerosis. Intermittent claudication results in individuals experiencing muscle pain and aches after mild use of the affected muscle group. The research that is being reviewed is a study of how different kinds of exercise can affect or improve cases of peripheral arterial disease and intermittent claudication. This research is important as it can assist our understanding of how to properly treat patients that are experiencing the effects of PAD and IC.

Where is the research from?
The research being reviewed comes from an original research article titled, 'Peripheral arterial disease and intermittent claudication: Efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home', and was authored by B M Parr, T D Noakes and E W Derman. T D Noakes is an author that has been involved with many articles within the field of exercise, nutrition, sport medicine and other health related topics. B M Parr has also been involved with multiple research articles involving Peripheral arterial disease. E W Derman, the director of the institute of sport and exercise medicine at the Stellenbosch university has also been involved in many research articles within the sport and exercise medicine field.

What kind of research was this?
The research conducted was a randomized controlled test. The control group for the experiment was the group advised to walk as much as they could from home without being placed in an actual program.

What did this research involve?
The research involved the participation of 30 patients that all had experience or history with PAD and IC. The participants of the trial were randomly assigned to either a strength based training program, a conventional exercise rehabilitation program or were advised to walk as much as possible from home. Over 6 weeks results were recorded on any physiological improvements in the patients. Before the patients began their specified trial they were all put through a standard graded treadmill test and a 6 minute walk test in order to determine certain physiological parameters such as, peak oxygen uptake, maximal walking distance, pain free walking distance and perceived pain.

What were the basic results?
The results from the study found that the maximum walking distance on the graded treadmill test increased for patients that participated in the conventional exercise rehabilitation program, compared to those in the strength training program and the home advice program. Similarly the vo2 peak increased for the conventional exercise group over the strength training and home advice groups. Patients involved in the strength training program and conventional exercise program saw an increase in pain free walking distance when undertaking the 6 minute walking test after the 6 weeks. There was also a decrease in the perceived pain of the participants that were involved in the conventional exercise rehabilitation program over those participants in the other 2 programs.

What conclusions can we take from this research?
The conclusions that can be taken from the research being reviewed is that dynamic training/ conventional exercise rehabilitation programs, are much more effective in the treatment and improvement of peripheral arterial disease and intermittent claudication. The authors of the original article have provided clear evidence that this type of exercise is much more physiologically rewarding than strength training or home training advice. However in saying this, the study was undertaken over a relatively short period of time (6 weeks) and may show differing results if testing for a longer period of time such as 4-6 months. Although this could possible be the case, through the study that has been provided, adequate evidence has been shown for the efficacy of dynamic training to significantly improve physiological barriers created by PAD and IC.

Practical advice
The results from this study can easily be implicated into real world scenarios. It can provide health professionals with the information and resources on how to best treat patients that are showing signs of peripheral arterial disease and intermittent claudication. The clear evidence shown from the study in relation to strengthening physiological barriers through dynamic exercise training can give insight to individuals and allied health professionals on what to avoid and how to achieve the greatest results for themselves or their patients. I think that study warrants individuals to seek medical assistance if they are perceiving symptoms of PAD or IC so that it can be treated properly and with the highest level of safety precautions.

Further information/resources
Some other articles that may interest anyone trying to learn more on this topic include:

1. https://www.sciencedirect.com/science/article/pii/S0741521405800400

2. https://www.ahajournals.org/doi/abs/10.1161/01.CIR.81.2.602