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Background: Supervised exercise training is recommended for people with peripheral artery disease (PAD), yet it remains underutilized. Home-based exercise programs (HBEPs) are a potential alternative. The aim of this study was to assess the feasibility of conducting a full scale trial of a 12-week HBEP for people living with symptomatic PAD., Methods: In a randomized feasibility trial, patients with intermittent claudication were allocated to either an HBEP or a nonexercise control. The HBEP group was given a Fitbit to use during a 12-week exercise program comprising of personalized step goals and a resistance-based circuit to be undertaken at home twice weekly. The primary outcome was feasibility, assessed via eligibility, recruitment, attrition, tolerability, and adherence. Acceptability was assessed via semistructured interviews. Secondary analysis was undertaken to determine the feasibility of collecting clinical outcome data., Results: 188 people were screened, 133 were eligible (70.7%), 30 were recruited (22.6%) and one withdrew (3.33%). Mean adherence to the daily step goal was 53.5% (range = 29.8-90.5%), and 58.6% of prescribed circuits were completed of which 56.4% were at the desired intensity. Six adverse events were recorded, 3 of which were related to study involvement. No significant differences were observed in exploratory outcomes. Small clinically important differences were seen in walking speed and pain-free treadmill walking distance which should be confirmed or refuted in a larger trial., Conclusions: The HBEP was feasible and well tolerated, with successful recruitment and minimal attrition. The intervention was acceptable, with walking seen as more enjoyable than circuit exercise. The WALKSTRONG program may be suitable for those who will not, or cannot, take part in supervised exercise outside of the home., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Current guidelines for intermittent claudication advocate exercise at moderate to maximal claudication pain. However, adherence rates to supervised exercise programmes (SEP) remain poor and claudication pain is a contributing factor. Limited evidence suggests that moderate or pain-free exercise may be just as beneficial and may be better tolerated. However, it remains unclear what 'level' of claudication pain is optimal for improving functional outcomes. We therefore conducted a systematic review to synthesise the evidence for exercise prescribed at different levels of claudication pain., Methods: The CENTRAL, MEDLINE, Embase and CINAHL databases were searched up to October 2020. Randomized controlled trials (RCTs) that directly compared at least 2 different intensities of claudication pain were included. Outcome measures included walking performance, adherence, quality of life and vascular function., Results: Of 1,543 search results, 2 studies were included. Maximal walking distance improved by 100-128% in the moderate-pain SEP groups, and by 77-90% in the pain-free SEP groups. Importantly, there were no significant differences between the moderate-pain and pain-free SEP groups in either study for improvements in walking performance, though comparison to a maximal-pain SEP group was not made., Conclusions: The efficacy of SEPs for patients with intermittent claudication is irrefutable, though there is no consensus on the optimal level of pain. Therefore, adequately powered RCTs are required to compare the effect of pain-free SEPs, moderate-pain SEPs and maximal-pain SEPs on functional outcomes. (PROSPERO ID: CRD42020213684)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The incremental shuttle walk test (ISWT) is a standardised assessment for cardiac rehabilitation. Three studies have reported oxygen costs (VO 2 )/metabolic equivalents (METs) of the ISWT. In spite of classic representations from these studies graphically showing curvilinear VO 2 responses to incremented walking speeds, linear regression techniques (also used by the American College of Sports Medicine [ACSM]) have been used to estimate VO 2 ., Purpose: The two main aims of this study were to (i) resolve currently reported discrepancies in the ISWT VO 2 -walking speed relationship, and (ii) derive an appropriate VO 2 versus walking speed regression equation., Methods: VO 2 was measured continuously during an ISWT in 32 coronary heart disease [cardiac] rehabilitation (CHD-CR) participants and 30 age-matched controls., Results: Both CHD-CR and control group VO 2 responses were curvilinear in nature. For CHD-CR VO 2  = 4.4e 0.23 × walkingspeed (km/h) . The integrated area under the curve (iAUC) VO 2 across nine ISWT stages was greater in the CHD-CR group versus the control group (p < 0.001): CHD-CR = 423 (±86) ml·kg -1 ·min -1 ·km·h -1 ; control = 316 (±52) ml·kg -1 ·min -1 ·km·h -1 ., Conclusions: CHD-CR group vs. control VO 2 was up to 30 % greater at higher ISWT stages. The curvilinear nature of VO 2 responses during the ISWT concur with classic studies reported over 100 years. VO 2 estimates for walking using linear regression models (including the ACSM) clearly underestimate values in healthy and CHD-CR participants, and this study provides a resolution to this when the ISWT is used for CHD-CR populations.