Influence of Changes in Sedentary Time on Outcomes of Supervised Exercise Therapy in Individuals with Comorbid Peripheral Artery Disease and Type 2 Diabetes

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Background: Although supervised exercise therapy (SET) is effective in improving walking distance among adults with symptomatic peripheral artery disease (PAD), some research suggests that individuals with comorbid PAD and type 2 diabetes mellitus (T2DM) may experience a blunted response to SET. It is unknown whether free-living sedentary time changes during SET, and if increases in sedentary time could, in part, explain poor response to SET. The purposes of this pilot study were to (1) determine if older adults with PAD (with and without T2DM) engaging in SET change their sedentary behavior and (2) examine the relationship between changes in sedentary behavior and SET outcomes. We hypothesized that decreased sedentary time during SET would be associated with greater improvements in six-minute walk test (6MWT) total distance and other key SET outcomes. Methods: Participants (n = 44) initiating a 12-week SET program completed the 6MWT, Short Physical Performance Battery, Walking Impairment Questionnaire, and accelerometer-assessed sedentary behavior at SET initiation, 6 weeks, and 12 weeks. Results: Participants’ mean age was 72.3 (7.1) years, mean ankle-brachial index was 0.71 (0.25), and 47.7% were female. On average, sedentary time did not change after SET, although there was substantial variability (−40% to +38% change in minutes of sedentary time/day). Participants with T2DM experienced greater improvements in claudication onset distance than participants without T2DM (mean = 35 m, P = 0.044, 95% confidence interval = 1.6 to 115.4 m). Neither changes in sedentary time from baseline to 6 weeks (P = 0.419) nor T2DM (P = 0.154) predicted changes in 6MWT total distance from baseline to 12 weeks. Conclusions: As SET availability increases, further examination of factors that may influence SET outcomes will help maximize benefits of this proven therapy.

Original languageEnglish (US)
Pages (from-to)369-383
Number of pages15
JournalAnnals of Vascular Surgery
StatePublished - Oct 2020

Bibliographical note

Funding Information:
Dr. Whipple was a 2015–2017 National Hartford Center of Gerontological Nursing Excellence (NHCGNE) Patricia G. Archbold Scholar. The Patricia G. Archbold Scholar program is supported by a grant to the Gerontological Society of America (GSA)/NHCGNE from the John A. Hartford Foundation. This publication was made possible by a dissertation research grant from the Midwest Nursing Research Society , by the National Institute of Nursing Research (NINR) , National Institutes of Health (NIH) under a Ruth L. Kirschstein National Research Service Award (F31NR016614, PI Whipple), by the National Institute of Aging (NIA), NIH (T32AG000279, PI Schwartz), and by the National Center for Advancing Translational Sciences (NCATS), NIH (UL1TR002494, PI Blazar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© 2020 Elsevier Inc.


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