Exercise and fitness technologies to improve outcomes for vascular patients

Abstract

Cardiovascular disease is the leading cause of premature death worldwide. Physical inactivity is a major risk factor but methods to address this are not well-defined. Abdominal aortic aneurysm (AAA) and peripheral arterial disease (PAD) are the two most common conditions represent a great burden of vascular disease. Exercise should improve outcomes in AAA but are yet to become an established part of management. Supervised Exercise Training (SET) is established in the treatment of PAD but provisions are poor. This thesis aimed to provide new evidence for exercise interventions, with or without the use of fitness technologies, in AAA and PAD. It is comprised of four main projects: An analysis of 19 years of outcome data for patients on AAA surveillance to establish the risks, and time available to influence them. A randomised controlled trial (RCT) of 24-week, patient-directed, community-based exercise to investigate its impact on fitness in a AAA population. A UK-wide audit of SET provisions for patients with PAD. A pilot RCT of the novel intervention REmotely SuPervised Exercise Training (RESPECT) to assess its acceptability and impact on functional walking distances in the PAD population. The results have demonstrated that patients on AAA surveillance are more likely to die of non-AAA related causes, primarily cardiovascular events, than undergo AAA repair. Longer duration community-based exercise does improve those measures of fitness related to impaired short and long-term survival after AAA repair. Only 6.8% of UK Vascular Centres offer NICE-compliant SET for all of their patients. RESPECT is acceptable to a PAD population and could offer a more-easily delivered form of exercise therapy. In conclusion, the use of exercise and fitness technologies has the potential to make major changes to clinical practice which should lead to improved outcomes for patients with vascular disease. There is now evidence to support definitive, multicentre RCTs of the interventions trialled in this thesis.

Date of Award	1 Aug 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Charles Mccollum (Supervisor) & Nicholas Wisely (Supervisor)