Comparison of Cardiovascular and Perceptual Responses During Guideline-Recommended and Self-Selected Intensity Exercises in Patients With Peripheral Artery Disease: A Randomized Crossover Study

Purpose:
Exercises with a self-selected intensity (SSI) have emerged as an alternative to guideline-recommended sessions to improve adherence to exercise programs. We compared the cardiovascular and perceptual responses during a walking exercise performed at SSI and in a session with intensity recommended by clinical guidelines.

Methods:
Twenty patients (mean 69.2 ± 7.7 years, 55% male, and mean ankle brachial index 0.59 ± 0.15) participated in two experimental sessions: guidelines (3−5 minutes of walking sets, 2−3 minutes of recovery, and moderate intensity by pain perception) and SSI (preferred walking speed and set duration) sessions. Blood pressure, heart rate, heart rate variability threshold, rating of perceived exertion, perception of pain, and affective response were assessed during the exercise.

Results:
Independent of time, perceived exertion (∆0.8: 95% CI, 0.1−1.5, Psession = .035) and pain (∆0.6: 95% CI, 0.3−0.9, Psession < .001) were lower, while affective responses (∆-0.8: 95% CI, - 1.5 to -0.1, Psession = .029) were higher in SSI session compared to the guideline session. Independent of time, the heart rate (∆5.5: 95% CI, 1.2−9.8 beats/min, Psession = .013) was lower in the SSI session, while blood pressure responses were similar between sessions (Psession > .05). The time spent above the heart rate variability threshold was significantly lower in the SSI session (∆4.2: 95% CI, 1.6−7.0 minutes, Pinteraction = .005).

Conclusion:
The SSI sessions promoted lower cardiovascular overload and better perceptual responses than guideline sessions in patients with symptomatic PAD.