Recreational Team Handball Programme for Patients With Peripheral Arterial Disease

Total distance covered (in meters) by each patient during 6 minutes of continuous walking will be assessed.

Distance covered until onset of claudication (in meters) will be measured in patients during 6 minutes of continuous walking.

Ankle-brachial index will be measured for each participant at rest.

The peak force (in kg) will be measured in patients using the hand-held dynamometry test.

Time taken (seconds) to perform the 5 repetitions of sitting and standing on a chair will be assessed.

At baseline, resting systolic blood pressure (mmHg) will be measured in both arms using an automated oscillometric sphygmomanometer, after 5 minutes of quiet rest, with 1 minute of recovery between readings. The arm with the higher systolic blood pressure will be identified and used for all subsequent assessments. Three consecutive measurements will be taken, with the mean of the three readings being recorded.

At baseline, resting diastolic blood pressure (mmHg) will be measured in both arms using an automated oscillometric sphygmomanometer, after 5 minutes of quiet rest, with 1 minute of recovery between readings. The arm with the higher systolic blood pressure will be identified and used for all subsequent assessments. Three consecutive measurements will be taken, with the mean of the three readings being recorded.

Gait speed (m/s) will be calculated by dividing the distance (4 metres) by the time taken to complete a straight-course walk at maximum speed.

Total cholesterol (mmol/L) will be analysed following standardised methods using commercial enzymatic test kits.

High-density lipoprotein cholesterol (mmol/L) will be analysed following standardised methods using commercial enzymatic test kits.

Low-density lipoprotein cholesterol (mmol/L) will be analysed following standardised methods using commercial enzymatic test kits.

Triglycerides (mmol/L) will be analysed following standardised methods using commercial enzymatic test kits.

Glycosylated hemoglobin (%) will be analysed following standardised methods using commercial enzymatic test kits.

Plasma interleukin-6 (pg/mL) will be analysed following standardised methods using commercial enzymatic test kits.

Number of heart beats per minute, measured by heart rate monitors.

Maximum oxygen consumption (mL/kg/min) will be determined by pulmonary gas exchange measurements during a maximal incremented exercise test in a cycle ergometer.

Determined by measuring stature (cm) and body mass(kg) and thereafter dividing the body mass by the square of the stature in metres (kg/m2) of each patient.

Bone mineral density (g / cm2 - grams of bone mineral content per area or analyzed bone cm2) will be measured by Dual Energy X-ray Absorptiometry.

Bone mineral content (grams) will be measured by Dual Energy X-ray Absorptiometry.

Lean mass (grams) will be measured by Dual Energy X-ray Absorptiometry.

Body fat (%) will be measured by Dual Energy X-ray Absorptiometry.

Body mass (kg) will be measured by Dual Energy X-ray Absorptiometry.

Health-related quality of life will be measured using the 36-Item Short-Form Health Survey (SF-36).

Mental health domain will be measured using the 9-item patient health questionnaire (PHQ-9).

Physical activity levels will be measured utilizing the international physical activity questionnaire short form.

Patient-reported walking ability will be assessed using the Walking Impairment Questionnaire (WIQ), that comprises 3 subscales: walking distance, walking speed, and ability to climb stairs.

Patient motivation to exercise will be assessed using the Behavioural Regulation in Exercise Questionnaire-3 (BREQ-3).

Mean relative heart rate (%HRmax) will be measured for every participant in the treatment group during each training session of the exercise programme.

Mean absolute heart rate (bpm) will be measured for every participant in the treatment group during each training session of the exercise programme.

Differential ratings of perceived exertion (0-10) will be measured for every participant in the treatment group during each training session of the exercise programme. Higher scores indicate greater perceived exertion.

Fun scores (0-10) using a visual analog scale will be measured for every participant in the treatment group during each training session of the exercise programme. Higher scores indicate greater enjoyment.

Blood lactate values (mmol/L) measurements during 4 training sessions will be performed for every participant in the treatment group of the exercise programme

The number of accelerations performed during each training session by every participant in the treatment group of the exercise programme will be measured.

Decelerations (m/s²) performed during each training session by every participant in the treatment group of the exercise programme will be measured

Ankle-brachial index (ABI) will be measured for each participant immediately following the graded treadmill test performed according to the Gardner-Skinner protocol, using the same standardised procedures as the resting ABI assessment.

Skeletal muscle oxygen saturation (StO₂) will be assessed non-invasively using near-infrared spectroscopy (NIRS) positioned over the medial head of the gastrocnemius muscle of the most symptomatic lower limb. StO₂ will be analysed at rest and continuously throughout the graded treadmill test.

Time (in seconds) required to rise from a chair, walk 3 metres, turn, and return to a seated position will be assessed using the timed up and go test.

Fasting blood glucose (mmol/L) will be measured from venous blood samples collected and analysed using automated analysers following standardised methods.

Total distance covered (meters) during each training session by every participant in the treatment group of the exercise programme will be measured.

Claudication pain experienced during each session will be assessed using the Intermittent Claudication Pain Scale (0-4). Participants will rate their perceived claudication pain at the end of each of the three periods.

Falls that occur during each training session by any participant in the treatment group of the exercise programme will be reported

Disease-specific health status reported by the patients will be assessed using Peripheral artery questionnaire (PAQ).

Plasma insulin (µIU/mL) will be measured from venous blood samples collected and analysed using automated analysers following standardised methods.

Peak relative heart rate (%HRmax) will be measured for every participant in the treatment group during each training session of the exercise programme.

Peak absolute heart rate (bpm) will be measured for every participant in the treatment group during each training session of the exercise programme.

Maximal number of repetitions performed of sitting and standing on a chair during 30 seconds will be assessed.

Smoking status will be classified into three categories: current smoker, former smoker, and never smoker. Participants will self-report their smoking history at each assessment timepoint.

Current smokers will self-report the average number of cigarettes smoked per day over the previous week at each assessment timepoint.

Distance (in metres) at which the patient first reports onset of claudication pain during the graded treadmill test performed according to the Gardner-Skinner protocol will be recorded.

Total distance covered (in metres) at which the patient reaches maximal tolerable claudication pain and is unable to continue walking during the graded treadmill test performed according to the Gardner-Skinner protocol will be recorded.

Dynamic balance will be assessed using the Four Square Step Test (FSST). Participants will step forward, sideways, and backward over two canes placed in a cross pattern on the floor, completing a full sequence in both clockwise and counterclockwise directions as fast as possible. The time (in seconds) to complete the test will be recorded.

Static balance will be assessed using the Single Leg Stance Test (SLST). Participants will be instructed to stand on one leg with hands placed on the hips and eyes open during 60 seconds. Timing begins when the raised foot leaves the ground and stops when the foot touches the ground or the hands leave the hips. The time (in seconds) achieved on the preferentiallower limb will be reported.