title: Hydrotherapy of patients with intermittent claudication: a novel approach to improve systolic ankle pressure and reduce symptoms.
abstract: OBJECTIVE
  To study the effects of alternating cold and hot water therapy on walking ability and systolic blood pressure in claudicants.
  
  
  METHODS
  A prospective case study with repeated measurements before and 1, 4 and 12 months after treatment. The systolic blood pressure levels were measured with an occlusion cuff for brachial and ankle and with a strain gauge for the first toe.
  
  
  METHODS
  Twenty consecutively included patients, 11 women and 9 men; mean age 73.9 yrs, with intermittent claudication according to clinical examination and ankle-arm systolic blood pressure (AAI) below 0.90.
  
  
  METHODS
  Alternate hot and cold hydrotherapy of the legs were given at ten 25-minute treatments during a three-week period. The outcome measures were maximal walking ability (MW), walking ability before pain (PW) and systolic blood pressures of toe, ankle, arm and AAI.
  
  
  RESULTS
  Fourteen patients (70%) reported reduced pain after treatment and their PW increased from 134 +/- 29 m to 415 +/- 119 m 12 months later (p < 0.05) and the MW in the total group increased form 348 +/- 75 m to 523 +/- 103 m. Systolic blood pressure increased in right ankle and toe one month after treatment in the total group. Among those who reported improved walking ability one year after treatment, systolic blood pressure in both right and left ankles and toes increased; e.g. right toe increasing from 72 +/- 7 to 86 +/- 2 (p < 0.001). Improvements of systolic blood pressure in left and right leg and changes of walking ability were correlated, in the order of 0.60 to 0.81, p < 0.05.
  
  
  CONCLUSIONS
  Showering the legs of claudicants improved walking ability and blood pressures which sustained up to 1-year later. This therapy might be an additional alternative to conservative treatment of intermittent claudication.
authors.affiliation: University of Lund, Malmö General Hospital, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Elmståhl
authors.forename: B
authors.initials: B
authors.lastname: Lilja
authors.forename: D
authors.initials: D
authors.lastname: Bergqvist
authors.forename: J
authors.initials: J
authors.lastname: Brunkwall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006875:Hydrotherapy / Q000379:methods; D007383:Intermittent Claudication / Q000503:physiopathology / Q000628:therapy*; D007866:Leg / Q000098:blood supply / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013599:Systole; D016896:Treatment Outcome; D016138:Walking