Exercise training in intermittent claudication.
BACKGROUND
Peripheral arterial occlusive disease (PAOD) at II stage results in a moderate to severe impairment in walking ability. Aim of this study, controlled and randomized, was to evaluate the efficacy of an intensive 4 weeks exercise training in PAOD followed by a six-month period and to analyse the risk factors for atherosclerosis and the site of the lesion for possible predictors of result outcome.


METHODS
Patients with PAOD were included in the study (ankle/arm ratio < or = 0.7 and < or = 0.5 after exercise) with initial claudication distance (ICD) < or = 200 m and absolute claudication distance (ACD) < or = 500 m evaluated on a constant-load treadmill test (3 km/hr, 0% slope). Forty patients were randomized (all with antiplatelet therapy): 20 to a supervised walking exercise (mean ICD 121.8 m, ACD 289.7 m) and 20 to a non exercising control group (ICD 111.6 m, ACD 230.1 m). Both groups were tested at 4 weeks (T1) and 6 months (T2). Training group was enrolled in a 4-week supervised training program.


RESULTS
In the training group 10% of patients became asymptomatic (>1000 m). At T1 ICD increased 141% (p<0.001) and ACD was with low-pain-claudication >1000 m in 50%, at T2 ICD was 200% (p<0.05) with 70% of asymptomatic for ICD and ACD. Control group has a no significant increase of ICD and ACD at T1 and T2. Only arterial hypertension and intermittent claudication severity emerged as negative predictive factors for the results of training.


CONCLUSIONS
Vascular training produces a significant and lasting improvement in walking distance in PAOD.
Gibellini
R
R
Salvatore Maugeri Foundation, IRCCS, Rehabilitation Institute, Montescano, Italy.
Fanello
M
M
Bardile
A F
AF
Salerno
M
M
Aloi
T
T
D000368:Aged; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000534:rehabilitation*; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler