Exercise rehabilitation improves functional outcomes and peripheral circulation in patients with intermittent claudication: a randomized controlled trial.
OBJECTIVE
To determine the effects of a 6-month exercise program on ambulatory function, free-living daily physical activity, peripheral circulation, and health-related quality of life (QOL) in disabled older patients with intermittent claudication.


METHODS
Prospective, randomized controlled trial.


METHODS
University Medical (Center and Veterans Affairs Medical Center, Baltimore, Maryland.


METHODS
Thirty-one of 61 patients with Fontaine stage II peripheral arterial occlusive disease (PAOD) were randomized to exercise rehabilitation and 30 to usual-care control. Three patients from the exercise group and six patients from the control group dropped out, leaving 28 and 24 patients, respectively, completing the study in each group.


METHODS
Six months of exercise rehabilitation.


METHODS
Treadmill distance walked to onset of claudication and to maximal claudication, ambulatory function, peripheral circulation, perceived QOL, and daily physical activity.


RESULTS
Compliance with the exercise program was 73% of the possible sessions. Exercise rehabilitation increased treadmill distance walked to onset of claudication by 134% (P < .001) and to maximal claudication by 77% (P < .001), walking economy by 12% (P = .003), 6-minute walk distance by 12% (P < .001), and maximal calf blood flow by 30% (P < .001). Changes in distance walked to maximal pain correlated with changes in walking economy (r = -.50, P = .013) and changes in maximal calf blood flow (r = .38, P = .047). Exercise rehabilitation increased accelerometer-derived daily physical activity by 38% (P < .001); this change correlated with the change in distance walked to maximal pain (r = .45, P = .020). These improvements were significantly better than the changes in the control group (P < .05).


CONCLUSIONS
Improvements in claudication following exercise rehabilitation in older PAOD patients are dependent on improvements in peripheral circulation and walking economy. Improvement in treadmill claudication distances in these patients translated into increased accelerometer-derived physical activity in the community, which enabled the patients to become more functionally independent.
Gardner
A W
AW
Claude D. Pepper Older Americans Independence Center, Department of Medicine, Division of Gerontology, University of Maryland, Baltimore, MD, USA.
Katzel
L I
LI
Sorkin
J D
JD
Bradham
D D
DD
Hochberg
M C
MC
Flinn
W R
WR
Goldberg
A P
AP
D000203:Activities of Daily Living; D000368:Aged; D001775:Blood Circulation; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods* / Q000592:standards; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D007383:Intermittent Claudication / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D010991:Plethysmography; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome