title: Efficacy of a short-course intensive rehabilitation program in patients with moderate-to-severe intermittent claudication.
abstract: BACKGROUND
  Many rehabilitation programs for intermittent claudication include physical training for several months, since the outcome of short-course protocols is still unclear. The aim of this study was to evaluate the efficacy of a short course of exercise therapy in patients with moderate-to-severe intermittent claudication in terms of walking distance variations.
  
  
  METHODS
  Twenty-six patients (males 88%, mean age 59 +/- 8 years, ankle-brachial index < or = 0.8 and < or = 0.5 before and after exercise respectively) were evaluated. Moderate-to-severe stenoses or occlusions were localized at color Doppler scanning of the abdominal aorta/iliac arteries and femoral/popliteal/tibial arteries in 15 and 31% of patients respectively, while in 54% of cases both the proximal and distal sites were involved. The initial and absolute claudication distances were recorded by means of the constant treadmill test (3 km/hour speed, 0% grade) at the time of presentation and after a short-course comprehensive rehabilitation program (4 week duration) including physical training, educational intervention, psychological support, and cardiovascular risk management.
  
  
  RESULTS
  At the end of the program, 1 patient (4%) became asymptomatic (walked > 1000 m without pain). In 25 patients who still developed pain, the average increase in the initial claudication distance was 132% (from 75 to 174 m). Among these, 20 patients (77%) were still unable to complete the treadmill test due to maximal claudication pain, but the absolute claudication distance increased by 87% from 204 to 381 m (p < 0.05). No cardiovascular complication occurred during the study period. Major clinical variables failed to predict an unsatisfactory increase in walking capacity.
  
  
  CONCLUSIONS
  Short-course training programs enhance the walking ability even in patients with moderate-to-severe intermittent claudication and seem to be well tolerated, supporting their widespread use in rehabilitation centers.
authors.affiliation: Division of Cardiology, S. Maugeri Foundation, Care and Research Institute, Tradate, VA, Italy. mambrosetti@fsm.it
authors.forename: Marco
authors.initials: M
authors.lastname: Ambrosetti
authors.forename: Mario
authors.initials: M
authors.lastname: Salerno
authors.forename: Roberto
authors.initials: R
authors.lastname: Tramarin
authors.forename: Roberto F E
authors.initials: RF
authors.lastname: Pedretti
mesh_terms: D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000145:classification / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D016138:Walking