Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial.
BACKGROUND
Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease (PAD) without intermittent claudication have been established as beneficial.


OBJECTIVE
To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication.


METHODS
Randomized controlled clinical trial performed at an urban academic medical center between April 1, 2004, and August 8, 2008, involving 156 patients with PAD who were randomly assigned to supervised treadmill exercise, to lower extremity resistance training, or to a control group.


METHODS
Six-minute walk performance and the short physical performance battery. Secondary outcomes were brachial artery flow-mediated dilation, treadmill walking performance, the Walking Impairment Questionnaire, and the 36-Item Short Form Health Survey physical functioning (SF-36 PF) score.


RESULTS
For the 6-minute walk, those in the supervised treadmill exercise group increased their distance walked by 35.9 m (95% confidence interval [CI], 15.3-56.5 m; P < .001) compared with the control group, whereas those in the resistance training group increased their distance walked by 12.4 m (95% CI, -8.42 to 33.3 m; P = .24) compared with the control group. Neither exercise group improved its short physical performance battery scores. For brachial artery flow-mediated dilation, those in the treadmill group had a mean improvement of 1.53% (95% CI, 0.35%-2.70%; P = .02) compared with the control group. The treadmill group had greater increases in maximal treadmill walking time (3.44 minutes; 95% CI, 2.05-4.84 minutes; P < .001); walking impairment distance score (10.7; 95% CI, 1.56-19.9; P = .02); and SF-36 PF score (7.5; 95% CI, 0.00-15.0; P = .02) than the control group. The resistance training group had greater increases in maximal treadmill walking time (1.90 minutes; 95% CI, 0.49-3.31 minutes; P = .009); walking impairment scores for distance (6.92; 95% CI, 1.07-12.8; P = .02) and stair climbing (10.4; 95% CI, 0.00-20.8; P = .03); and SF-36 PF score (7.5; 95% CI, 0.0-15.0; P = .04) than the control group.


CONCLUSIONS
Supervised treadmill training improved 6-minute walk performance, treadmill walking performance, brachial artery flow-mediated dilation, and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication. Lower extremity resistance training improved functional performance measured by treadmill walking, quality of life, and stair climbing ability.


BACKGROUND
clinicaltrials.gov Identifier: NCT00106327.
McDermott
Mary M
MM
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. mdm608@northwestern.edu
Ades
Philip
P
Guralnik
Jack M
JM
Dyer
Alan
A
Ferrucci
Luigi
L
Liu
Kiang
K
Nelson
Miriam
M
Lloyd-Jones
Donald
D
Van Horn
Linda
L
Garside
Daniel
D
Kibbe
Melina
M
Domanchuk
Kathryn
K
Stein
James H
JH
Liao
Yihua
Y
Tao
Huimin
H
Green
David
D
Pearce
William H
WH
Schneider
Joseph R
JR
McPherson
David
D
Laing
Susan T
ST
McCarthy
Walter J
WJ
Shroff
Adhir
A
Criqui
Michael H
MH
D000368:Aged; D055109:Ankle Brachial Index; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000628:therapy*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000628:therapy*; D010809:Physical Fitness; D011788:Quality of Life; D055070:Resistance Training; D016138:Walking