title: Unbalanced risk factors, could compromise the effectiveness of physical training in patients with intermittent claudication?
abstract: OBJECTIVE
  The correction of atherosclerotic risk factors is the unavoidable assumption to assure the maximal effectiveness and duration of the results of any therapeutic intervention (pharmacological and surgical) for the treatment of intermittent claudication. Aim of this study has been to verify if the presence/absence of risk factors and the degree of their correction could compromise the responsiveness of claudicant patients to the supervised physical training.
  
  
  METHODS
  Initial (IDC), absolute (ACD) claudication distance, and recovery time (RT) have been measured by maximal treadmill exercise in 74 claudicants. The measurements have been repeated after 18 days of supervised physical training consisting of a daily walk reaching either a distance goal of 1-2 km or a time goal of at least 30 min. The working load of each single training session has been tailored at 60-70% of the ACD measured by a non-maximal treadmill exercise. The patients' cohort has been stratified in 7 groups and 18 sub-groups (no smokers, smokers in the past, still smokers, no-diabetics, well balanced and unbalanced diabetes, absent, well balanced and unbalanced hypercholesterolemia, normal weight, over weight and light obesity, hypertensive and no-hypertensive, with and without previous myocardial infarction and TIAs or stroke). The mean and standard error of ICD, ACD and RT before and after 18 days of physical training have been calculated and compared with Student's t test in each group and sub-group. On the data before and after training of ICD, ACD and RT of each group of risk factors the multivariate analysis of the variance has been carried out by analysis of variance (ANOVA). All the analyses were considered significant when the P value was less than 0.05.
  
  
  RESULTS
  ICD values increased from 55.12 to 121.86 m, ACD from 103.16 to 191.58 m, RT reduced from 204.04 to 87.46 s, confirming the relevant (P<0.0001) effectiveness of supervised physical training on the walking capacity of claudicant patients. The comparison between the deltas (value after minus value before) of each sub-group did not show any significant difference. The multivariate ANOVA of before and after ICD ACD and RT of each risk factor groups showed values relevantly lesser than 0.05, indicating that risk factors did not influence the result of physical training.
  
  
  CONCLUSIONS
  The supervised physical training is confirmed as an effective tool for the treatment of claudicant patient. We did not find any significant difference in the response to the programme related with the presence, absence or balance degree of risk factors, and we conclude that physical training effectiveness is independent from the their presence, absence or balance degree. This statement is very important because highlights the physical training as the only therapeutic tool for peripheral arterial disease (PAD) independent from the results of the risk factors' treatment.
authors.affiliation: Vascular Rehabilitation Unit, ''Casa di Cura Carmide'' Rehabilitation Clinic, Catania, Italy. alfredo_leone@fastwebnet.it
authors.forename: A
authors.initials: A
authors.lastname: Leone
authors.forename: R
authors.initials: R
authors.lastname: Laudani
authors.forename: G
authors.initials: G
authors.lastname: Definite
authors.forename: R
authors.initials: R
authors.lastname: Martini
authors.forename: G M
authors.initials: GM
authors.lastname: Andreozzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000704:Analysis of Variance; D015331:Cohort Studies; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015397:Program Evaluation; D020127:Recovery of Function; D055070:Resistance Training; D012307:Risk Factors; D055502:Secondary Prevention; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D016138:Walking