Peripheral arterial disease and intermittent claudication: efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home.
OBJECTIVE
To compare the effect of two training programmes and advice to exercise at home on physiological adaptations in patients with peripheral arterial disease (PAD).


METHODS
30 patients with a typical history of PAD and intermittent claudication were randomised to either an upper body strength training programme (UBST), a dynamic (walking, cycling, circuit) conventional exercise rehabilitation programme (CER), or advice to 'walk as much as possible at home' (CONT). Before and after intervention groups performed a standard graded treadmill exercise test (GTET) and a 6-minute walk test (SMWT) to determine peak physiological parameters and walking distances. Maximal walking distance (MWD), pain-free walking distance (PFWD), peak oxygen uptake (VO2) , heart rate and perceived pain were measured.


RESULTS
MWD on the GTET increased significantly in the CER group compared with the CONT and UBST groups (93.9 +/- 79% v. 7.0 +/- 19.8% v. 7.3 +/- 46%; CER v. UBST v. CONT p = 0.003). Similarly, peak VO2 increased with CER compared with the CONT and UBST groups (28.4 +/- 20 v. -6.2 +/- 15 v. -1.0 +/- 21%; CER v. UBST v. CONT p = 0.004). During the SMWT the CER and UBST groups improved in PFWD compared with the CONT group (37 +/- 47% v. 27 +/- 71% v. -30 +/- 29%; CER v. UBST v. CONT p = 0.03), and perceived pain decreased in the CER group compared with the UBST group (-24 +/- 39% v. 27 +/- 48%; CER v. UBST p = 0.01).


CONCLUSIONS
CER improves physiological parameters and walking distances more than UBST does. CER is effective within 6 weeks. Verbal encouragement to exercise is an ineffective form of management.
Parr
B M
BM
Cape Peninsula University of Technology, Cape Town. parrb@cput.ac.za
Noakes
T D
TD
Derman
E W
EW
D000368:Aged; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006339:Heart Rate; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010353:Patient Education as Topic; D016491:Peripheral Vascular Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function; D055070:Resistance Training; D012648:Self Care