title: Exercise prescription using the heart of claudication pain onset in patients with intermittent claudication.
abstract: OBJECTIVE
  To assess the acute metabolic and cardiovascular responses to walking exercise at an intensity corresponding to the heart rate of claudication pain onset and to investigate the effects of a 12-week walking training program at this intensity on walking capacity.
  
  
  METHODS
  Twenty-nine patients with intermittent claudication were randomly allocated to the walking training (n=17) or control (CO, n=12) group. The walking training group performed an acute exercise session comprising 15×2-min bouts of walking at the heart rate of claudication pain onset, with 2-min interpolated rest intervals. The claudication symptoms and cardiovascular and metabolic responses were evaluated. Walking training was then performed at the same intensity twice each week for 12 weeks, while the control group engaged in twice weekly stretching classes. The claudication onset distance and total walking distance were evaluated before and after the interventions. Brazilian Registry Clinical Trials: RBR-7M3D8W.
  
  
  RESULTS
  During the acute exercise session, the heart rate was maintained within tight limits. The exercise intensity was above the anaerobic threshold and >80% of the heart rate peak and VO2peak. After the exercise training period, the walking exercise group (n=13) showed increased claudication onset distance (309±153 vs. 413±201m) and total walking distance (784±182 vs. 1,100±236m) compared to the control group (n=12) (p<0.05).
  
  
  CONCLUSIONS
  Walking exercise prescribed at the heart rate of claudication pain onset enables patients with intermittent claudication to exercise with tolerable levels of pain and improves walking performance.
authors.affiliation: Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Gabriel Grizzo
authors.initials: GG
authors.lastname: Cucato
authors.forename: Marcel da Rocha
authors.initials: Mda R
authors.lastname: Chehuen
authors.forename: Luis Augusto Riani
authors.initials: LA
authors.lastname: Costa
authors.forename: Raphael Mendes
authors.initials: RM
authors.lastname: Ritti-Dias
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.forename: John Michael
authors.initials: JM
authors.lastname: Saxton
authors.forename: Cláudia Lúcia de Moraes
authors.initials: CL
authors.lastname: Forjaz
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007383:Intermittent Claudication / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D010147:Pain Measurement; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
references.citation: J Vasc Surg. 2005 Oct;42(4):702-9
references.pmid: 16242558
references.citation: Eur J Vasc Endovasc Surg. 2000 Jul;20(1):72-8
references.pmid: 10906302
references.citation: Atherosclerosis. 2011 Sep;218(1):1-12
references.pmid: 21601857
references.citation: J Cardiopulm Rehabil Prev. 2009 Nov-Dec;29(6):396-401
references.pmid: 19770807
references.citation: J Appl Physiol. 1973 Aug;35(2):236-43
references.pmid: 4723033
references.citation: Med Sci Sports Exerc. 1991 Apr;23(4):402-8
references.pmid: 2056896
references.citation: Vasa. 2012 Jul;41(4):275-81
references.pmid: 22825861
references.citation: Eur J Appl Physiol Occup Physiol. 1985;54(1):84-8
references.pmid: 4018061
references.citation: Med Sci Sports Exerc. 1991 May;23(5):562-8
references.pmid: 2072834
references.citation: Int Angiol. 2007 Jun;26(2):81-157
references.pmid: 17489079
references.citation: J Cardiopulm Rehabil. 1995 May-Jun;15(3):193-6
references.pmid: 8542524
references.citation: J Gerontol A Biol Sci Med Sci. 2000 Oct;55(10):M570-7
references.pmid: 11034229
references.citation: J Vasc Surg. 2010 Jan;51(1):89-95
references.pmid: 19837534
references.citation: Circulation. 2006 Mar 21;113(11):e463-654
references.pmid: 16549646
references.citation: Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005263
references.pmid: 16625633
references.citation: J Vasc Surg. 2012 Oct;56(4):1132-42
references.pmid: 23026425
references.citation: JAMA. 1995 Sep 27;274(12):975-80
references.pmid: 7674529
references.citation: Sports Med. 2010 May 1;40(5):433-47
references.pmid: 20433214