Diabetic women are poor responders to exercise rehabilitation in the treatment of claudication.
BACKGROUND
It is not clear whether subgroups of patients with peripheral artery disease (PAD) and claudication respond more favorably to exercise rehabilitation than others. We determined whether sex and diabetes were factors associated with the response to exercise rehabilitation in patients with claudication.


METHODS
Eighty patients were randomized to home-based and supervised exercise programs, and 60 finished with complete exercise intervention data. Exercise consisted of intermittent walking to near maximal claudication pain for 3 months. Primary outcome measures included claudication onset time (COT) and peak walking time. Patients were partitioned into diabetic and nondiabetic groups and then further partitioned by sex to form four groups.


RESULTS
Overall, exercise adherence was high (84%), and there was no significant difference (P > .05) in the amount of exercise completed among the four groups. All groups had significant improvements (P < .05) in COT and peak walking time after exercise rehabilitation, except for diabetic women (P > .05). Only 37% of women with diabetes had an increase in COT compared with 100% of men with diabetes (P < .01), and their risk ratio for nonresponse was 9.2 (P < .0001).


CONCLUSIONS
Women with PAD and claudication, particularly those with diabetes, represent a vulnerable subgroup of patients who respond poorly to a program of exercise rehabilitation. Diabetic women with PAD and claudication may need a greater dose of exercise or another intervention separate from or in combination with exercise to elicit improvements in claudication measures that are similar to nondiabetic women and to diabetic and nondiabetic men.
Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla; Veterans Affairs Medical Center, Oklahoma City, Okla. Electronic address: andrew-gardner@ouhsc.edu.
Andrew W
AW
Gardner
Department of Biostatistics and Epidemiology, OUHSC, Oklahoma City, Okla.
Donald E
DE
Parker
Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Okla.
Polly S
PS
Montgomery
General Internal Medicine Section, Department of Medicine, OUHSC, Oklahoma City, Okla.
Steve M
SM
Blevins
D000368:Aged; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000503:physiopathology*; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009825:Oklahoma; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking