Exercise training in intermittent claudication

Abstract

Background: Peripheral arterial occlusive disease (PAOD) at II stage results in a moderate to severe impairment in walking ability. Aim of this study, controlled and randomized, was to evaluate the efficacy of an intensive 4 weeks exercise training in PAOD followed by a six-month period and to analyse the risk factors for atherosclerosis and the site of the lesion for possible predictors of result outcome.

Methods: Patients with PAOD were included in the study (ankle/arm ratio < or = 0.7 and < or = 0.5 after exercise) with initial claudication distance (ICD) < or = 200 m and absolute claudication distance (ACD) < or = 500 m evaluated on a constant-load treadmill test (3 km/hr, 0% slope). Forty patients were randomized (all with antiplatelet therapy): 20 to a supervised walking exercise (mean ICD 121.8 m, ACD 289.7 m) and 20 to a non exercising control group (ICD 111.6 m, ACD 230.1 m). Both groups were tested at 4 weeks (T1) and 6 months (T2). Training group was enrolled in a 4-week supervised training program.

Results: In the training group 10% of patients became asymptomatic (>1000 m). At T1 ICD increased 141% (p<0.001) and ACD was with low-pain-claudication >1000 m in 50%, at T2 ICD was 200% (p<0.05) with 70% of asymptomatic for ICD and ACD. Control group has a no significant increase of ICD and ACD at T1 and T2. Only arterial hypertension and intermittent claudication severity emerged as negative predictive factors for the results of training.

Conclusions: Vascular training produces a significant and lasting improvement in walking distance in PAOD.