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Randomized Controlled Trial
. 2014 Apr;59(4):1036-43.
doi: 10.1016/j.jvs.2013.10.058. Epub 2013 Nov 15.

Diabetic women are poor responders to exercise rehabilitation in the treatment of claudication

Andrew W Gardner  1 , Donald E Parker  2 , Polly S Montgomery  3 , Steve M Blevins  4
Affiliations
Randomized Controlled Trial

Diabetic women are poor responders to exercise rehabilitation in the treatment of claudication

Andrew W Gardner et al. J Vasc Surg. 2014 Apr.

Abstract

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.

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Figures

Figure 1
Figure 1
Percentage of patients, stratified by sex and diabetes status, who had an increase in their change score for claudication onset time (i.e., responder) following exercise rehabilitation. Significantly different than zero: * p < 0.05, ** p < 0.01.
Figure 2
Figure 2
Percentage of patients, stratified by sex and diabetes status, who had an increase in their change score for peak walking time (i.e., responder) following exercise rehabilitation. Significantly different than zero: * p < 0.05, ** p < 0.01.
See this image and copyright information in PMC

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