High-intensity progressive resistance training improves flat-ground walking in older adults with symptomatic peripheral arterial disease. Maintaining Physical Fitness and Function in Alzheimer’s Disease Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. Effects of a 6-Week Aquatic Treadmill Exercise Program on Cardiorespiratory Fitness and Walking Endurance in Subacute Stroke Patients: A PILOT TRIAL Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial. Exercise training is beneficial for Alzheimer's patients. Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Corridor-based functional performance measures correlate better with physical activity during daily life than treadmill measures in persons with peripheral arterial disease. Differential effects of water-based exercise on the cognitive function in independent elderly adults Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. Training rather than walking: the test in -train out program for home-based rehabilitation in peripheral arteriopathy. Community-based walking exercise for peripheral artery disease: An exploratory pilot study Chronic Stroke Survivors Benefit From High-Intensity Aerobic Treadmill Exercise Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial. Step‐Monitored Home Exercise Improves Ambulation, Vascular Function, and Inflammation in Symptomatic Patients With Peripheral Artery Disease: A Randomized Controlled Trial Benefit of exercise conditioning for patients with peripheral arterial disease. Near-Infrared Spectroscopy Assessment Following Exercise Training in Patients With Intermittent Claudication and in Untrained Healthy Participants Hospital vs Home-Based Exercise Rehabilitation for Patients with Peripheral Arterial Occlusive Disease Combined aerobic and resistance exercise program improves task performance in patients with heart failure. Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response. Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9-Week Randomized, Controlled Trial. Exercise training improves functional status in patients with peripheral arterial disease. Effects of training on functional performance in 65, 75 and 85 year-old women: experiences deriving from community based studies in Odense, Denmark.
OBJECTIVES To assess the efficacy of whole-body progressive resistance training ( PRT ) as a treatment for the symptoms of peripheral arterial disease ( PAD ) in older adults . DESIGN R and omized controlled pilot trial . SETTING University clinical weight training facility in Sydney , Australia . PARTICIPANTS Twenty-two older adults with symptomatic PAD . INTERVENTIONS The efficacy of supervised whole-body high-intensity PRT ( H-PRT ) with low-intensity nonprogressive resistance training ( L-RT ) and a usual care control group that performed unsupervised walking for 6 months was compared . MEASUREMENTS Pilot outcome measures included 6-minute walk ( 6 MW ) outcomes , body composition , dynamic muscle strength and endurance , and performance-based tests of function . RESULTS Mean age was 71.1 ± 7.2 . Mean ankle brachial index was 0.55 ± 0.13 .  Exercise adherence was similar in all groups ( P = .29 ) . H-PRT ( n = 8) improved total 6MW distance ( mean difference ( MD ) 62.6 ± 58.0 m , P = .02 ) significantly more than L-RT ( n = 7 ; MD=-48.2 ± 67.6 m ) and controls ( n = 7 ; MD=-9.9 ± 52.9 m ) . Change in 6MW onset of claudication was significantly and independently related to change in bilateral calf endurance ( correlation coefficient ( r ) = 0.65 , P = .03 ) , and change in 6MW distance was significantly and independently related to change in bilateral hip extensor endurance ( r = 0.71 , P = .02 ) in all groups . CONCLUSION H-PRT  significantly improved 6MW ability in older adults with intermittent claudication from PAD , whereas L-RT and unsupervised walking did not . Improvement in walking ability was significantly related to improvements in bilateral calf and hip extensor endurance , supporting further investigations targeted at musculoskeletal impairment in this cohort Background : Little is known about how aerobic exercise affects physical functioning in persons with Alzheimer ’s disease ( AD ) . Methods : This pilot study used a 1-group repeated measures design to examine the feasibility and impact of a 6-month individualized moderate intensity cycling intervention on cardiorespiratory fitness and lower extremity function in 8 participants aged 81.4 ± 3.58 . Cardiorespiratory fitness was measured using the shuttle walk and modified YMCA cycle ergometer tests , and lower extremity function was measured using the Short Physical Performance Battery ( SPPB ) at baseline , 3 months and 6 months . Results : The YMCA test showed a significant reduction in heart rate at stage 2 ( 103.4 vs 90.9 vs 91.6 ; P = .01 ) , while no significant changes were observed in the shuttle walk and SPPB tests . Conclusions : Persons with AD are able to improve cardiorespiratory conditioning from aerobic exercise . R and omized , controlled trials are needed to confirm these findings . Implication s for future research are detailed CONTEXT Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease ( PAD ) without intermittent claudication have been established as beneficial . OBJECTIVE To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled clinical trial performed at an urban academic medical center between April 1 , 2004 , and August 8 , 2008 , involving 156 patients with PAD who were r and omly assigned to supervised treadmill exercise , to lower extremity resistance training , or to a control group .  MAIN OUTCOME MEASURES Six-minute walk performance and the short physical performance battery . Secondary outcomes were brachial artery flow-mediated dilation , treadmill walking performance , the Walking Impairment Question naire , and the 36-Item Short Form Health Survey physical functioning ( SF-36 PF ) score . RESULTS For the 6-minute walk , those in the supervised treadmill exercise group increased their distance walked by 35.9 m ( 95 % confidence interval [ CI ] , 15.3 - 56.5 m ; P < .001 ) compared with the control group , whereas those in the resistance training group increased their distance walked by 12.4 m ( 95 % CI , -8.42 to 33.3 m ; P = .24 ) compared with the control group . Neither exercise group improved its short physical performance battery scores . For brachial artery flow-mediated dilation , those in the treadmill group had a mean improvement of 1.53 % ( 95 % CI , 0.35%-2.70 % ; P = .02 ) compared with the control group . The treadmill group had greater increases in maximal treadmill walking time ( 3.44 minutes ; 95 % CI , 2.05 - 4.84 minutes ; P < .001 ) ; walking impairment distance score ( 10.7 ; 95 % CI , 1.56 - 19.9 ; P = .02 ) ; and SF-36 PF score ( 7.5 ; 95 % CI , 0.00 - 15.0 ; P = .02 ) than the control group . The resistance training group had greater increases in maximal treadmill walking time ( 1.90 minutes ; 95 % CI , 0.49 - 3.31 minutes ; P = .009 ) ; walking impairment scores for distance ( 6.92 ; 95 % CI , 1.07 - 12.8 ; P = .02 ) and stair climbing ( 10.4 ; 95 % CI , 0.00 - 20.8 ; P = .03 ) ; and SF-36 PF score ( 7.5 ; 95 % CI , 0.0 - 15.0 ; P = .04 ) than the control group . CONCLUSIONS Supervised treadmill training improved 6-minute walk performance , treadmill walking performance , brachial artery flow-mediated dilation , and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication .  Lower extremity resistance training improved functional performance measured by treadmill walking , quality of life , and stair climbing ability . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00106327 Objective : To assess the feasibility and safety of a 6-week course of water walking performed using a motorized aquatic treadmill in individuals with subacute stroke for cardiorespiratory fitness , walking endurance , and activities of daily living . Methods : Twenty subacute stroke patents were r and omly assigned to aquatic treadmill exercise ( ATE ) or l and -based exercise ( LBE ) . The ATE group ( n = 10 ) performed water-based aerobic exercise on a motorized aquatic treadmill , and the LBE group ( n = 10 ) performed l and -based aerobic exercise on a cycle ergometer . Both groups performed aerobic exercise for 30 minutes , 5 times per week for 6 weeks . Primary outcome measures were 6-minute walk test for walking endurance and cardiopulmonary fitness parameters of a symptom-limited exercise tolerance test , and secondary measures were Korean version of the Modified Barthel Index ( K-MBI ) for activities of daily living . All variables were assessed at baseline and at the end of the intervention . Results : The ATE group showed significant improvements in 6-minute walk test ( P = .005 ) , peak oxygen uptake ( O2peak ; P = .005 ) , peak heart rate ( P = .007 ) , exercise tolerance test duration ( P = .005 ) , and K-MBI ( P = .008 ) . The LBE group showed a significant improvement only in K-MBI ( P = .012 ) . In addition , improvement in O2peak was greater in the ATE than in the LBE group . Conclusion : This preliminary study showed that a 6-week ATE program improved peak aerobic capacity and walking endurance in patients with subacute stroke . The improvement in O2peak after an ATE exercise program was greater than that observed after an LBE program . Therefore , ATE effectively improves cardiopulmonary fitness in patients with subacute stroke QUESTION Among people who are hospitalised for community-acquired pneumonia , does an inpatient exercise-based rehabilitation program improve functional outcomes , symptoms , quality of life and length of hospital stay more than a respiratory physiotherapy regimen ? DESIGN R and omised trial with concealed allocation , intention-to-treat analysis and blinding of some outcomes . PARTICIPANTS Forty-nine adults hospitalised for community-acquired pneumonia . INTERVENTION The experimental group ( n=32 ) underwent a physical training program that included warm-up , stretching , peripheral muscle strength training and walking at a controlled speed for 15 minutes . The control group ( n=17 ) underwent a respiratory physiotherapy regimen that included percussion , vibrocompression , respiratory exercises and free walking . The intervention regimens lasted 8 days . OUTCOME MEASURES The primary outcome was the Glittre Activities of Daily Living test , which assesses the time taken to complete a series of functional tasks ( eg , rising from a chair , walking , stairs , lifting and bending ) . Secondary outcomes were distance walked in the incremental shuttle walk test , peripheral muscle strength , quality of life , dyspnoea , lung function , C-reactive protein and length of hospital stay . Measures were taken 1 day before and 1 day after the intervention period . RESULTS There was greater improvement in the experimental group than in the control group on the Glittre Activities of Daily Living test ( mean between-group difference 39 seconds , 95 % CI 20 to 59 ) and the incremental shuttle walk test ( mean between-group difference 130 m , 95 % CI 77 to 182 ) . There were also significantly greater improvements in quality of life , dyspnoea and peripheral muscle strength in the experimental group than in the control group . There were no between-group differences in lung function , C-reactive protein or length of hospital stay . CONCLUSION The improvement in functional outcomes after an inpatient rehabilitation program was greater than the improvement after st and ard respiratory physiotherapy . The exercise training program led to greater benefits in functional capacity , peripheral muscle strength , dyspnoea and quality of life . REGISTRATION Clinical Trials.gov , NCT02103400 Decreased ability to perform activities of daily living ( ADLs ) associated with deterioration in physical capacity are key determinants of the poor quality of life and loss of independence of patients with Alzheimer 's disease ( AD ) . The purpose of this study was to determine the effects of a 12-week training program ( including resistance , flexibility , joint mobility and balance/coordination exercises ) for Spanish patients with AD on their i ) overall functional capacity ( muscle strength and flexibility , agility and balance while moving , and endurance fitness ) , and ii ) ability to perform ADLs . Using a r and omized block design , 16 patients were assigned to a training ( mean [ SD ] age : 76 [ 4 ] yrs ) or control group ( 73 [ 4 ] yrs ) ( n = 8 subjects [ 3 male , 5 female ] per group ) . The results showed significant improvements after training ( p < 0.05 ) in upper and lower body muscle strength and flexibility , agility and dynamic balance , and endurance fitness ( using the Senior Fitness test ) , gait and balance abilities ( with subsequent decrease in risk of falls ) ( Tinetti scale ) and in the ability to perform ADLs independently ( Katz and Barthel scores ) . No changes ( p > 0.05 ) were found in the control group over the 12-week period . Exercise training could be included in the overall medical/nursing care protocol for patients with AD OBJECTIVE To ascertain the effectiveness of the National Arthritis Foundation ( NAF ) aquatic and on-l and exercise programs on functional fitness and perceived ability to perform activities of daily living ( ADL ) measures in older adults with arthritis . DESIGN The effects of aquatic and on-l and exercise intervention programs were analyzed by repeated- measures analysis of variance by using a planned comparison approach with an independent 3 x 2 ( group by test ) design . omega(2 ) analyses were used to ascertain the relative treatment magnitude of each dependent variable . SETTING Testing in an indoor track facility ; exercise programs conducted in community setting s. PARTICIPANTS A volunteer sample of 30 men and women with arthritis ( osteoarthritis , n=22 ; rheumatoid arthritis , n=8 ) , r and omly assigned into either an aquatic exercise ( n=10 ) , on-l and exercise ( n=10 ) , or control group ( n=10 ) . INTERVENTION Eight-week on-l and and aquatic exercise program . MAIN OUTCOME MEASURES Functional fitness , ADLs , and h and -held dynamometry measures assessed on a 1-day pretest and posttest session , before and after an 8-week exercise program . RESULTS Aquatic and on-l and exercise subjects showed significant improvements on 9 of 12 functional fitness , 3 of 4 ADLs , and 7 of 8 h and -held isometric strength tests after their respective exercise programs . No significant changes were found in any of these measures for the control group . CONCLUSION Both NAF exercise programs appear to be effective in improving functional physical fitness and perceived ability to perform ADL measures in older adults with arthritis OBJECTIVE To compare associations of physical activity during daily life with treadmill walking performance and corridor-based functional performance measures in persons with lower extremity peripheral arterial disease ( PAD ) . STUDY DESIGN Cross-sectional . SUBJECTS One hundred fifty-six men and women with PAD who completed baseline measurements and were r and omized into the study to improve leg circulation ( SILC ) exercise clinical trial . MAIN OUTCOME MEASURES Participants completed a  Gardner-Skinner treadmill protocol . Corridor-based functional performance measures were the 6-minute walk , walking velocity over four meters at usual and fastest pace , and the short physical performance battery ( SPPB ) ( 0 - 12 scale , 12 = best ) .  Physical activity during daily life was measured continuously over 7 days with a Caltrac ( Muscle Dynamics Fitness Network , Inc , Torrence , Calif ) accelerometer . RESULTS Adjusting for age , gender , and race , higher levels of physical activity during daily life were associated with greater distance achieved in the 6-minute walk ( P trend = .001 ) , faster fast-paced four-meter walking velocity ( P trend < .001 ) , faster usual-paced four-meter walking speed ( P trend = .027 ) and a higher SPPB ( P trend = .005 ) . The association of physical activity level with maximum treadmill walking distance did not reach statistical significance ( P trend = .083 ) . There were no associations of physical activity with treadmill distance to onset of leg symptoms ( P trend = .795 ) . CONCLUSION Functional performance measures are more strongly associated with physical activity levels during daily life than treadmill walking measures Background Physical exercise has been reported to be the most effective method to improve cognitive function and brain health , but there is as yet no research on the effect of water-based exercise . Aims The aim of the present study was to compare the effects of water-based exercise with and without cognitive stimuli on cognitive and physical functions . Methods The design is a single-blind r and omized controlled study . Twenty-one participants were r and omly assigned to a normal water-based exercise ( Nor-WE ) group or a cognitive water-based exercise ( Cog-WE ) group . The exercise sessions were divided into two exercise series : a 10-min series of l and -based warm-up , consisting of flexibility exercises , and a 50-min series of exercises in water . The Nor-WE consisted of 10 min of walking , 30 min of strength and stepping exercise , including stride over , and 10 min of stretching and relaxation in water . The Cog-WE consisted of 10 min of walking , 30 min of water-cognitive exercises , and 10 min of stretching and relaxation in water .  Cognitive function , physical function , and ADL were measured before the exercise intervention ( pre-intervention ) and 10 weeks after the intervention ( post-intervention ) . Results Participation in the Cog-WE performed significantly better on the pegboard test and the choice stepping reaction test and showed a significantly improved attention , memory , and learning , and in the general cognitive function ( measured as the total score in the 5-Cog test ) . Participation in the Nor-WE dramatically improved walking ability and lower limb muscle strength . Conclusion Our results reveal that the benefits elderly adults may obtain from water-based exercise depend on the characteristics of each specific exercise program . These findings highlight the importance of prescription for personalized water-based exercises to elderly adults to improve cognitive function IMPORTANCE Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease ( PAD ) to participate in a home-based walking exercise program . OBJECTIVE To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention , incorporating both group support and self-regulatory skills , can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication . DESIGN , SETTING , AND PATIENTS R and omized controlled clinical trial of 194 patients with PAD , including 72.2 % without classic symptoms of intermittent claudication , performed in Chicago , Illinois between July 22 , 2008 , and December 14 , 2012 . INTERVENTIONS Participants were r and omized to 1 of 2 parallel groups : a home-based group-mediated cognitive behavioral walking intervention or an attention control condition . MAIN OUTCOMES AND MEASURES The primary outcome was 6-month change in 6-minute walk performance . Secondary outcomes included 6-month change in treadmill walking , physical activity , the Walking Impairment Question naire ( WIQ ) , and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey . RESULTS Participants r and omized to the intervention group significantly increased their 6-minute walk distance ( [ reported in meters ] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group ; mean difference , 53.5 [ 95 % CI , 33.2 to 73.8 ] ; P < .001 ) , maximal treadmill walking time ( intervention , 7.91 to 9.44 minutes vs control , 7.56 to 8.09 ; mean difference , 1.01 minutes [ 95 % CI , 0.07 to 1.95 ] ; P = .04 ) , accelerometer-measured physical activity over 7 days ( intervention , 778.0 to 866.1 vs control , 671.6 to 645.0 ; mean difference , 114.7 activity units [ 95 % CI , 12.82 to 216.5 ] ; P = .03 ) , WIQ distance score ( intervention , 35.3 to 47.4 vs control , 33.3 to 34.4 ; mean difference , 11.1 [ 95 % CI , 3.9 to 18.1 ] ; P = .003 ) , and WIQ speed score ( intervention , 36.1 to 47.7 vs control , 35.3 - 36.6 ; mean difference , 10.4 [ 95 % CI , 3.4 to 17.4 ] ; P = .004 ) . CONCLUSION AND RELEVANCE A home-based walking exercise program significantly improved walking endurance , physical activity , and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms . These findings have implication s for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00693940 BACKGROUND Exercise training reduces walking disability in peripheral arterial disease ( PAD ) . This non-r and omized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation , the test in -train out program ( Ti-To ) , compared with the traditional home-based free walking exercise ( Tr-E ) . METHODS AND RESULTS A total of 143 patients with claudication ( 117 men , average age 68+/-10 years ) , were included in a Ti-To ( n=83 ) or Tr-E program ( n=60 ) . Evaluations , which were carried out upon entry and at 1 , 2 , 3 , 4 and 6 months , included : self-reported claudication , walking ability ( ie , absolute claudication distance , pain threshold speed ) , resting/exercise heart rates ( HR ) , systolic/diastolic brachial pressure ( SBP/DBP ) , ankle pressure ( AP ) , ankle-brachial index ( ABI ) . Ti-To involved 2 daily 10-min home walking sessions at maximal asymptomatic speed and the patient attending monthly check-ups at hospital . Tr-E involved 20 - 30 min of daily walking at self-selected speeds up to pain tolerance . A total of 126 patients ( Ti-To , n=74 ; Tr-E , n=52 ) completed the program . Ti-To induced better relief from claudication ( p=0.001 ) . Functional parameters improved significantly for both groups ( p<0.0001 ) with significant intergroup difference for Ti-To ( p<0.0001 ) . SBP and exercise HR decreased significantly in both groups , with Ti-To improving resting HR ( p=0.0002 ) , DBP ( p=0.003 ) , lowest AP worse limb ( p=0.004 ) and ABI worse limb ( p=0.0002 ) . CONCLUSIONS In patients with PAD , a Ti-To program had more positive effects on perceived claudication , and functional and hemodynamic parameters than did a Tr-E program Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease ( PAD ) , but few exercise programs in community setting s have been effective . The aim of this study was to determine the efficacy of a community-based walking exercise program with training , monitoring and coaching ( TMC ) components to improve exercise performance and patient-reported outcomes in PAD patients . This was a r and omized , controlled trial including PAD patients ( n=25 ) who previously received peripheral endovascular therapy or presented with stable claudication . Patients r and omized to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks . Patients in the control group did not receive treatment beyond st and ard advice to walk . The primary outcome in the intent-to-treat ( ITT ) analyses was peak walking time ( PWT ) on a grade d treadmill . Secondary outcomes included claudication onset time ( COT ) and patient-reported outcomes assessed via the Walking Impairment Question naire ( WIQ ) . Intervention group patients ( n=10 ) did not significantly improve PWT when compared with the control group patients ( n=10 ) ( mean±st and ard error : + 2.1±0.7 versus 0.0±0.7 min , p=0.052 ) . Changes in COT and WIQ scores were greater for intervention patients compared with control patients ( COT : + 1.6±0.8 versus −0.6±0.7 min , p=0.045 ; WIQ : + 18.3±4.2 versus −4.6±4.2 % , p=0.001 ) . This pilot using a walking program with TMC and an ITT analysis did not improve the primary outcome in PAD patients . Other walking performance and patient self-reported outcomes were improved following exercise in community setting s. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size Background and objective . Ambulatory subjects after stroke may benefit from gait-oriented cardiovascular fitness training , but trials to date have not primarily assessed older persons . Methods . Thirty-eight subjects ( age > 60 years ) with residual hemiparetic gait were enrolled > 6 months after stroke . Participants were r and omized to receive 3 months ( 3 × /week ) progressive grade d , high-intensity aerobic treadmill exercise ( TAEX ) or conventional care physiotherapy . Primary outcome measures were peak exercise capacity ( Vo2peak ) and sustained walking capacity in 6-minute walks ( 6MW ) . Secondary measures were gait velocity in 10-m walks , Berg Balance Scale , functional leg strength ( 5 chair-rise ) , self-rated mobility ( Rivermead Mobility Index ) , and quality of life ( SF-12 ) . Results . Thirty-six participants completed the study ( 18 TAEX , 18 controls ) .  TAEX but not conventional care  improved Vo2peak ( difference 6.4 mL/kg/min , P < .001 ) and 6MW ( 53 m , P < .001 ) . Likewise , maximum walking speed ( 0.13 m/s , P = .01 ) , balance ( P < .05 ) , and the mental subscore of the SF-12 ( P < .01 ) improved more after TAEX . Gains in Vo2peak correlated with the degree at which training intensity could be progressed in the individual participant ( P < .01 ) . Better walking was related to progression in treadmill velocity and training duration ( P < .001 ) . Vo2peak and 6MW performances were still higher 1 year after the end of training when compared with the baseline , although endurance walking ( 6MW ) at 1 year was lower than immediately after training ( P < .01 ) . Conclusion . This trial demonstrates that TAEX effectively improves cardiovascular fitness and gait in persons with chronic stroke OBJECTIVES To investigate the effects of a 24-week program of upper- and lower-limb aerobic exercise training on walking performance in patients with symptomatic peripheral arterial disease ( PAD ) and to study the mechanisms that could influence symptomatic improvement . METHODS After approval from the North Sheffield Local Research Ethics Committee , 104 patients ( median age , 69 years ; range , 50 to 85 years ) with stable PAD were r and omized into an upper- or lower-limb aerobic exercise training group ( UL-Ex or LL-Ex ) , or to a nonexercise training control group . Training was performed twice weekly for 24 weeks at equivalent relative exercise intensities . An incremental arm- and leg-crank test ( ACT and LCT ) to maximum exercise tolerance was performed before and at 6 , 12 , 18 , and 24 weeks of the intervention to determine peak oxygen consumption ( VO(2 ) ) . Walking performance , defined as the claudicating distance ( CD ) and maximum walking distance ( MWD ) achieved before intolerable claudication pain , was assessed at the same time points by using a shuttle-walk protocol . Peak blood lactate concentration , Borg ratings of perceived exertion ( RPE ) and pain category ratio ( CR-10 ) were recorded during all assessment s. RESULTS CD and MWD increased over time ( P < .001 ) in both training groups . At 24 weeks , CD had improved by 51 % and 57 % , and MWD had improved by 29 % and 31 % ( all P < .001 ) in the UL-Ex and LL-Ex groups , respectively . An increase in peak heart rate at MWD in the UL-Ex group ( 109 + /- 4 vs 115 + /- 4 beats/min ; P < .01 ) and LL-Ex group ( 107 + /- 3 vs 118 + /- 3 beats/min ; P = .01 ) was accompanied by an increase in the amount of pain experienced in both groups ( P < .05 ) , suggesting that exercising patients could tolerate a higher level of cardiovascular stress and an increased intensity of claudication pain before test termination after training . Patients assigned to exercise training also showed an increase in LCT peak VO2 at the 24-week time point in relation to baseline ( P < .01 ) and control patients ( P < .01 ) , whereas ACT peak VO2 was only improved in the UL-Ex group ( P < .05 ) . CONCLUSIONS Our results suggest that a combination of physiologic adaptations and improved exercise pain tolerance account for the improvement in walking performance achieved through upper-limb aerobic exercise training in patients with PAD . Furthermore , that both arm- and leg-crank training could be useful exercise training modalities for improving cardiovascular function , walking performance , and exercise pain tolerance in patients with symptomatic PAD Background This prospect i ve , r and omized , controlled clinical trial compared changes in primary outcome measures of claudication onset time ( COT ) and peak walking time ( PWT ) , and secondary outcomes of submaximal exercise performance , daily ambulatory activity , vascular function , inflammation , and calf muscle hemoglobin oxygen saturation ( StO2 ) in patients with symptomatic peripheral artery disease ( PAD ) following new exercise training using a step watch ( NEXT Step ) home‐exercise program , a supervised exercise program , and an attention‐control group . Methods and Results One hundred eighty patients were r and omized . The NEXT Step program and the supervised exercise program consisted of intermittent walking to mild‐to‐moderate claudication pain for 12 weeks , whereas the controls performed light resistance training . Change scores for COT ( P<0.001 ) , PWT ( P<0.001 ) , 6‐minute walk distance ( P=0.028 ) , daily average cadence ( P=0.011 ) , time to minimum calf muscle StO2 during exercise ( P=0.025 ) , large‐artery elasticity index ( LAEI ) ( P=0.012 ) , and high‐sensitivity C‐reactive protein ( hsCRP ) ( P=0.041 ) were significantly different among the 3 groups . Both the NEXT Step home program and the supervised exercise program demonstrated a significant increase from baseline in COT , PWT , 6‐minute walk distance , daily average cadence , and time to minimum calf StO2 . Only the NEXT Step home group had improvements from baseline in LAEI , and hsCRP ( P<0.05 ) . Conclusions NEXT Step home exercise utilizing minimal staff supervision has low attrition , high adherence , and is efficacious in improving COT and PWT , as well as secondary outcomes of submaximal exercise performance , daily ambulatory activity , vascular function , inflammation , and calf muscle StO2 in symptomatic patients with PAD . Clinical Trial Registration URL : Clinical Trials.gov . Unique Identifier : NCT00618670 Patients with atherosclerotic peripheral arterial disease ( PAD ) of the lower extremities have impaired walking ability due to exercise-induced muscle ischemia and the result ant pain of intermittent claudication . To evaluate the benefit of exercise training as a treatment for patients with PAD , as well as possible mechanisms associated with improvement , we r and omly assigned 19 men with disabling claudication to treated and control groups . Treatment consisted of supervised treadmill walking ( 1 hr/day , 3 days/wk , for 12 weeks ) with progressive increases in speed and grade as tolerated . Grade d treadmill testing was performed to maximal toleration of claudication pain on entry and after 12 weeks of training to define changes in peak exercise performance . After 12 weeks , treated subjects had increased their peak walking time 123 % , peak oxygen consumption 30 % , and pain-free walking time 165 % ( all p less than 0.05 ) . Control subjects had no change in peak oxygen consumption , but after 12 weeks , peak walking time increased 20 % ( p less than 0.05 ) . In treated subjects , maximal calf blood flow ( measured by a plethysmograph ) increased 38 + /- 45 % ( p less than 0.05 ) , but the change in flow was not correlated to the increase in peak walking time . Elevated plasma concentrations of acylcarnitines have been associated with the functional impairment of PAD and may reflect the metabolic state of ischemic skeletal muscle . In treated subjects , a 26 % decrease in resting plasma short-chain acylcarnitine concentration was correlated with improvement in peak walking time ( r = -0.78 , p less than 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Selected near-infrared spectroscopy ( NIRS ) parameters were assessed in healthy untrained participants and in peripheral arterial disease ( PAD ) trained patients to evaluate their usefulness in rehabilitative outcome . Forty-five PAD and 15 healthy participants were studied at entry and at 34 ± 2 weeks . Healthy participants performed their usual activities . Patients with PAD performed 2 home-based programs : structured at prescribed pace ( S-pre , n = 31 ) and unstructured at free pace ( U-free , n = 14 ) . We measured ankle – brachial index ( ABI ) , NIRS calf oxygen consumption at rest , NIRS dynamic muscle perfusion during an incremental test , and walking capacity . In all patients with PAD the NIRS parameters significantly increased approaching the stable values of untrained healthy participants . Among PAD , only S-pre group showed significant improvements in hemodynamic , functional , and NIRS parameters with selective adaptations in the worse legs . The assessment of NIRS parameters , that were found stable without training in healthy and modified in PAD only following structured training , might outline the local exercise-induced adaptations Supervised , hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease . However , it has been suggested that unsupervised , home-based exercise programs , which have been relatively little evaluated , would be equally efficacious as compared with hospital-based programs . The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise perfor mance more than a home-based program . Of 20 consecutively enrolled patients with claudication , 10 were r and omly placed into a supervised , hospital-based program and 10 into an unsupervised , home-based program for a three-month period .  Exercise perfor mance was evaluated by treadmill testing using a grade d protocol . In addition , func tional status was evaluated by the Walking Impairment Question naire ( WIQ ) and the Medical Outcomes Study SF-20 question naire ( MOS ) . Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit . Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with ( continued on next page ) the program . Patients in the hospital-based group improved peak walking time by 137 % , pain-free walking time by 150 % , and peak oxygen consumption by 19 % ( all P<0.05 ) . Patients reported an improved walking distance and speed according to WIQ data ( both P<0.05 ) . In addition , the MOS physical functioning score in the hospital-based group improved by 20 percentage points ( P<0.05 ) . In contrast , patients in the home-based program did not improve exercise performance measured on the treadmill . Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home- based program ( P<0.05 ) . The ability to walk distances was the only question naire measure that improved in persons who received the home-based program ( P<0.05 ) . Preliminary results suggest that a supervised , hospital-based program is more effective for improving treadmill exercise performance than an unsupervised , home-based program OBJECTIVES To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association ( NYHA ) class II and III patients and systolic heart failure ( HF ) . DESIGN R and omized controlled trial . SETTING Home based . PARTICIPANTS Stable patients ( N=24 ; mean age , 60 ± 10 y ; left ventricular ejection fraction , 25 % ± 9 % ; 50 % white ; 50 % women ) with New York Heart Association ( NYHA ) classes II and III ( NYHA class III , 58 % ) systolic heart failure ( HF ) . INTERVENTION A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise . Attention control wait list participants performed light stretching and flexibility exercises . MAIN OUTCOME MEASURES A 10-item performance-based physical function measure , the Continuous Scale Physical Functional Performance test ( CS-PFP10 ) , was the major outcome variable and included specific physical activities measured in time to complete a task , weight carried during a task , and distance walked . Other measures included muscle strength , HRQOL ( Minnesota Living With Heart Failure Question naire , Epworth Sleepiness Scale ) , functional capacity ( Duke Activity Status Index ) , and disease severity ( brain natriuretic peptide ) levels . RESULTS After the exercise intervention , 9 of 10 specific task activities were performed more rapidly , with increased weight carried by exercise participants compared with the attention control wait list group . Exercise participants also showed significant improvements in CS-PFP10 total score ( P<.025 ) , upper and lower muscle strength , and HRQOL ( P<.001 ) compared with the attention control wait list group . Adherence rates were 83 % and 99 % for the aerobic and resistance training , respectively . CONCLUSIONS Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach . Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify . Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population BACKGROUND In patients with intermittent claudication , a supervised walking exercise program increases peak exercise performance and community-based functional status .  Patients with peripheral arterial disease also have muscle weakness in the affected extremity that may contribute to the walking impairment . However , the potential benefits of training modalities other than walking exercise , such as strength training , have not been critically evaluated in this patient population . The present study tested the hypothesis that a strength training program would be as effective as treadmill walking exercise and that combinations of strengthening and walking exercise would be more effective than either alone in improving exercise performance . METHODS AND RESULTS Twenty-nine patients with disabling claudication were r and omized to 12 weeks of supervised walking exercise on a treadmill ( 3 h/wk at a work intensity sufficient to produce claudication ) , strength training ( 3 h/wk of resistive training of five muscle groups of each leg ) , or a nonexercising control group . Grade d treadmill testing was performed to maximally tolerated claudication pain to define changes in peak exercise performance . After 12 weeks , patients in the treadmill training program had a 74 + /- 58 % increase in peak walking time as well as improvements in peak oxygen consumption ( VO2 ) and the onset of claudication pain . Patients in the strength-trained group had a 36 + /- 48 % increase in peak walking time but no change in peak VO2 or claudication onset time . Control subjects had no changes in any of these measures over the 12-week period . After the first 12 weeks , patients in the initial walking exercise group continued for 12 more weeks of supervised treadmill training . This result ed in an additional 49 + /- 53 % increase in peak walking time ( total of 128 + /- 99 % increase over the 24 weeks ) . After the initial 12 weeks , patients in the strength-trained group began 12 weeks of supervised treadmill training , and patients in the control group participated in a 12-week combined program of strengthening and treadmill walking exercise . The combined strength and treadmill training program and treadmill training after 12 weeks of strength training result ed in increases in peak exercise performance similar to those observed with 12 weeks of treadmill training alone . CONCLUSIONS A supervised treadmill walking exercise program is an effective means to improve exercise performance in patients with intermittent claudication , with continued improvement over 24 weeks of training . In contrast , 12 weeks of strength training was less effective than 12 weeks of supervised treadmill walking exercise . Finally , strength training , whether sequential or concomitant , did not augment the response to a walking exercise program OBJECTIVES To compare the effects of two exercise programs on proxy- and performance-based measures of activities of daily living ( ADLs ) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia . DESIGN A parallel , three-group , single-blind , r and omized , controlled trial . SETTING Psychogeriatric wards . PARTICIPANTS Individuals with dementia ( mean age 85.6 ± 5.1 ) . INTERVENTIONS Each 9-week intervention consisted of thirty-six 30-minute sessions . A combined group ( n = 35 ) participated in two strength and two walking sessions , an aerobic group ( n = 35 ) participated in four walking sessions , and a social control group ( n = 35 ) participated in four nonexercise social visits per week . The social group was used as a reference for the mediation analysis , which was performed in the combined and aerobic groups . MEASUREMENTS ADLs were assessed using the Katz index ( proxy-reported ADL performance ) , Erlangen-ADL test ( E-ADL ) ( instrumental ADL performance ) , and 7-item Physical Performance Test ( PPT-7 ) ( physical ADL performance ) . RESULTS There was a group effect for Katz index ( P = .02 ) , E-ADL ( P < .001 ) , and PPT-7 ( P = .003 ) . Differences from baseline to after the intervention were similar in the combined and aerobic groups . Exercise-induced changes in global cognition mediated changes in Katz index ( 95 % confidence interval ( CI ) = 0.05 - 0.41 ) , leg muscle strength mediated changes in E-ADL ( 95 % CI = 0.03 - 0.43 ) , and leg muscle strength ( 95 % CI = 0.01 - 0.36 ) and walking endurance ( 95 % CI = 0.01 - 0.43 ) mediated changes in PPT-7 only in the combined group . CONCLUSION Physical exercise can improve ADL levels in individuals with dementia , but improvements are small and seem independent of exercise type . Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic-only exercise to effectively target ADL dysfunction in individuals with dementia . Future research is warranted to justify these exercise-specific findings PURPOSE In patients with intermittent claudication ( IC ) a structured walking exercise program improves exercise performance . However , few studies have evaluated the effects of exercise training on functional status during daily activities . We hypothesized that a supervised exercise training program would improve functional status in patients with IC , with 24 weeks of training more beneficial than 12 weeks . A secondary aim was to evaluate the effects of strength training and combinations of strength and treadmill training on functional status . METHODS Twenty-nine men with disabling IC were r and omized to 12 weeks of either supervised treadmill training ( 3 hr/wk at a work intensity sufficient to produce claudication ) , strength training ( 3 hr/wk of resistive training of six muscle groups of each leg ) , or to a nonexercising control group .  Functional status was assessed by question naires characterizing walking ability ( Walking Impairment Question naire , WIQ ) , habitual physical activity level ( Physical Activity Recall , PAR ) , and physical , social , and role functioning , well-being , and overall health ( Medical Outcomes Study SF-20 , MOS ) . Patients alos had their activity levels monitored with an activity monitor ( Vitalog ) . RESULTS After 12 weeks of treadmill training  PAR scores increased by 48 metabolic equivalent hr/wk , the MOS physical functioning score by 24 percentage points , and the number of bouts of walking activity measured by the Vitalog by 4.5 bouts/hr ( all p < 0.05 ) . No changes were seen in WIQ scores . After 12 additional weeks of treadmill training improvements initially observed in the PAR , MOS , and Vitalog scores were maintained , and in addition the ability to walk distances ( WIQ ) improved by 31 percentage points , and the IC severity score had improved by 29 percentage points ( both p < 0.05 ) . After 12 weeks of strength training patients improved their WIQ walking speed , stair climbing scores , and MOS well-being scores with no other changes in functional status . Subjects in the control group did not improve functional status by any measure . Twelve weeks of treadmill training after the strength training program maintained WIQ walking speed scores , and activity level defined by Vitalog improved . Twelve weeks of combined treadmill and strength training after the control period had no effect on functional status . CONCLUSIONS A supervised treadmill training program improved functional status during daily activities , with 24 weeks more effective than 12 . In addition , treadmill training alone was more effective in improving functional status in patients with IC than strength training or combinations of the training modalities The aim of the Odense training studies is to eluci date if regular physical training influences the expected decline in physical functional ability in order to assess capacity for postponing dependence in old age . All participants were healthy community-dwelling women representing three different age-cohorts of 65 , 75 and 85 year-old subjects . The 65 and 85 year-old participants of the training group took part in physical class-based exercises for eight months with one session of 60 min a week , whereas the 75 year-old women trained twice a week over eight months . The multicomponent training consisted of various exercises typically involving body awareness , rhythm , aerobic performance ( walking ) , muscle strength and muscle endurance , flexibility , reaction and balance exercises . Physical ability was measured as physical performance test ( PPT ) , isometric muscle strength of the trunk , hip and leg , aerobic capacity and walking speed . This shows that regular training can significantly improve physical ability of elderly women with regard to PPT , maximal oxygen uptake and maximal walking speed , suggesting that both young-old and old-old women are able to benefit from regular tailored exercise training . Thus , physical training of old community-dwelling women appears to represent a prophylactic remedy that merits further research aim ed at evaluating the preliminary findings of the present studies in larger , less selective groups of participants
Conclusion Although data are limited , there is a strong significant relationship between plantar flexor muscle strength and treadmill walking ability .
Background and Objective Exercise is a widely accepted treatment known to improve walking ability in persons with peripheral arterial disease ( PAD ) ; however , it has not been confirmed as to whether exercise improves fitness and performance-based function and , consequently , performance of activities of daily living ( ADL ) .
This systematic review aims to identify whether any mode of structured exercise improves physical fitness or performance-based tests of function and whether improvement in walking ability is related to an improvement in these outcomes .
Data Sources and Study Selection Eligible studies included r and omized controlled trials ( RCTs ) using an exercise intervention for the treatment of intermittent claudication with fitness ( including the 6-min walk ( 6MW ) , aerobic capacity , shuttle and muscle strength ) tests and performance-based tests of function as the outcomes .