Treatment efficacy of intermittent claudication by invasive therapy, supervised physical exercise training compared to no treatment in unselected randomised patients II: one-year results of health-related quality of life. Influence of the Physical Training on Muscle Function and Walking Distance in Symptomatic Peripheral Arterial Disease in Elderly Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease. SUPERvised exercise therapy or immediate PTA for intermittent claudication in patients with an iliac artery obstruction--a multicentre randomised controlled trial; SUPER study design and rationale. Gender differences following supervised exercise therapy in patients with intermittent claudication. A non-randomised controlled trial of the clinical and cost effectiveness of a Supervised Exercise Programme for claudication. Does supervised exercise offer adjuvant benefit over exercise advice alone for the treatment of intermittent claudication? A randomised trial. Changes in pain-free walking based on time in accommodating pain-free exercise therapy for peripheral arterial disease. Walking performance and health-related quality of life after surgical or endovascular invasive versus non-invasive treatment for intermittent claudication--a prospective randomised trial. The vascular nurse in practice: Results of prescribed exercise training in patients with intermittent claudication. The effects of exercise training on walking function and perception of health status in elderly patients with peripheral arterial occlusive disease. A randomised controlled trial of supervised exercise regimens and their impact on walking performance, skeletal muscle mass and calpain activity in patients with intermittent claudication. Physiological and functional impact of an unsupervised but supported exercise programme for claudicants. Long-term effects of structured home-based exercise program on functional capacity and quality of life in patients with intermittent claudication. Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication. A primary care walking exercise program for patients with intermittent claudication. The effect of supervised exercise and cilostazol on coagulation and fibrinolysis in intermittent claudication: a randomized controlled trial. Effects of a 6-month exercise program pilot study on walking economy, peak physiological characteristics, and walking performance in patients with peripheral arterial disease The constitutive procoagulant and hypofibrinolytic state in patients with intermittent claudication due to infrainguinal disease significantly improves with percutaneous transluminal balloon angioplasty. Randomized clinical trial comparing Nordic pole walking and a standard home exercise programme in patients with intermittent claudication Effective training for patients with intermittent claudication The influence of a long term exercise program on lower limb movement variability and walking performance in patients with peripheral arterial disease. Nordic pole walking improves walking capacity in patients with intermittent claudication: a randomized controlled trial
OBJECTIVE to compare the effectiveness of invasive therapy , supervised physical training and no treatment in terms of health-related quality of life ( HRQL ) in patients with intermittent claudication ( IC ) . DESIGN a prospect i ve , r and omised , controlled study . MATERIAL S a total of 253 unselected patients with stable IC were sequentially r and omised into 3 balanced treatment groups . At 1 year follow-up data from a battery of generic and disease specific HRQL question naires , and global indices of quality of life and physical condition were available in 171 patients . RESULTS compared with a non-diseased reference group , claudicants were substantially limited in daily physical functioning , but little affected regarding emotional , cognitive and social functioning , or well-being .  Invasive therapy yielded significantly greater improvements in some aspects of physical functioning and walk-related symptoms than training . Training was not superior to invasive therapy on any HRQL dimension and superior to no treatment on only one dimension . Treatment effects , however , were generally small-to-moderate and levels of physical dysfunction in all groups remained higher than reference values . CONCLUSIONS invasive therapy is more effective than supervised training in alleviating illness-specific symptoms and improving certain aspects of physical functioning - the primary HRQL domains impacted on by IC and the principal goals of its treatment . However , since treatment effect sizes were at most moderate and given that untreated claudicants reported at most small deterioration in HRQL , the level of evidence supporting invasive therapy is modest Introduction A typical symptom of chronic lower-limb ischaemia is lower-limb pain , which occurs during walking forcing the patient to stop , intermittent claudication ( IC ) .  Exercise rehabilitation is the basic form of treatment for these patients . Aim The aim of this study was to compare the effectiveness of three types of physical training programmes conducted over a 12-week period in patients with chronic lower-limb arterial insufficiency . Material s and Methods Ninety-five people qualified for the 3-month supervised motor rehabilitation programme , conducted three times a week . The respondents were assigned to three types of rehabilitation programmes using a pseudo-r and omization method : Group I ( TW ) , subjects undertaking treadmill walking training ; Group II ( NW ) , subjects undertaking Nordic walking training ; Group III ( RES+NW ) , subjects undertaking resistance and Nordic walking training . Treadmill test , 6 Minute Walk Test ( 6MWT ) , and  isokinetic test  were repeated after 3 months of rehabilitation , which 80 people completed . Results Combined training ( RES+NW ) is more effective than Nordic walking alone and supervised treadmill training alone for improving ankle force-velocity parameters ( p<0.05 ) in patients with intermittent claudication . Each of the proposed exercise rehabilitation programmes increased walking distance of patients with intermittent claudication ( p<0.05 ) , especially in 6MWT ( p=0.001 ) . Significant relationships of force-velocity parameters are observed in the maximum distance obtained in 6MWT , both in Group III ( RES + NW ) and in Group II ( NW ) at the level of moderate and strong correlation strength , which indicates that if the lower limbs are stronger the walking distance achieved in 6MWT is longer . Conclusions Given both the force-velocity parameters and the covered distance , the training RES + NW gives the most beneficial changes compared to training TW alone and NW alone . All types of training increased walking distance , which is an important aspect of the everyday functioning of people with IC OBJECTIVE The purpose of the study was to examine the effects of a 12-month exercise program on lower limb mobility ( temporal-spatial gait parameters and gait kinematics ) , walking performance , peak physiological responses , and physical activity levels in individuals with symptoms of intermittent claudication due to peripheral arterial disease ( PAD-IC ) . METHODS Participants ( n = 21 ) with an appropriate history of PAD-IC , ankle-brachial pressure index ( ABI ) < 0.9 in at least one leg and a positive Edinburgh claudication question naire response were prospect ively recruited . Participants were r and omly allocated to either a control PAD-IC group ( CPAD-IC )  ( n = 11 ) that received st and ard medical therapy and a treatment PAD-IC group ( TPAD-IC ) ( n = 10 ) , which also took part in a 12-month supervised exercise program . A further group of participants ( n = 11 ) free of PAD ( ABI > 0.9 ) and who were non-regular exercisers were recruited from the community to act as age and mass matched controls ( CON ) . Lower limb mobility was determined via two-dimensional video motion analysis . A grade d treadmill test was used to assess walking performance and peak physiological responses to exercise . Physical activity levels were measured via a 7-day pedometer recording . Differences between groups were analyzed via repeated measures analysis of variance ( ANOVA ) . RESULTS The 12-month supervised exercise program had no significant effect on lower limb mobility , peak physiological responses , or physical activity levels in TPAD-IC compared with CPAD-IC participants . However , the TPAD-IC participants demonstrated significantly greater walking performance ( 171 % improvement in pain free walking time and 120 % improvement in maximal walking time compared with baseline ) . CONCLUSION The results of this study confirm that a 12-month supervised exercise program will result in improved walking performance , but does not have an impact on lower limb mobility , peak physiological responses , or physical activity levels of PAD-IC patients INTRODUCTION Treatment of intermittent claudication ( IC ) due to peripheral arterial disease ( PAD ) is aim ed at improving walking distance and includes secondary prevention of cardiovascular disease . Both supervised exercise therapy ( SET ) and percutaneous transluminal angioplasty ( PTA ) have proven to be effective in increasing maximum and pain-free walking distance in IC . However , the optimal treatment strategy in patients with IC due to iliac artery stenosis or occlusion remains unclear . OBJECTIVE To compare the ( cost- ) effectiveness of initial PTA versus initial SET in patients with disabling IC due to an iliac artery obstruction . DESIGN In a multicentre r and omised controlled trial 400 consecutive patients with IC will be r and omly assigned to PTA ( with additional stent placement on indication ) or SET . Primary outcomes are maximum walking distance and health-related quality of life measured using the disease-specific VascuQol instrument after 1 year . Secondary outcomes are pain-free walking distance , functional status , generic quality of life , complications related to each of the interventions , additional interventions , treatment failures and costs ( cost-effectiveness and cost-utility ) after 1 year . CONCLUSION AND IMPLICATION S Based on the results of this proposed large study well-founded adjustments of existing guidelines on the treatment of iliac artery occlusive disease can be implemented ( Clinical Trials.gov NCT01385774 ; Nederl and s Trial Register NTR2776 ) OBJECTIVE Prevalence of peripheral arterial disease is equal in men and women . However , women seem to suffer more from the burden of disease . Current studies on gender-related outcomes following supervised exercise therapy ( SET ) for intermittent claudication ( IC ) yield conflicting results . METHODS A follow-up analysis was performed on data from the 2010 Exercise Therapy in Peripheral Arterial Disease ( EXITPAD ) study , a multicenter r and omized controlled trial including IC patients receiving SET or a walking advice .  The SET program was supervised by physiotherapists and included interval-based treadmill walking approximating maximal pain combined with activities such as cycling and rowing . Patients usually started with three 30-minute sessions a week . Training frequency was adapted during the following year on the basis of individual needs . The primary outcome was gender differences regarding the change in absolute claudication distance ( ACD ) after SET . ACD was defined as the number of meters that a patient had covered just before he or she was forced to stop walking because of intolerable pain . Secondary outcomes were gender differences in change of functional walking distance , quality of life , and walking (dis)ability after SET . Walking distances were obtained by  st and ardized treadmill testing  according to the Gardner-Skinner protocol . Quality of life was measured by the 36-Item Short Form Health Survey , and walking (dis)ability was determined by the Walking Impairment Question naire ( WIQ ) . Measurements were performed at baseline and after 3 , 6 , 9 , and 12 months . Only patients who met the 12-month follow-up measure were included in the analysis . RESULTS A total of 113 men and 56 women were available for analysis . At baseline , groups were similar in terms of clinical characteristics and ACD walking distances ( men , 250 meters ; women , 270 meters ; P = .45 ) . ACD improved for both sexes . However , ACD increase was significantly lower for women than for men during the first 3 months of SET ( Δ 280 meters for men vs Δ 220 meters for women ; P = .04 ) . Moreover , absolute walking distance was significantly shorter for women compared with men after 1 year ( 565 meters vs 660 meters ; P = .032 ) . Women also reported less on several WIQ subdomains , although total WIQ score was similar ( 0.69 for men vs 0.61 for women ; P = .592 ) . No differences in quality of life  after SET were observed . CONCLUSIONS Women with IC benefit less during the first 3 months of SET and have lower absolute walking distances  after 12 months of follow-up compared with men . More research is needed to determine whether gender-based IC treatment strategies are required OBJECTIVES The main aims of treatment in patients with intermittent claudication ( IC ) are to improve the clinical indicators of lower limb ischaemia and patients ' quality of life ( QoL ) . The aims of this study were assess the clinical and cost effectiveness of a supervised exercise programme ( SEP ) in patients with IC . DESIGN Non-r and omised , controlled trial . SETTING University teaching hospital . PATIENTS AND METHODS Two groups of patients with IC were studied . Seventy patients were sequentially recruited before and after the establishment of a Supervised Exercise Programme at our unit . Thirty-seven patients ( median age 69 years , 26 men ) received  conservative medical therapy ( CMT ) and 33 patients ( median age 67 years , 22 men ) received CMT plus a 3 month SEP of graduated physical exercise for sixty minutes , three times each week . Patients were assessed prior to and at 6 months following treatment . At each assessment patient reported walking distances ( PRWD ) , treadmill claudication and maximal distances ( ICD and MWD ) , ankle brachial pressure indices ( ABPI ) pre & post exercise and patient reported QoL using the SF36 question naire were assessed . RESULTS Prior to intervention the two groups were well matched . Following treatment , CMT patients demonstrated no significant change in PRWD or ICD but did record a small but significant improvement in MWD .  CMT was also associated with a negative effect size in the SF36 index and in 7 of the 8 SF36 QoL domains , effect size > -0.5 for the domains of Physical Function and Emotional Role . SEP patients demonstrated significant improvement in PRWD , ICD and MWD . SEP was associated with a positive effect size in the SF36 index and in 2 SF36 QoL domains but a negative effect size in a further 2 domains . However , all QoL effect sizes following SEP were < + /-0.5 . Intergroup differences in effect sizes were > 0.5 for the SF36 domains of Physical Function , Physical Role , Emotion Role and SF36 index . SEP result ed in a 0.027 quality adjusted life year ( QALY ) gain over CMT in the first year post-treatment thus the cost/QALY gained of SEP is pound1780 at 1 year . CONCLUSIONS Compared to CMT , SEP increases walking distances , improves QoL and is a highly cost-effective treatment for IC OBJECTIVE Exercise advice is the main treatment for symptom relief in the UK for patients with mild to moderate Intermittent Claudication ( IC ) . Would a weekly exercise and motivation class for 6 months offer adjuvant benefit over written and verbal exercise advice alone ? PATIENTS AND METHODS Fifty-nine patients attending a regional vascular centre for whom IC was the main factor affecting mobility were r and omised to either exercise advice alone ( n=30 ) or exercise advice with a once a week 45 min supervised exercise/motivation class ( n=29 ) . The mean age was 68 years . Baseline and 6-month assessment included a Quality of Life Question naire -- the Short-Form-36 , the Charing Cross Symptom Specific Claudication Question naire ( CCCQ ) and treadmill walking distance ( 3.5 km/h 12 % ) . RESULTS At 6-month follow-up the supervised exercise group had improved their treadmill walking by 129 % compared to 69 % in the advice alone group ( p=0.001 ) . This significant improvement was maintained at the subsequent 9 and 12-month follow-up assessment s. By the 9-month stage the advice only group CCCQ score had improved 16 % from baseline , while the supervised exercise group had a significantly better 43 % improvement in base line score ( p<0.05 ) . Self reported frequency of walks was higher in the exercise class group being significant for improvement in CCCQ score . CONCLUSION A weekly , supervised exercise and motivation class for a 6-month period provides a significant improvement in patients ' symptoms , quality of life , and distance walked compared with advice alone and this improvement continues after attendance at class has ceased Symptoms of intermittent claudication ( IC ) can be relieved by lifestyle modification , medications , and walking exercises . The intensity of the walking exercise is still debatable . The goal of this study was to determine the effects of accommodating pain-free walking exercise therapy program length on pain-free walking . A descriptive , longitudinal study with repeated measures of exercise capacity was conducted . An IC question naire was administered to assess IC signs , symptoms , and lifestyle . Walking was performed on a treadmill for 30 to 50 minutes below the participant 's individualized walking pain threshold . The study included patients diagnosed with IC due to peripheral arterial disease . All participants were r and omly assigned to three groups . Group A ( n = 28 ) participated in the walking program for 2 - 9 weeks , group B ( n = 30 ) for 10 - 14 weeks , and group C ( n = 26 ) for 15 - 94 weeks . The main outcome measure of the study was to determine changes in exercise capacity : walking distance ( miles ) , walking duration ( minutes ) , and walking speed ( mph ) . Group A increased the amount of distance , duration , and speed walked from pretest to posttest by 80 % ( P < .001 ) , 27 % ( P < .001 ) , and 37 % ( P < .001 ) , respectively . Group B increased the amount of distance , duration , and speed walked from pretest to posttest by 122 % ( P < .001 ) , 56 % ( P < .001 ) , and 43 % ( P < .001 ) , respectively . Group C increased the amount of distance , duration , and speed walked from pretest to posttest by 26 % ( P = .002 ) , 22 % ( P = .002 ) , and 5 % ( P = .541 ) respectively . We reached the conclusion that a walking program of 10 - 14 weeks is optimal for achieving the best improvements in walking distance , duration , and speed OBJECTIVES Despite limited scientific evidence for the effectiveness of invasive treatment for intermittent claudication ( IC ) , revascularisation procedures for IC are increasingly often performed in Sweden . This r and omised controlled trial compares the outcome after 2 years of primary invasive ( INV ) versus primary non-invasive ( NON ) treatment strategies in unselected IC patients . MATERIAL S/ METHODS Based on arterial duplex and clinical examination , IC patients were r and omised to INV ( endovascular and /or surgical , n = 100 ) or NON ( n = 101 ) . NON patients could request invasive treatment if they deteriorated during follow-up . Primary outcome was maximal walking performance ( MWP ) on grade d treadmill test at 2 years and secondary outcomes included health-related quality of life ( HRQL ) , assessed with Short Form ( 36 ) Health Survey ( SF-36 ) . RESULTS MWP was not significantly ( p = 0.104 ) improved in the INV versus the NON group . Two SF-36 physical subscales , Bodily Pain ( p < 0.01 ) and Role Physical ( p < 0.05 ) improved significantly more in the INV versus the NON group . There were 7 % crossovers against the study protocol in the INV group . CONCLUSIONS Although invasive treatment did not show any significant advantage regarding MWP , the HRQL improvements associated with invasive treatment tentatively suggest secondary benefits of this regimen . On the other h and , a primary non-invasive treatment strategy seems to be accepted by most IC patients Intermittent claudication ( IC ) is a mild stage of peripheral arterial disease that affects between 3 % and 7 % of the population and up to 1 in 5 patients over the age of 75 years . Risk factors such as hypertension , hyperlipidemia , diabetes , smoking , and genetics increase the incidence of peripheral arterial disease . Patients with IC have limitations in functional capacity and can benefit from regular exercise . Walking is the preferred mode of exercise and improves the symptoms of claudication in several ways . Vascular nurses can play an important role during exercise therapy . A personalized , home-based exercise program can be developed , and nurses can assist and motivate patients during follow-up periods . Helping patients to quit smoking and control other risk-factor modifications ( ie , high blood pressure and lipid levels ) also has high priority in daily practice of the vascular nurse . This prospect i ve study will illustrate the results of prescribed home-based exercise training by a vascular nurse on the maximum painless walking distance for patients with IC and will be applied to subgroups of vascular pathology OBJECTIVE To determine the effects of 12-week exercise programme on ambulatory function , free-living daily physical activity and health-related quality of life in disabled older patients with intermittent claudication . DESIGN Prospect i ve , r and omized controlled trial . SETTING University Medical Center and Veterans Affairs Medical Center , Taipei , Taiwan . SUBJECTS Thirty-two of 64 patients with Fontaine stage II peripheral arterial occlusive disease ( PAOD ) were r and omized to exercise training and 32 to usual care control .  Five patients from the exercise group and six patients from the control group dropped out , leaving 27 and 26 patients , respectively , completing the study in each group . INTERVENTIONS Twelve weeks of treadmill exercise training . MAIN OUTCOME MEASURES Treadmill walking time to onset of claudication pain and to maximal claudication pain , 6-min walk distance , self-reported ambulatory ability and perceived health-related quality of life ( QOL ) . RESULTS Compliance of exercise programme was 83 % of the possible sessions . Exercise training increased treadmill walking time to onset of claudication pain by 88 % ( P < 0.001 ) , time to maximal pain by 70 % ( P < 0.001 ) , and 6-min walk distance by 21 % ( P < 0.001 ) . SUBJECTS Perception of health-related QOL improved from 12 % to 178 % in the exercise group . These improvements were significantly better than the changes in the control group ( P < 0.05 ) . CONCLUSIONS Significant improvements in claudication following 12-week exercise training in elderly PAOD patients were observed . Increase in treadmill walking time to maximal claudication pain in these patients translated into the improvement of perceived physical health , which enabled the patients to become more functionally independent OBJECTIVES Supervised exercise training ( SET ) is recommended for patients with intermittent claudication ( IC ) . The optimal exercise programme has not been identified , and the potential adverse effects of exercise on these patients warrant consideration . Calpain proteases have been linked with tissue atrophy following ischaemia-reperfusion injury . High calpain activity may therefore cause muscle wasting in claudicants undergoing SET , and skeletal muscle mass ( SMM ) is integral to healthy ageing . This study assesses the impact of ( 1 ) treadmill-based SET alone ; and ( 2 ) treadmill-based SET combined with resistance training on pain-free walking distance ( PFWD ) , SMM , and calpain activity . METHODS Thirty-five patients with IC were r and omised to 12 weeks of treadmill only SET ( group A ) , or combined treadmill and lower-limb resistance SET ( group B ) . PFWD via a 6-minute walking test , SMM via dual energy X-ray absorptiometry , and calpain activity via biopsies of gastrocnemius muscles were analysed . RESULTS Intention-to-treat analyses revealed PFWD improved within group A ( 160 m to 204 m , p = .03 ) , but not group B ( 181 m to 188 m , p = .82 ) . There was no between group difference ( p = .42 ) . Calpain activity increased within group A ( 1.62 × 10(5 ) fluorescent units [ FU ] to 2.21 × 10(5 ) FU , p = .05 ) , but not group B. There was no between group difference ( p = .09 ) . SMM decreased within group A ( -250 g , p = .11 ) and increased in group B ( 210 g , p = .38 ) ( p = .10 between groups ) . Similar trends were evident for per protocol analyses , but , additionally , change in SMM was significantly different between groups ( p = .04 ) . CONCLUSIONS Neither exercise regimen was superior in terms of walking performance . Further work is required to investigate the impact of the calpain system on SMM in claudicants undertaking SET OBJECTIVES To evaluate an unsupervised home-based exercise programme for physiological , functional , and quality of life impact in patients with symptomatic peripheral arterial disease . DESIGN Prospect i ve cohort with exercise intervention . MATERIAL S Human performance laboratory with non-invasive haemodynamic assessment facilities . METHODS Forty-seven patients with symptomatic peripheral arterial disease ( mean age 67.6+/-7 years , 33 males ) participated in an unsupervised home-based exercise programme .  Heart rate ( HR ) , ankle brachial blood pressure index ( ABPI ) , leg blood flow ( BF ) , and blood lactate were measured before and after a grade d treadmill walk at baseline and after the 12-week exercise programme .  Maximum walking distance ( MWD ) during the treadmill walk was measured at baseline and 12 weeks . Exercise compliance , functional parameters , and quality of life ( VascuQoL ) were assessed by question naire . RESULTS MWD , leg BF , and VascuQoL scores increased significantly , while resting HR , exercise HR , and end of walk rate-pressure-product ( RPP ) decreased significantly after 12 weeks . Exercise compliance was significantly correlated with increase in MWD ( r=0.89 , p<0.001 ) and QOL score improvement ( r=0.61 , p<0.001 ) . CONCLUSIONS This supported but unsupervised exercise programme generated improvements in walking distance and leg blood flow without detectable increases in cardiorespiratory work . Exercise compliance is related to MWD and VascuQoL score in a dose-response manner OBJECTIVES To evaluate effects of a structured home-based exercise program on functional capacity and quality of life ( QoL ) in patients with intermittent claudication ( IC ) after 1-year follow-up , and to compare these results with those from a concurrent control group who received supervised exercise training ( SET ) . DESIGN Comparative longitudinal cohort study . SETTING Referral center . PARTICIPANTS Patients ( N=142 ) with IC . INTERVENTIONS Structured home-based exercise training or SET . MAIN OUTCOME MEASURES The maximum ( pain-free ) walking distance and the ankle-brachial index ( ABI ) ( at rest and postexercise ) were measured at baseline and after 6 and 12 months ' follow-up . Additionally , QoL was evaluated using a self-administered question naire consisting of the Euroqol-5D ( scale 0 - 1 ) , rating scale ( scale 0 - 100 ) , Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ; scale 0 - 100 ) , and the Vascular Quality of Life Question naire ( VascuQol ; scale 1 - 7 ) . Comparison of the groups was performed with adjustment for the nonr and omized setting using propensity scoring . RESULTS One hundred forty-two patients with IC started the  structured home-based exercise program , of whom 95 ( 67 % ) completed 12 months ' follow-up . The mean relative improvement compared with baseline was statistically significant after 12 months ' follow-up for the maximum and pain-free walking distance ( 342 % , 95 % confidence interval [ CI ] , 169 - 516 ; P<.01 and 338 % , 95 % CI , 42 - 635 ; P=.03 , respectively ) and for the ABI postexercise ( mean change , .06 ; 95 % CI , .01-.10 ; P=.02 ) . For the QoL outcomes , the improvement compared with baseline was statistically significant after 12 months for the VascuQol ( mean change , .42 ; 95 % CI , .20-.65 ; P<.01 ) and for the SF-36 physical functioning ( mean change , 5.17 ; 95 % CI , .77 - 9.56 ; P=.02 ) . Compared with the structured home-based exercise program , patients in the control group showed significantly better results in the mean relative improvement of maximum and pain-free walking distance and change in the ABI at rest after 12 months ' follow-up . CONCLUSIONS Structured home-based exercise training is effective in improving both functional capacity and QoL in patients with IC and may be considered as a feasible and valuable alternative toSET , since supervised exercise programs are not often available BACKGROUND Patients with intermittent claudication ( IC ) could benefit from low-cost , effective rehabilitative programs . This retrospective study evaluates compliance , impact on Quality of Life ( QoL ) and cost-effectiveness of a hospital prescribed , at-home performed ( Test-in/Train-out ) rehabilitative program for patients with IC . METHODS AND RESULTS Two-hundred and eighty-nine patients with IC ( 71 ± 10.1 years , M = 210 ) were enrolled for a 2-year period .  Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed , with serial check-ups at the hospital . Compliance with the program was assessed by assigning a score of 1 ( lowest compliance ) to 4 ( highest compliance ) . The SF-36 question naire and a constant-load treadmill test  were used to evaluate QoL and Initial/Absolute Claudication Distance , respectively . Both direct and indirect costs of the program were considered for cost-effectiveness analysis . Two-hundred and fifty patients ( 70.5 ± 9.2 years , M = 191 ) , at Fontaine 's II-B stage ( 86 % ) , were included in the study . No adverse events were reported . The average compliance score was 3.1 . At discharge , both SF-36 domains and walking performance significantly increased ( P < 0.0001 ) . A total of 1,839 in-hospital check-ups ( 7.36 /patient ) were performed . Direct and indirect costs represented 93 % and 7 % of the total costs , respectively . The average costs of a visit and of a therapy cycle were C68.93 and C507.20 , respectively . The cost to walk an additional meter before stopping was C9.22 . CONCLUSIONS A Test-in/Train-out program provided favourable patient compliance , QoL impact and cost-effectiveness in patients with IC PURPOSE In a pilot study , the hypothesis was tested that a home-based walking exercise program with structured coaching would improve walking performance and adherence in patients with intermittent claudication ( IC ) . METHODS Thirty-one IC patients with a rest ankle-brachial pressure index < 0.90 started a 24-wk walking program in the home environment . They were coached according to the Health Counseling Model ( HCM ) . Patients were instructed to walk at least 9 bouts.wk-1 and to walk through the pain . The main effect measures were pain-free ( initial claudication distance ( ICD ) ) and maximum walking distance ( absolute claudication distance ( ACD ) ) measured with a grade d treadmill test , a corridor exercise test , a  walking-diary  , and the score on the Walking Impairment Question naire ( WIQ ) . RESULTS Twenty-four participants completed the program . The reported walking frequency was 7.4 times.wk-1 . The average ICD improved from 289 m ( 95 % CI , 209 - 369 ) to 347 m ( 95 % CI , 244 - 449 ) ( P < 0.05 ) and from 241 m ( 95 % CI , 171 - 310 ) to 373 m ( 95 % CI , 273 - 472 ) on the treadmill and the corridor test , respectively . The average ACD improved from 490 m ( 95 % CI , 397 - 583 ) to 544 m ( 95 % CI , 438 - 650 ) and from 564 m ( 95 % CI , 412 - 717 ) to 726 m ( 95 % CI , 546 - 906 ) ( P < 0.01 ) on the treadmill and the corridor test , respectively . The average maximum distance reported in the walking-diary improved from 957 m ( 95 % CI , 291 - 1623 ) to 1294 m ( 95 % CI , 646 - 1941 ) . The score of the walking distance on the WIQ improved from 57 % ( 95 % CI , 42 - 71 % ) to 60 % ( 95 % CI , 46 - 74 % ) . CONCLUSION IC patients improved their average ICD and ACD . The walking exercise program in the home environment with coaching according to the HCM seems a promising intervention to be tested in a r and omized controlled trial BACKGROUND The prothrombotic , hypofibrinolytic state that develops in patients with intermittent claudication ( IC ) upon walking due to ischemia-reperfusion injury ( IRI ) of the leg muscles may contribute to the high incidence of life- and limb-threatening thrombotic events observed in this patient group . Treatments , such as angioplasty , that obtund the IRI also ameliorate the procoagulant diathesis . The effect on this diathesis of supervised exercise and cilostazol , both of which provide symptomatic benefit in IC , but without significantly obtunding IRI , is unknown . METHODS Thirty-four patients ( 27 men and 7 women ; median age , 67 years ; range , 63 - 72 years ) were r and omized to receive best medical therapy ( BMT ) plus supervised exercise ( n = 9 ) , BMT plus cilostazol ( n = 9 ) , BMT plus supervised exercise plus cilostazol ( n = 7 ) , or BMT alone ( n = 9 ) in a 2 x 2 factorial design . Thrombin-antithrombin complex and prothrombin fragments 1 and 2 , both markers of thrombin generation ; plasminogen activator inhibitor antigen and tissue plasminogen activator antigen , both markers of fibrinolysis ; ankle-brachial pressure index ( ABPI ) ; and initial and absolute claudication distance ( ACD ) were measured at baseline and then 3 and 6 months after r and omization . RESULTS At 6 months , when compared with receiving BMT only , supervised exercise and cilostazol result ed in improvements in ABPI of 18 % and 13 % and in ACD of 40 % and 64 % , respectively . The effects on ABPI and ACD of combining supervised exercise and cilostazol were additive . Supervised exercise , cilostazol , and supervised exercise combined with cilostazol had no significant effect on any of the four hemostatic markers . CONCLUSIONS Treatment of IC by supervised exercise or cilostazol results in significant improvements in ABPI and ACD but has no demonstrable effect on the prothrombotic diathesis . This suggests that supervised exercise and cilostazol , unlike angioplasty , are unlikely to have a long-term beneficial effect on the thrombotic risks faced by these patients The purpose of this study was to examine the effects of a 6-month exercise program on submaximal walking economy in individuals with peripheral arterial disease and intermittent claudication ( PAD-IC ) . Participants ( n = 16 ) were r and omly allocated to either a control PAD-IC group ( CPAD-IC , n = 6 ) which received st and ard medical therapy , or a treatment PAD-IC group ( TPAD-IC ;  n = 10 ) which took part in a supervised exercise program . During a grade d treadmill test , physiological responses , including oxygen consumption , were assessed to calculate walking economy during submaximal and maximal walking performance . Differences between groups at baseline and post-intervention were analyzed via Kruskal – Wallis tests . At baseline , CPAD-IC and TPAD-IC groups demonstrated similar walking performance and physiological responses . Postintervention , TPAD-IC patients demonstrated significantly lower oxygen consumption during the grade d exercise test , and greater maximal walking performance compared to CPAD-IC . These preliminary results indicate that 6 months of regular exercise improves both submaximal walking economy and maximal walking performance , without significant changes in maximal walking economy . Enhanced walking economy may contribute to physiological efficiency , which in turn may improve walking performance as demonstrated by PAD-IC patients following regular exercise programs BACKGROUND Patients with intermittent lower limb claudication ( IC ) exhibit a prothrombotic diathesis that is acutely exacerbated by exercise . This may occur because of ischemia/reperfusion injury within the leg muscles during walking and may contribute to the increased risk of thrombotic vascular events in this group of patients . This r and omized study compared the effect of lower limb revascularization by percutaneous transluminal balloon angioplasty ( PTA ) , supervised exercise , and best medical therapy ( BMT ) alone on this prothrombotic state . METHODS Twenty-three patients ( 16 men and 7 women ; median age , 67 years ; range , 57 - 77 years ) with IC due to infrainguinal disease were r and omized to receive BMT alone ( n = 7 ) , BMT plus PTA ( n = 9 ) , or BMT plus supervised exercise ( n = 7 ) as part of the Health Technology Assessment -funded EXercise vs Angioplasty in Claudication Trial ( EXACT ) . Patients were assessed at baseline and at 3 and 6 months . Thrombin-antithrombin complex ( TAT ) was determined as a marker of thrombin generation , and plasminogen activator inhibitor ( PAI ) antigen was determined as a marker of fibrinolysis . Increased TAT indicates a procoagulant state , and increased PAI antigen indicates a hypofibrinolytic state . RESULTS At 6 months , subjects r and omized to BMT plus PTA demonstrated a significant improvement in ankle-brachial pressure index ( P = .013 ) and maximal walking distance ( P = .008 ) , a significant decline in resting thrombin generation ( median [ interquartile range ] TAT , 6.4 microg/L [ 2.7 - 13.5 microg/L ] to 1.5 microg/L [ 0.3 - 2.9 microg/L ] ; P = .038 ) , and an improvement in resting fibrinolysis ( median [ interquartile range ] PAI-1 , 10.0 ng/mL [ 1.0 - 20.5 ng/mL ] to 1.0 ng/mL [ 1.0 - 14.8 ng/mL ] ; P = .043 ) . There was no significant change in any of these parameters in patients r and omized to BMT plus supervised exercise or to BMT alone . CONCLUSIONS The addition of lower limb revascularization by PTA to BMT in patients with IC due to infra-inguinal disease results in a medium-term improvement in the resting procoagulant and hypofibrinolytic state . This may translate into a reduction in morbidity and mortality from thrombotic vascular events in this group of patients This was a r and omized clinical trial to determine whether Nordic pole walking ( NPW ) is more effective in improving walking distance than a st and ard home exercise programme ( HEP ) in patients with intermittent claudication Objective . Current guidelines for treatment of intermittent claudication ( IC ) do not include a specific recommendation for the intensity of exercise therapy . Thus , the purpose of this study was to determine the relative effectiveness of high versus low intensity exercise for patients with IC , and further to study the effect of such training on blood flow to the legs during exercise . Design . The effect of eight weeks of supervised endurance training was examined in 16 patients with IC . The patients were r and omly assigned to training at intensities corresponding to either 60 % or 80 % of their peak oxygen consumption ( VO2peak ) , respectively . Results . VO2peak and time to exhaustion increased significantly ( 9 % and 16 % , respectively ) more in the high intensity group ( p<0.05 ) . Blood flow to the legs did not change after training in any of the groups . Conclusion . High intensity training gave larger improvements in VO2peak and time to exhaustion than low intensity training . As blood flow did not change after the exercise program , it is likely that the observed different increase of VO2peak was due to changed mitochondrial oxidative capacity and /or skeletal muscle diffusive capacity The purpose of this study was to examine the effects of a 12month exercise program on lower limb movement variability in patients with peripheral arterial disease ( PAD ) . Participants ( n=21 ) with an appropriate history of PAD and intermittent claudication ( IC ) volunteered for this study and were r and omly allocated to either a control group ( CPAD-IC ) ( n=11 ) , which received normal medical therapy and a treatment group ( TPAD-IC ) ( n=10 ) , which received normal medical therapy treatment and a 12month supervised exercise program . All participants underwent 2D joint angular kinematic analysis during normal walking to assess lower limb movement variability and walking speed . Between-group differences were analyzed via mixed measures ANOVA . The 12month supervised exercise program made no significant impact on the lower limb movement variability or walking speed of the TPAD-IC group as determined by either intralimb joint coordination or single joint analysis techniques . Long term supervised exercise programs do not appear to influence the lower limb movement variability of PAD-IC patients Abstract Purpose : The aim of the study was to compare the efficacy of Nordic pole walking ( NPW ) training with traditional treadmill training ( TT ) on a claudication ( CD ) and maximum walking distance ( MWD ) in patients with peripheral arterial disease ( PAD ) . Method : Patients with intermittent claudication ( IC ) ( n = 70 ; age=68.27 ) in the Fontaine class II were r and omized into a two three-month rehabilitation programs performed three times per week . TT were finished by 31 patients , NPW by 21 . Walking capacity was measured by an  exercise treadmill test ( ETT ) with the Gardner – Skinner protocol ( before and after the program ) and  six minute walk test ( 6MWT ) ( before , during and after the program ) . Results : In an ETT both groups reached significant increase in CD and MWD ( p ≤ 0.005 ) . In 6MWT NPW group reached significant increase in both CD ( p = 0.001 ) and MWD ( p = 0.001 ) , whereas the TT group only in MWD ( p = 0.001 ) . Conclusions : NPW has been shown to be as effective as the st and ard TT and is much less expensive . It should be the preferred method of exercise for PAD patients with IC . Implication s for Rehabilitation Nordic walking training is a valuable form of rehabilitation for peripheral arterial disease ( PAD ) patients with intermittent claudication ( IC ) . Nordic walking has been shown to be as efficient as traditional treadmill training . It is however more cost-effective method of rehabilitation in PAD patients
The effect of exercise compared with placebo or usual care was inconclusive on mortality , amputation and peak exercise calf blood flow due to limited data .
Angioplasty may produce greater improvements than exercise in the short term but this effect may not be sustained .
Exercise programmes were of significant benefit compared with placebo or usual care in improving walking time and distance in selected patients with leg pain from IC
BACKGROUND Exercise programmes are a relatively inexpensive , low-risk option compared with other more invasive therapies for leg pain on walking ( intermittent claudication ( IC ) ) .
OBJECTIVES To determine the effects of exercise programmes on IC , particularly in respect of reduction of symptoms on walking and improvement in quality of life .