Efficacy of arm-ergometry versus treadmill exercise training to improve walking distance in patients with claudication

Abstract

The efficacy of treadmill walking training to improve pain-free (PFWD) and maximal (MWD) walking distance in patients with claudication is well documented. The effects of aerobic arm-ergometry to improve PFWD and MWD compared to treadmill walking or usual care are not known. Forty-one participants (29 male, 12 female, mean age 67.7 years, 92.7% smoking history, 36.6% with diabetes) with lifestyle-limiting claudication were randomized to 12 weeks of 3 hours/week of supervised exercise training using either arm-ergometry, treadmill walking, or a combination, versus control. PFWD and MWD were assessed before and after training, and after 12 weeks of follow-up. The 12-week MWD increased significantly in the arm-ergometry (+53%), treadmill (+69%), and combination (+68%) groups (p < 0.002 versus control). The 24-week MWD was maintained in the arm-ergometry (p = 0.009) and treadmill (p = 0.019) groups, whereas the combination group declined (p = 0.751) versus control. The 12-week PFWD increased significantly in the arm-ergometry group (+82%; p = 0.025 versus control). Change in PFWD in treadmill (+54%; p = 0.196 versus control) and combination (+60%; p = 0.107 versus control) groups did not reach statistical significance. PFWD improvement was maintained in the arm-ergometry group after a 12-week follow-up (+123%; p = 0.011 versus control). In conclusion, these pilot data demonstrate for the first time that dynamic arm exercise training can improve walking capability in people with peripheral arterial disease (PAD)-induced claudication compared to participants receiving usual care and that improvement was not different from that seen with treadmill walking exercise training. Dynamic arm exercise may be a therapeutic exercise option for patients with PAD.

Upper versus lower limb exercise training in patients with intermittent claudication: A systematic review

“…However, they were encouraged to maintain an active lifestyle possibly including engagement in unsupervised training. The amount of unsupervised exercise was only monitored by Bronas et al 25 and Treat-Jacobson et al 28 .…”

“…Baseline and final measurements also included an incremental shuttle walk test with a standard protocol, 26,[29][30][31] or a symptom-limited graded cardiopulmonary treadmill exercise test (GXT). 25,28 To determine UL/LE maximum power 31 25 Saxton et al 29 and Walker et al 31 limited the assessment to a pre-and a post-training test. Saxton et al 26 were the only who implemented an additional follow-up assessment at 48 and 72 weeks.…”

The Completeness Of Intervention Descriptions In Randomised Trials Of Supervised Exercise Training In Peripheral Arterial Disease

“…Only one main publication described a modification to a supervised exercise programme after recruitment had commenced (Item 10): Parmenter and colleagues explained that the leg press exercise was dropped from both of their resistance training programmes after one participant had experienced exacerbation of a heel fissure while using it [26]. Only 7 interventions (9%), across 5 publications [12,[27][28][29][30], reported on planned strategies to enhance intervention fidelity besides direct supervision (Item 11). These strategies included use of an intervention oversight committee [12], an educational component promoting regular exercise [28,29], and allowing participants to make up missed sessions [27].…”

“…Only 7 interventions (9%), across 5 publications [12,[27][28][29][30], reported on planned strategies to enhance intervention fidelity besides direct supervision (Item 11). These strategies included use of an intervention oversight committee [12], an educational component promoting regular exercise [28,29], and allowing participants to make up missed sessions [27]. Procedures for assessing adherence or fidelity were described for only 31 (41%) interventions.…”

Applied methods of exercise based therapy for the extension of walking distance in patients with intermittent claudication

“…Patients who were prescribed this form of training in conjunction with ambulatory training showed a superior tolerance to exertion as well as improvements in gait cycle performance [24][25][26][27].…”