Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response.

Abstract

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 randomized 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. Graded 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 resulted 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 resulted 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.

Evaluation of Patients with Lower Extremity Peripheral Artery Disease by Walking Tests: A Pilot Study

“…In Hiatt's study, also confirmed by other studies, is revealed that if a patient walks on a Treadmill 3 hour per week during 12 weeks, his/her performance improves within 24 months and the improvements are even higher compared to the strength training (3 hours/week of resistive training of five muscle groups of each leg) (Hiatt et al, 1994;Libby et al, 2007;Regensteiner et al, 2002). This underlines the importance of exercises in the evolution of PAD and that a sedentary life style will badly influence the natural course of the disease (Craft et al, 2008;Acampa et al, 2016;Gibbons et al, 2002).…”

Avaliação da reprodutibilidade de testes funcionais na doença arterial periférica

“…Os portadores de DAP sintomáticos possuem passo encurtado, cadência lenta e deficit no equilíbrio, motivando a redução do desempenho, da velocidade de caminhar e da capacidade de percorrer longas distâncias 2,[5][6][7][8][9][10][11][12] . Pacientes com DAP grave caminham com velocidades reduzidas para conseguir percorrer maiores distâncias 13 .…”

“…Vários autores demonstraram que os portadores de DAP têm pico de consumo de oxigênio 50% menor do que indivíduos normais, contribuindo para a redução do desempenho durante o exercício e a restrição na capacidade de realizar atividades domiciliares 2,8,12,14 . Os pacientes que apresentam CI têm suas atividades de vida diária reduzidas e baixa qualidade de vida 1,2,6,10 .…”

“…Essa redução na força contribui para o prejuí-zo funcional durante a deambulação 2,[5][6][7][8]10,11,12,16 .…”

Treatment of Intermittent Claudication due to Peripheral Arterial Disease

“…The optimal exercise program for improving claudication pain distance in patients with peripheral arterial disease uses intermittent walking to near-maximal pain during a program of at least 6 months [17]. Strength training is not as effective as a treadmill walking program [18]. A home-based walking exercise program significantly improved walking endurance, physical activity, and speed in patients with peripheral arterial disease and should be used by patients unwilling to participate in a supervised exercise training program [19].…”