Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication

Abstract

Background The role of strength training in peripheral arterial disease (PAD) is unclear. Benefits of supervised treadmill exercise in PAD patients without intermittent claudication (IC) are not established. Objective To determine whether supervised treadmill exercise and lower extremity resistance training, respectively, improve functional performance compared to a control group in PAD persons with and without IC. Design Randomized controlled clinical trial performed between 4/1/04 and 8/19/08. Participants 156 people with PAD (ankle brachial index ≤ 0.95), including 81.4% without IC. Measurements Primary outcomes were six-minute walk performance and the short physical performance battery (SPPB). Additional outcomes were brachial artery flow-mediated dilation (FMD), treadmill walking performance, the Walking Impairment Questionnaire (WIQ), and the Short-Form 36 Physical Functioning score (SF-36 PF). Interventions Three parallel arms: supervised treadmill exercise, supervised lower extremity resistance training, and a control group. Results Compared to control, the treadmill exercise group increased six-minute walk distance (+35.9 meters, 95% confidence interval (CI), +15.3 to +56.5; P <0.001), while the resistance trained group did not improve (+12.4 meters, 95% CI, −8.42 to +33.3; P=0.24). Neither exercise group improved the SPPB. Compared to control, treadmill exercise improved brachial artery FMD (+1.53%, 95% CI, +0.35 to +2.70, P=0.018), time on treadmill (+3.44 minutes, 95% CI, +2.05 to +4.84; P<0.001), the WIQ distance score P=0.015), and the SF-36 PF score (P=0.02). Compared to control, resistance training improved time on treadmill (+1.98 minutes, 95% CI, +0.56 to +3.39; P=0.007), the WIQ distance score (P=0.02), the WIQ stair climbing score (P=0.02), and the SF-36 PF score (P=0.04). Conclusion Supervised treadmill exercise improved six-minute walk distance, treadmill walking performance, brachial artery FMD, and quality of life, but not the SPPB, in PAD participants with and without classic IC symptoms. Resistance training improved treadmill walking performance, quality of life, and stair climbing ability in patients with PAD.

Effects of Three Methods of Exercise Training on Cardiovascular Risk Factors in Obese Boys

“…Several researches have shown that regular long term exercises with low to middle intensity can improve lipid profile risk factors (8,9). By contrast, some other researchers found no improvement in lipid profile after the endurance exercise training in childhood (10)(11)(12). Researchers suggested that endurance exercise training compared with resistance exercise training can increase fitness to perform daily activity and has more useful effects for individuals susceptible to cardiovascular diseases.…”

Peripheral arterial disease and chronic heart failure: a dangerous mix

“…Intermittent claudication often restricts patients from everyday living activities [26]. The impact of PAD on both functional and clinical outcomes was examined in the Heart Failure-A Controlled Trial Investigating Outcomes in Exercise Training (HF-ACTION) study cohort [1].…”

“…It is also recognised to be increasingly important to understand the clinical characteristics of participants and process and outcomes of chronic disease management programmes [25]. It is likely that individuals with CHF and PAD may have worse outcomes compared with patients without PAD [26]. This underscores the importance of considering coexisting conditions in planning of chronic disease management interventions.…”

Transcutaneous Electrical Nerve Stimulation Improves Walking Performance in Patients With Intermittent Claudication

“…8,9 Exercise therapy, particularly supervised, is a mainstay of PAD and IC management that has been shown to have a significant effect on increasing walking distance, self-reported physical activity, measured cardio-respiratory fitness, exercise time and functional ability. 3,[10][11][12][13][14][15][16] Despite the clear benefits of exercise therapy, over 45% of patients are non-compliant with healthcare professional advice to take regular exercise and to walk 'through' IC pain. 11 The pain associated with IC has been identified as a key barrier to walking.…”