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Rivista di Angiologia
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2004 Dicembre;23(4):379-87
Training guided by pain threshold speed. Effects of a home-based program on claudication
Manfredini F., Conconi F., Malagoni A. M., Manfredini R., Basaglia N., Mascoli F., Liboni A., Zamboni P.
Vascular Diseases Center, University of Ferrara, Ferrara, Italy
Aim. To verify the effectiveness of a 120 day home-based program guided by the pain threshold speed (PTS).
Methods. Twenty-nine patients with stable claudication were measured for ankle pressure (AP), ankle-brachial index (ABI), PTS, maximal speed (Smax) on treadmill. Daily walking sessions at a speed 20-30% below PTS were prescribed. Determination of the training speed was supervised and facilitated at home. The program included a daily record of exercise data and symptoms, an intermediate PTS re-evaluation to adjust the training speed, and the reassessment of all the parameters after 120 days.
Results. Overall patients showed a reduction of systemic blood pressure (151.3±14.3 to 147.6±18.3 mmHg; 77.1 ±9.1 to 72.4±8, p=0.008) while AP did not. ABI increased from 0.65±0.13 to 0.71± 0.18 (p=0.01). PTS and Smax rose from 3.2±1.1 to 4.2±1.5 km/h (p=0.0001) and from 3.9±1.3 to 4.6±1.3 km/h (p=0.0001), respectively. According to their compliance, patients were divided into 3 groups: 1) trained (T, n=14): exercise at the prescribed speed, 2) free-walkers (FW, n=7): walking speed markedly below PTS and 3) untrained (U, n=8): incomplete program compliance. T group showed symptom reduction up to pain disappearance. The ABI change (0.72±0.09 to 0.82± 0.16, p<0.02) was correlated to AP increase (r= 0.879). PTS and Smax rose from 3.6±1.1 to 5.4±0.8 km/h (p<0.02) and from 4.7±1.2 to 5.7±0.7 (p<0.02), respectively. FW showed improvement of all parameters, and U a better walking efficiency.
Conclusion. In patients with claudication, a low-cost home-based program driven by PTS allows dramatic improvements of functional parameters.