ORIGINAL ARTICLES   

International Angiology 2000 March;19(1):8-13

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English

Exercise training in intermittent claudication

Gibellini R., Fanello M., Ferrari Bardile A., Salerno M., Aloi T.

From the "Salvatore Maugeri" Foundation, IRCCS, Rehabilitation Institute, Section of Angiology, Montescano (PV) Italy * Division of Cardiology, Tradate (VA) Italy

Background. Peripheral arte­ri­al occlu­sive dis­ease (PAOD) at II stage ­results in a mod­er­ate to ­severe impair­ment in walk­ing abil­ity. Aim of this study, con­trolled and ran­dom­ized, was to eval­u­ate the effi­ca­cy of an inten­sive 4 weeks exer­cise train­ing in PAOD fol­lowed by a six-­month peri­od and to ana­lyse the risk fac­tors for ath­ero­scler­o­sis and the site of the ­lesion for pos­sible pre­dic­tors of ­result out­come.
Methods. Patients with PAOD were includ­ed in the study (ankle/arm ratio ≤0.7 and ≤0.5 after exer­cise) with ­initial claud­i­ca­tion dis­tance (ICD) ≤200 m and abso­lute claud­i­ca­tion dis­tance (ACD) ≤500 m eval­u­at­ed on a con­stant-load tread­mill test (3 km/hr, 0% slope). Forty ­patients were ran­dom­ized (all with anti­plate­let ther­a­py): 20 to a super­vised walk­ing exer­cise (mean ICD 121.8 m, ACD 289.7 m) and 20 to a non exer­cis­ing con­trol group (ICD 111.6 m, ACD 230.1 m). Both ­groups were test­ed at 4 weeks (T1) and 6 ­months (T2). Training group was ­enrolled in a 4-week super­vised train­ing pro­gram.
Results. In the train­ing group 10% of ­patients ­became asymp­to­mat­ic (>1000 m). At T1 ICD ­increased 141% (p<0.001) and ACD was with low-pain-claud­i­ca­tion >1000 m in 50%, at T2 ICD was 200% (p<0.05) with 70% of asymp­to­mat­ic for ICD and ACD. Control group has a no sig­nif­i­cant ­increase of ICD and ACD at T1 and T2. Only arte­ri­al hyper­ten­sion and inter­mit­tent claud­i­ca­tion sever­ity ­emerged as neg­a­tive pre­dic­tive fac­tors for the ­results of train­ing.
Conclusions. Vascular train­ing pro­duc­es a sig­nif­i­cant and last­ing improve­ment in walk­ing dis­tance in PAOD.