Optimal exercise program length for patients with claudication

• Published in: Journal of vascular surgery 2012-05, Vol.55 (5), p.1346-1354
• Main Authors: Gardner, Andrew W., PhD, Montgomery, Polly S., MS, Parker, Donald E., PhD
• Format: Article
• Language: English
• Subjects: Aged; Baltimore; Biological and medical sciences; Chi-Square Distribution; Exercise Test; Exercise Therapy; Exercise Tolerance; Female; General and cellular metabolism. Vitamins; Humans; Intermittent Claudication - etiology; Intermittent Claudication - physiopathology; Intermittent Claudication - therapy; Male; Medical sciences; Middle Aged; Patient Compliance; Peripheral Arterial Disease - complications; Peripheral Arterial Disease - physiopathology; Peripheral Arterial Disease - therapy; Pharmacology. Drug treatments; Prospective Studies; Recovery of Function; Regional Blood Flow; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Walking
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.11.123

Background This prospective, randomized controlled clinical trial determined whether an optimal exercise program length exists to efficaciously change claudication onset time (COT) and peak walking time (PWT) in patients with peripheral artery disease and claudication. Methods The study randomized 142 patients to supervised exercise (n = 106) or a usual care control group (n = 36), with 80 completing the exercise program and 27 completing the control intervention. The exercise program consisted of intermittent walking to nearly maximal claudication pain 3 days per week. COT and PWT were the primary outcomes obtained from a treadmill exercise test at baseline and bimonthly during the study. Results After exercise, changes in COT ( P < .001) and PWT ( P < .001) were consistently greater than changes after the control intervention. In the exercise program, COT and PWT increased from baseline to month 2 ( P < .05) and from months 2 to 4 ( P < .05) but did not significantly change from months 4 to 6 ( P > .05). When changes were expressed per mile walked during the first 2 months, middle 2 months, and final 2 months of exercise, COT and PWT only increased during the first 2 months ( P < .05). Conclusions Exercise-mediated gains in COT and PWT occur rapidly within the first 2 months of exercise rehabilitation and are maintained with further training. The clinical significance is that a relatively short 2-month exercise program may be preferred to a longer program to treat claudication because adherence is higher, costs associated with personnel and use of facilities are lower per patient, and more patients can be trained for a given amount of personnel time and resource utilization.