Abstract
We compared the changes in ambulatory outcomes between men and women with symptomatic peripheral arterial disease (PAD) following completion of a supervised, on-site, treadmill exercise program, and we determined whether exercise training variables and baseline clinical characteristics were predictive of changes in ambulatory outcomes in men and women. Twenty-three men and 25 women completed the supervised exercise program, consisting of intermittent walking to mild-to-moderate claudication pain for three months. Men and women significantly increased claudication onset time (COT) (p < 0.001 and p < 0.01, resp.) and peak walking time (PWT) (p < 0.001 for each group). However, change in PWT was less in women (54%) than in men (77%) (p < 0.05). Neither group significantly changed 6-minute walk distance (6MWD). In women, baseline COT was the only predictor for the change in COT (p = 0.007) and the change in PWT (p = 0.094). In men, baseline COT (p < 0.01) and obesity (p < 0.10) were predictors for the change in COT, and obesity was the only predictor for the change in PWT (p = 0.002). Following a supervised, on-site, treadmill exercise program, women had less improvement in PWT than men, and neither men nor women improved submaximal, overground 6MWD. Furthermore, obese men and patients with lower baseline COT were least responsive to supervised exercise. This trial is registered with ClinicalTrial.gov, unique identifier: NCT00618670.
Highlights
Peripheral artery disease (PAD) is a highly prevalent [1], costly [2], and deadly condition [3]
A recent meta-analysis found that exercise training variables did not predict change in claudication onset time (COT) and peak walking time (PWT), but this study did not evaluate whether sexspecific differences existed in exercise training variables, and the analysis was conducted at the study level, which does not take into consideration individual patient differences
The primary findings were that (a) both men and women increased COT and PWT following the supervised, on-site, treadmill exercise program, but 6-minute walk distance (6MWD) did not change in either group, (b) women had a smaller absolute and relative increase in PWT than men, (c) obesity was a significant predictor for the change in COT and PWT in men, but not in women, and (d) baseline COT was a significant predictor for the change in COT and PWT in both men and women
Summary
Peripheral artery disease (PAD) is a highly prevalent [1], costly [2], and deadly condition [3]. PAD results in low patient-perceived health-related quality of life, primarily due to ambulatory leg pain and dysfunction [4]. Exercise rehabilitation improves claudication, ambulation, physical function, and quality of life [7,8,9,10], it is less clear whether the volume of exercise completed during a program of supervised exercise is predictive of a more favorable response in both men and women with PAD. We previously found that exercise-mediated improvements in claudication onset time (COT) and peak walking time (PWT) occur rapidly within the first two months of exercise rehabilitation, but this was primarily in men [11]. A recent meta-analysis found that exercise training variables did not predict change in COT and PWT, but this study did not evaluate whether sexspecific differences existed in exercise training variables, and the analysis was conducted at the study level, which does not take into consideration individual patient differences
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