Change In Walk Distance Research Articles

IP175. A Modified Activity Protocol for Claudication

Supervised exercise therapy (SET) programs are known to improve walking distance in patients with claudication. In this pilot study, we propose the use of a monitored step tracking device, the Fitbit (Fitbit, Inc) to supplant SET programs as a method to facilitate improvement in walking distance in Veterans with claudication. In this prospective study, we enrolled patients with clinical and radiographic evidence of lower extremity claudication to participate in our 6-month intervention. Each patient was given a FitBit device to track daily number of steps. Patients were seen in the clinic once monthly to set new walking distance goals and collect recorded data. Surveys were collected at the beginning and end of each study to assess patient perception of changes in walking distance as well as symptoms. Of the 48 patients enrolled, 12 patients have completed the 6 months. Of these patients, 100% carried a diagnosis of hypertension and hyperlipidemia. All but one patient was diabetic (91%), and all patients reported previous or current (42%) smoking history. A total of 21 patients did not complete the study due to loss of the Fitbit device or failure to follow-up, and 15 patients are actively enrolled with ongoing data collection. Of those that completed the study, the average number of steps during the initial month was 4799 with average improvement in daily steps at 286 (P = .50). While all but one patient (91%) believed their walking distance to have improved, only 42% (5 of 12) actually showed improvement from the first to last intervention month. In the Veteran population, the use of a monitored step tracking device is not an effective strategy to replace SET programs to improve walking distance in patients with claudication despite patient perception of improvement. Additional investigation is needed to better understand the optimal strategy for treatment of claudication in this population.

Padma 28 for intermittent claudication.

Intermittent claudication (IC) is pain caused by chronic occlusive arterial disease that develops in a limb during exercise and is relieved with rest. Most drug treatments of IC have a limited effect in improving walking distance. Padma 28, a Tibetan herbal preparation, has been used to treat IC, but there is debate as to whether Padma 28 produces a clinical benefit beyond the placebo effect. This is an update of a review first published in 2013. To determine whether Padma 28 is effective, compared with placebo or other medications, in increasing pain-free and maximum walking distance for patients with intermittent claudication. For this update the Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (September 2015), the Cochrane Register of Studies ((CENTRAL) (2015, Issue 8)) and clinical trials databases. Randomised controlled trials of Padma 28 compared with placebo or other pharmacological treatments in people suffering from IC. All review authors independently assessed the selected studies and extracted the data. Risk of bias was evaluated independently by two review authors. Depending on the data provided in the individual trials, we extracted mean or median walking distance at the end of the trial, or change in walking distance over the course of the trial, or both. Where not provided, and whenever possible, the statistical significance of differences in these parameters between treatment and placebo groups in individual trials was calculated. Where possible, data were combined by meta-analysis. No new trials were identified in the search for this review update. In total five trials involving 365 participants were included in this review. All trials compared Padma 28 with placebo for at least 16 weeks of follow-up. Pain-free and maximum walking distances both increased significantly in the groups treated with Padma 28, with no significant change in the placebo group. In general, the studies presented results comparing the treatment arms before and after treatment but made no comparisons between the Padma 28 and placebo groups. Pooled data of maximum walking distance after treatment with Padma 28 and placebo from two studies (193 participants) indicated a higher maximum walking distance (mean difference (MD) 95.97 m, 95% confidence interval (CI) 79.07 m to 112.88 m, P < 0.00001, very low quality evidence) in the Padma 28 group compared with placebo. The clinical importance of these observed changes in walking distance is unclear as no quality of life data were reported. There was no effect on ankle brachial index (ABI): change in ABI values between baseline and six months follow up MD -0.01, 95% CI -0.07 to 0.05, 1 study, 56 participants, P = 0.72, very low quality evidence). Mild side effects, especially gastrointestinal discomfort, tiredness and skin eruption, were reported but this outcome was not different between the Padma 28 and placebo groups (odds ratio 1.09, 95% CI 0.42 to 2.83, four studies, 231 participants, P = 0.86, very low quality evidence). Some evidence exists from individual trials to suggest that Padma 28 may be effective in increasing walking distances, at least in the short term (four months), in people with IC. Side effects do not appear to be a problem. However, the longer term effects of treatment are unknown and the clinical significance of the improvements in walking distance are questionable. Moreover, the quality of the evidence is limited by the small sample size of the available trials, limited reporting of statistical analyses that compared treatment groups, and relatively high withdrawal rates that were linked to the outcome. That is, patients were withdrawn if they failed to improve walking distance. There was also evidence of publication bias. We therefore feel there is currently insufficient evidence to draw conclusions regards the effectiveness of Padma 28 in the routine management of IC. Further well-designed research would be required to determine the true effects of this herbal preparation.

Walking Distance of Commuters after Modal Shift to Rail Transit in Bangkok

This paper investigates the walking distance of commuters in Bangkok who changed transport modes to rail transit, and examines the factors that may determine the degree of change in walking distance. The authors hypothesize that people walk a longer distance after the modal shift and that socioeconomic, trip characteristics, residential and job location choice affect the change in walking distance. The authors test the hypotheses by analyzing 1,020 commuter surveys, conducted at 34 stations of the Bangkok Mass Transit System, using regression techniques. The results suggest that people walk farther, averaging a 750-m increase, after modal shift. The regression results imply that socioeconomic characteristics, including gender, age, income and occupation, and trip characteristics, such as type of origin stations, significantly affect the degree of change in walking distance, while residential and job locations choice have a more limited impact on the change.

Effect of Angiotensin-Converting Enzyme Inhibitors on Physical Function in Elderly Subjects: A Systematic Review and Meta-Analysis.

Sarcopenia has been accepted as a new geriatric syndrome, which will become a common and important public health challenge. And angiotensin-converting enzyme inhibitors (ACEIs) have been shown to improve exercise capacity in elderly without heart failure. To evaluate the effect of angiotensin-converting enzyme inhibitors (ACEIs) on physical function in elderly. The Cochrane Library, PubMed, EMBASE and Web of Science were searched. All researches included were randomized controlled trials (RCTs) which compared any kind of ACEIs with placebo or other anti-hypertensives in elderly, and provided empirical data of grip strength and 6-min walk distance change from baseline. Risk of bias was systematically assessed by using the Cochrane risk of bias tool. Data of grip strength and 6-min walk distance change from baseline were collected and mean differences (MDs) were calculated along with 95% CI (confidence interval) by using a random effects model. In 3 RCTs including 337 elderly participants, ACEIs (n = 178) did not significantly improved 6-min walk distance (13.45, 95% CI: -16.71 to 43.61; P = 0.38) versus placebo or other antihypertensives (n = 159). In 3 RCTs including 499 elderly participants, grip strength was not significantly different (-0.67, 95% CI: -1.53 to 0.19; P = 0.12) between ACEIs (n = 260) and placebo or other antihypertensives (n = 239). There exists only 4 RCTs and the number of participants is limited. Pooling of data were from different trials including different participant characteristics. And intervention is not strictly consistent. This study shows that ACEIs can not significantly improve walk distance or the age-related decline of muscle strength for older participants in clinical trials.

Robot-Assisted Training Early After Cardiac Surgery.

To assess feasibility and safety of a robot-assisted gait therapy with the Lokomat® system in patients early after open heart surgery. Within days after open heart surgery 10 patients were subjected to postoperative Lokomat® training (Intervention group, IG) whereas 20 patients served as controls undergoing standard postoperative physiotherapy (Control group, CG). All patients underwent six-minute walk test and evaluation of the muscular strength of the lower limbs by measuring quadriceps peak force. The primary safety end-point was freedom from any device-related wound healing disturbance. Patients underwent clinical follow-up after one month. Both training methods resulted in an improvement of walking distance (IG [median, interquartile range, p-value]: +119 m, 70-201 m, p = 0.005; CG: 105 m, 57-152.5m, p < 0.001) and quadriceps peak force (IG left: +5 N, 3.8 7 N, p = 0.005; IG right: +3.5 N, 1.5-8.8 N, p = 0.011; CG left: +5.5 N, 4-9 N, p < 0.001; CG right: +6 N, 4.3-9.8 N, p < 0.001) in all participants. Results with robot-assisted training were comparable to early postoperative standard in hospital training (median changes in walking distance in percent, p = 0.81; median changes in quadriceps peak force in percent, left: p = 0.97, right p = 0.61). No deep sternal wound infection or any adverse event occurred in the robot-assisted training group. Robot-assisted gait therapy with the Lokomat® system is feasible and safe in patients early after median sternotomy. Results with robot-assisted training were comparable to standard in hospital training. An adapted and combined aerobic and resistance training intervention with augmented feedback may result in benefits in walking distance and lower limb muscle strength (ClinicalTrials.gov number, NCT 02146196).

Minimal important difference in field walking tests in non-cystic fibrosis bronchiectasis following exercise training

The 6-min walk distance (6MWD) and incremental shuttle walk distance (ISWD) are clinically meaningful measures of exercise capacity in people with non-cystic fibrosis (CF) bronchiectasis, but the change in walking distance which constitutes clinical benefit is undefined. This study aimed to determine the minimal important difference for the 6MWD and ISWD in non-CF bronchiectasis. Thirty-seven participants with mean FEV1 70% predicted completed both field walking tests before and after an 8-week exercise program. The minimal important difference was calculated using a distribution-based and anchor-based method, with the global rating of change scale used. The mean change in 6MWD in participants who reported themselves to be unchanged was 10m, compared to 36m (small change) and 45m (substantial change) (p=0.01). For the ISWD, the mean change in participants who reported themselves to be unchanged was 33m, compared to 54m (small change) and 73m (substantial change) (p=0.04). The anchor-based method defined the minimal important difference for 6MWD as 24.5m (AUC 0.76, 95% CI 0.61-0.91) and for ISWD as 35m (AUC 0.88, 95% CI 0.73-0.99), based on participant's global rating of change. The distribution-based method indicated a value of 22.3m for the 6MWD and 37m for the ISWD. There was excellent agreement between the two methods for the 6MWD (kappa=0.91) and the ISWD (kappa=0.92). Small changes in 6MWD and ISWD may represent clinically important benefits in people with non-CF bronchiectasis. These data are likely to assist in the interpretation of change in exercise capacity following intervention.

Prostanoids for intermittent claudication

Peripheral arterial disease (PAD) is a common cause of morbidity in the general population. While numerous studies have established the efficacy of prostanoids in PAD stages III and IV, the question of the role of prostanoids as an alternative or additive treatment in patients suffering from intermittent claudication (PAD II) has not yet been clearly answered. This is an update of a Cochrane Review first published in 2004. To determine the effects of prostanoids in patients with intermittent claudication (IC) Fontaine stage II. For this update, the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched January 2013) and CENTRAL (2012, Issue 12). Clinical trials databases were searched for details of ongoing or unpublished studies. In addition, reference lists of relevant articles were checked. Randomised clinical trials of prostanoids versus placebo or alternative ('control') treatment in people with intermittent claudication were considered for inclusion. Two authors independently assessed trial quality and extracted data. Primary outcomes included pain-free walking distance (PFWD) and maximum walking distance (MWD), presented as mean change in walking distance during the course of the trial (% improvement) and as final walking distance (that is walking distance, in metres, after treatment) for the prostanoid and control groups. Eighteen trials with a total of 2773 patients were included (16 in the original review and a further two in this update). As the majority of trials did not report standard deviations for the primary PFWD and MWD outcomes, it was often not possible to test for the statistical significance of any improvements in walking distance between groups. The quality of individual trials was variable and usually unclear due to insufficient reporting information. Comparison between trials was hampered by the use of different treadmill testing protocols, including different walking speeds and gradients. Such limitations in the data and the trial heterogeneity meant it was not possible to meaningfully pool results by meta-analysis.Four trials compared prostaglandin E1 (PGE1) with placebo; individual trials showed significant increases in walking distances with administration of PGE1 and in several trials the walking capacity remained increased after termination of treatment. Compared with pentoxifylline, PGE1 was associated with a higher final PFWD and MWD but these results were based on final walking distances rather than changes in walking distance from baseline. When PGE1 was compared with other treatments including laevadosin, naftidrofuryl and L-arginine, improvements in walking distances over time were observed for both PGE1 and the alternative treatment, but it was not possible from the data available to analyse statistically whether or not one treatment was more effective than the other.Six studies compared various preparations of prostacyclins (PGI2) with placebo. In one study using three different dosages of iloprost, PFWD and MWD appeared to increase in a dose-dependent manner; iloprost was associated with headache, pain, nausea and diarrhoea, leading to a higher rate of treatment withdrawal. Of three studies using beraprost sodium, one showed an improvement in PFWD and MWD compared with placebo while two showed no significant benefit. Beraprost sodium was associated with an increased incidence of drug-related adverse events. Of two studies on taprostene, the results of one in particular must be interpreted with caution due to an imbalance in walking capacity at baseline.Comprehensive, high quality data on outcomes such as quality of life, ankle brachial index, venous occlusion plethysmography and haemorrheological parameters were lacking. Whilst results from some individual studies suggested a beneficial effect of PGE1, the quality of these studies and of the overall evidence available is insufficient to determine whether or not patients with intermittent claudication derive clinically meaningful benefit from the administration of prostanoids. Further well-conducted randomised, double blinded trials with a sufficient number of participants to provide statistical power are required to answer this question.

Relationship Between Perceived and Measured Changes in Walking After Stroke

Examining participant-perceived change in walking provides insight into whether changes were meaningful for participants. This study examined the relationships between change scores in standardized walking outcomes and ratings of perceived change following exercise poststroke. Self- and fast-paced gait speed and Six-Minute Walk Test (6MWT) distance were assessed in 22 participants (age 67 ± 10.3 years, 1.8 ± 0.9 years poststroke) before and after a 3-month exercise program. Perceived changes were evaluated using a 15-point Likert scale. Correlation analyses between measured and perceived changes were performed. Subgroups of low and high baseline scores were compared for differences in measured and perceived changes. Six-Minute Walk Test change was correlated with perceived change (ρ = 0.52, P = 0.01), greater 6MWT change was demonstrated among participants who perceived improvement compared to those who did not (difference 34.4 m, 95% CI: 17.2-51.6, P = 0.04). After controlling for measured change, participants with low baseline 6MWT distances perceived less change than those who walked high distances at baseline (P = 0.006) even when relative change was equivalent. A global rating scale using meaningful and context-specific questions was used to determine the relationship between measured and participant-perceived changes in 6MWT distance. A meaningful difference in 6MWT change was observed between participants who did and those who did not perceive improvement. Individuals with lower baseline scores may require larger changes in walking distance to perceive that a change has occurred. This study contributes to a growing body of evidence about the relationships between perceived and measured changes in function and is a step in determining thresholds for perceived change in walking after stroke.

Behavioral Outcomes of an Educational Program For Male Veterans with Peripheral Artery Disease

Peripheral artery disease (PAD) affects 8 to 12 million Americans. Untreated PAD results in leg pain, decreased quality of life, and amputation of the legs. Walking has been shown to improve functional impairment and decrease pain among persons with PAD. This study describes a two-group randomized trial that assesses the effectiveness of an educational program, “Vet Walk,” on change in walking distance and health outcomes. The intervention is based on Pender's Health Promotion Model. Fifty male veterans with PAD completed the Health-Promoting Lifestyle Profile II (HPLP II) and 6-Minute Walk test and were randomly assigned to a control group or an intervention group who attended “Vet Walk.” Both groups completed testing at 8 weeks post-intervention. Outcome variables were statistically analyzed for differences between the intervention and control groups. The adjusted mean distance walked in the 6-Minute Walk test for the intervention group increased from 875.5 ft to 1095.5 ft, while the control group increased its adjusted mean walking distance from 826.7 ft to 848.3 ft at 8 weeks, which was a statistically significant difference. There were no statistically significant differences in HPLP II total scores and physical activity subscale scores between the intervention and control group. Although pain decreased in the intervention group, the change was not statistically significant. Among this sample of veterans diagnosed with PAD, the education intervention, “Vet Walk,” proved effective in increasing distance walked and, although not statistically significant, decreasing pain experienced over an 8-week period.

Significance of changes in endurance shuttle walking performance

BackgroundThe endurance shuttle walking test (ESWT) has shown good responsiveness to interventions in patients with chronic obstructive pulmonary disease (COPD). However, the minimal important difference (MID) for this test remains...

Correlation of six-minute walk test, pulmonary function test and radiation pneumonitis in the management of carcinoma of oesophagus: A prospective pilot study

AbstractPurpose: To correlate six-minute walk test (6MWT) and pulmonary function test (PFT) with incidence of radiation pneumonitis (RP) while treating patients with oesophageal cancer with conformal radiotherapy.Methods: Forty-five patients were selected to the study protocol. Pulmonary evaluation was done objectively by chest x-ray (CXR), 6MWT and PFT and subjectively by symptoms of cough, dyspnoea and fatigue. These tests were performed before radiation and then repeated at 1, 3, 6 and 9 months after treatment. The dose-volume histogram (DVH) was used to derive doses received by lung and organs at risk. χ2-test was used for calculating the p value.Results: The walk distance change (WDC) correlated with the changes in PFT values (p = 0.001) were done at 3 and 9 months after radiation, respectively. V30 values of ≥20% correlated with the incidence of acute pneumonitis (p = 0.007). 6MVT/vital capacity (VC) values of ≤4 ft/l had a correlation with the incidence of clinically symptomatic RP at 9 months.Conclusion: 6MWT and PFT are supplementary to each other for assessing the lung function status; but their individual role in predicting RP is weak. However, they are complementary to each other in assessing the risk of radiation-induced lung dysfunction.

Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication

The initial treatment for intermittent claudication is supervised exercise therapy (SET). Owing to limited capacity and patient transports costs of clinic-based SET, a concept of SET provided by local physiotherapists was developed. We hypothesized that provision of daily feedback with an accelerometer in addition to SET would further increase walking distance. This multicenter randomized trial was set in vascular surgery outpatient clinics and included 304 patients with intermittent claudication. Patients were randomized to exercise therapy in the form of "go home and walk" advice (WA), SET, or SET with feedback. Local physiotherapists provided SET. The primary outcome measure was the change in absolute claudication distance. Secondary outcomes were the change in functional claudication distance and results on the Walking Impairment Questionnaire (WIQ) and Short-Form 36 (SF-36) Health Survey after 12 months. In 11 centers, 102, 109, and 93 patients were included, respectively, in the WA, SET, and SET with feedback groups, and data for 83, 93, and 76, respectively, could be analyzed. The median (interquartile range) change in walking distance between 12 months and baseline in meters was 110 (0-300) in the WA group, 310 (145-995) in the SET group, and 360 (173-697) in the SET with feedback group (P < .001 WA vs SET). WIQ scores and relevant domains of the SF-36 improved statistically significantly in the SET groups. SET is more effective than WA in improving walking distance, WIQ scores, and quality of life for patients with intermittent claudication. Additional feedback with an accelerometer did not result in further improvement. SET programs should be made available for all patients with intermittent claudication.

The 6 minute walk in idiopathic pulmonary fibrosis: longitudinal changes and minimum important difference

RationaleThe response characteristics of the 6 minute walk test (6MWT) in studies of idiopathic pulmonary fibrosis (IPF) are only poorly understood, and the change in walk distance that constitutes the...

Assessment of Resynchronization Therapy on Functional Status and Quality of Life in Patients Requiring an Implantable Defibrillator

The effect of cardiac resynchronization therapy (CRT) on physical function and Quality of Life (QoL) in patients who require an implantable defibrillator but do not meet guideline criteria for CRT has not been studied in detail. This was a randomized study of 72 patients with high risk of sudden cardiac death, ejection fraction (EF) < or =35%, mild-to-moderate heart failure symptoms, and QRS > 120 ms. Patients received a CRT defibrillator and were randomized to CRT turned ON or OFF. Objective and subjective measures were performed at baseline and after 6 months. There was no difference in change in left ventricular end-systolic volume (ESV) by radionuclid angiogram scan, the primary endpoint, between the CRT ON group (DeltaESV =-7 +/- 52 mL), and CRT OFF group (DeltaESV =-30 +/- 47 mL). Similarly, echocardiogram measures of ESV and EF showed no difference between the two groups. In the CRT ON group, selected measures of QoL and subjective exercise tolerance but not heart failure symptoms improved significantly. Six-minute walk distance prolonged in the CRT ON group (baseline 313.6 +/- 114.4 m, 6-month 365.0 +/- 122.5 m, P = 0.01), but the difference in change in walk distance between the two groups was not significant. Further studies with larger sample size and longer follow-up will be required to allow definite conclusions regarding the potential benefit of CRT in this patient population.

Comparison of Walking Parameters and Cardiorespiratory Changes during the 6-Minute Walk Test in Healthy Sexagenarians and Septuagenarians

Background: The 6-minute walk test (6-MWT) is commonly used in research, with a focus on walking distance parameters rather than the physiological parameters. Even though it has been reported that the distance walked during the 6-MWT decreases with age, the adaptation of cardiorespiratory functions in healthy older adults remains to be studied. Objectives: The primary objective of this study was to compare the changes in walking distance and cardiorespiratory parameters during the 6-MWT in healthy sexagenarians and septuagenarians. A secondary objective was to determine the cardiorespiratory parameters and functional performance variables that best predict the distance covered during the 6-MWT. Methods: Ten healthy sexagenarians (G60, mean age 63.6 ± 3.3 years) and 10 septuagenarians (G70, mean age 76.0 ± 3.3 years) performed the 6-MWT while the distance, heart rate and oxygen uptake (VO₂) were recorded. The subjects also completed the Timed-Up-and-Go, the Berg Balance Scale and the Human Activity Profile to establish their functional level. Results: Results showed that G60 reached significantly greater (p < 0.05) distance and VO₂ values during the 6-MWT than G70. In contrast, the energy cost of walking (O₂ cost) and heart rate did not differ between the 2 groups. Correlational analyses of the combined groups revealed that VO₂ was the variable that showed the strongest correlation with walking distance during the 6-MWT. Conclusion: Results revealed that, while G60 achieved a greater level of walking performance than G70, the 2 groups maintained the same level of walking efficiency (O₂ cost) during the walk. Both groups adjusted their walking speed to have an oxygen consumption rate at a level sufficient to meet the energy demands of the task and prevent early exhaustion. Therefore, the 6-MWT appears to be a simple tool that can be used to assess cardiorespiratory parameters in older adults and be sensitive enough to detect differences between sexagenarians and septuagenarians.

The six‐minute walk test: a useful metric for the cardiopulmonary patient

Measurement of exercise capacity is an integral element in assessment of patients with cardiopulmonary disease. The 6-min walk test (6MWT) provides information regarding functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. A distance less than 350 m is associated with increased mortality in chronic obstructive pulmonary disease, chronic heart failure and pulmonary arterial hypertension. Desaturation during a 6MWT is an important prognostic indicator for patients with interstitial lung disease. The 6MWT is sensitive to commonly used therapies in chronic obstructive pulmonary disease such as pulmonary rehabilitation, oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. However, it appears less reliable to detect changes in clinical status associated with medical therapies for heart failure. A change in walking distance of more than 50 m is clinically significant in most disease states. When interpreting the results of a 6MWT, consideration should be given to choice of predictive values and the methods by which the test was carried out.

Predictors of Change in Walking Distance in Patients with Peripheral Arterial Disease Undergoing Endovascular Intervention

Endovascular treatment of peripheral artery disease is becoming frequent, yet the clinical factors which predict ambulatory outcomes are not known. To identify predictors of change in walking distance in patients who underwent endovascular intervention for their lower extremity peripheral arterial disease (PAD). A total of 134 patients underwent lower extremity peripheral arterial intervention, 52 patients were contacted via phone between 1 and 36 months (a mean of 22 mo) after their initial procedure. The remaining 82 patients were excluded due to the following reasons: death (n = 13), contact information was not available (n = 50), and refusal to participate in the follow-up (n = 19). The patients were 63 +/- 12 years old (mean +/- standard deviation [SD]), 46% were male, 47% were diabetics, 49% had coronary artery disease, of whom 29% had prior revascularization, and 22% had coronary artery bypass grafts (CABG). The disease severity described by Fontaine classification were as follows: 44.2% were in stage II, 15.4% were in stage III, and 40.4% were in stage IV. Walking distance was improved in 21% of patients, worsened in 73% of patients, and unchanged in 6% of patients. Stepwise multiple regression demonstrated that patients who started to walk or exercise (R = 0.372, P < 0.012) and who had a prior history of CABG (R = 0.467, P < 0.006) were the only independent predictors of the change in walking distance at follow-up. Those who started to walk reported worse walking distance at follow-up, while those with a history of CABG reported better walking distance at follow-up. CABG prior to endovascular intervention is predictive of favorable change in walking distance in patients with PAD at follow-up. Therefore, post-CABG patients are good candidates for exercise rehabilitation and risk factor modification.

The vascular and biochemical effects of cilostazol in patients with peripheral arterial disease

Cilostazol improves walking distance and quality of life in patients with peripheral arterial disease (PAD). This study assessed the vascular and biochemical effects of cilostazol therapy in PAD patients. PAD patients were prospectively recruited to a randomized, double-blinded, placebo-controlled trial. Baseline clinical data were recorded. Clinical assessment included measurement of arterial compliance, transcutaneous oxygenation, ankle-brachial index (ABI), and treadmill walking distance. Blood analyses included a full blood panel, coagulation screen, urea and electrolytes, liver function tests, estimated glomerular filtration rate, and lipid profiles. Quality of life indices were recorded using validated generic and walking-specific questionnaires. All tests were performed at baseline, 6, and 24 weeks. Eighty patients (53 men) were recruited from December 2004 to January 2006. The cilostazol group had a significant reduction in the augmentation index compared with the placebo group at 6 weeks (19.7% vs 26.7%, P = .001) and at 24 weeks (19.7% vs 27.7%, P = .005). A paradoxic reduction in transcutaneous oxygenation levels was identified in the cilostazol group for the left foot at 6 weeks and for the right foot at both 6 and 24 weeks. The ABIs were not significantly different between treatment groups at baseline, 6 weeks, or 24 weeks for the left and right lower limbs. The mean percentage change in walking distance from baseline improved more markedly in the cilostazol compared with the placebo group for absolute claudication distance at 6 (78.6% vs 26.4%, P = .20) and 24 weeks (173.1% vs 92.1%, P = .27); however, these failed to reach significance. Significant improvements in lipid profiles were demonstrated with cilostazol therapy at 6 weeks (triglycerides, high-density lipoprotein [HDL]) and at 24 weeks (cholesterol, triglycerides, HDL, and low-density lipoprotein). The cilostazol treatment group demonstrated significant improvements in the Short Form-36 (physical functioning, physical component score), Walking Impairment (distance and speed), and Vascular Quality of Life (pain) indices at 6 and 24 weeks. Although cilostazol was associated with side effects in approximately one-third of patients, most settled within 6 weeks, facilitating the continuation of therapy in >89%. Cilostazol is a well-tolerated, safe, and efficacious treatment for PAD patients. It not only improves patients' symptomatology and quality of life but also appears to have beneficial effects on arterial compliance, possibly through its lipid-lowering property.

Interpreting Changes in Endurance Shuttle Walking Performance

Rationale: The endurance shuttle walk has recently been shown to be highly responsive to both bronchodilation and pulmonary rehabilitation. The degree to which changes in endurance shuttle walking performance are perceptible to patients is unknown. &#x0D; &#x0D; Objective: To evaluate the relationship between objective and subjective measures of change in endurance shuttle walking performance. &#x0D; &#x0D; Methods: 129 comparison points were obtained from 69 patients with COPD (FEV1: 47±16%) who completed two or more endurance shuttle walking tests as part of a bronchodilation study. Patients were asked to rate their performance of the day in comparison to their previous performance on a 7&amp;S209; point scale ranging from -3 (large deterioration) to +3 (large improvement). These ratings were related to changes in walking distance and endurance time, expressed both as delta and percent change. &#x0D; &#x0D; Results: Patient ratings of change were significantly correlated with delta walking distance (r=0.44, P &lt; 0.001), delta endurance time (r=0.46, P &lt; 0.001), percent change in walking distance (r=0.54, P &lt; 0.001), and percent change in endurance time (r=0.55, P &lt; 0.001). Deteriorations in walking performance were perceived in 34% of cases, while improvements were detected in 81% of cases.&#x0D; &#x0D; Conclusion: Changes in endurance shuttle walking performance, especially improvements, are well perceived by patients with COPD. From this set of data, it should be possible to identify the smallest change in walking performance with a high likelihood of being perceived by the patients (MCID).

Medially Wedged Insoles Reduce Knee Pain During Functional Activities in Subjects with Lateral Knee Osteoarthritis

We have previously demonstrated that laterally wedged orthotics can alleviate knee pain in subjects with medial compartment knee osteoarthritis. However, this effect has not yet been demonstrated in subjects with lateral knee osteoarthritis (LKOA) using a medially wedged orthotic. PURPOSE: To determine the effect of medially wedged orthotics on knee pain and function in subjects with LKOA. METHODS: As part of a larger study, ten subjects aged 65± 7 years with LKOA (K-L grades II-IV) were chosen for evaluation. Subjects were given an orthotic with an individually determined amount of wedging (range 5–15 degrees, average 9 ± 3 degrees) based on maximum pain reduction during a lateral step-down test. Subjects returned for testing following two weeks of accommodation to the orthotic. Two functional tests were performed: a walking test to see how far the subject could walk in six minutes, followed by a stair test to determine how long the subject took to ascend and descend a twelve step flight of stairs. No wedge (NW) and wedge (W) conditions were tested in random order. Subjects were asked to rate their knee pain before and after each test on a 100mm visual analog scale, 0 being no pain and 100 being the worst pain imaginable. Dependent t-tests (p≤0.05) were used to assess changes in walking distance, stair test time, and knee pain between the NW and W conditions. RESULTS: There were no differences between the NW and W conditions for six minute walk distance (p=0.57) or stair test time (p=0.12). For the stair test, knee pain significantly increased in the NW condition (pre-test pain 14.9±18.7mm, post-test pain 22.6±21.3mm; p=0.02) while there was no change in pain for the W condition (pre pain 11±12.3mm, post pain 13.8±15.5mm; p=0.16). Similar results were found for the six minute walk, with pain increasing significantly in the NW condition (pre pain 13.4±15.5mm, post pain 22.9±17.8mm; p=0.005) but not in the W condition (pre pain 11±15.6mm, post pain 17±18.7mm; p=0.25). CONCLUSION: Short term accommodation to medially wedged orthotics, while not affecting objective measures of functional ability, appear to prevent increases in knee pain associated with walking and stair climbing in patients with lateral knee OA. Support from NIH-RR16548 (Thomas Buchanan, PI) is acknowledged.