Maximal Walking Time Research Articles

Effects of prolonged and maintenance strength training on force production, walking, and balance in aging women and men

To examine effects of 21-week twice/week strength training (ST) period followed by an additional 21-week twice or once/week ST period on force production, walking and balance in aging people. Seventy-two women (58 ± 7 years; W) and 63 (58 ± 6 years) men (M) were randomized for the first 21-week ST period: STW and STM, control (C) CW and CM. Training participants were randomized for the second 21-week ST period: once/week STWx1 and STMx1, twice/week STWx2 and STMx2. LegPress, isometric leg extension rate of force development (RFD), walking time, and balance. First 21-week ST period: leg press, RFD, balance, and walking improved significantly in STW and STM. Second 21-week ST period: leg press first increased in STMx1 and STMx2, and then decreased to the level of 21 weeks in STMx2 and remained unchanged in STWx2 and decreased in STWx1 and STMx1. Walking and balance improved significantly in STWx1 and STWx2. A progressive 21-week ST period twice/week in aging people can lead to large improvements in maximal strength, walking time, and balance in both genders. A further strength training period with the same amount of training may maintain the strength gains, whereas balance and walking may be maintained with less training.

Nutritional Supplementation during Resistance Training Improved Skeletal Muscle Mass in Community-Dwelling Frail Older Adults.

Sarcopenia, the age-related loss of skeletal muscle mass, is highly prevalent in older adults. The aim of this study was to investigate the effects of the combination of resistance training and multinutrients supplementation (including vitamin D and protein) on muscle mass and physical performance in frail older adults. This trial was conducted in Japanese frail older adults (n=77), which underwent a standardized protocol of a 3-month physical exercise intervention. The sample population was divided into two groups, according to the adoption (S/Ex: n = 38) or not (Ex: n = 39) of the additional multinutrient supplementation. The outcome measures of interest for the present analyses were the skeletal muscle mass index (SMI) and several physical performance tests. Participants in S/Ex group had significant improvements for the outcome measures, including SMI and maximum walking time (P<0.05), compared to those in Ex group. The prevalence of sarcopenia decreased from 65.7% to 42.9% in S/Ex group, while that in Ex group remained unchanged (68.6% to 68.6%) (relative risk = 1.60, 95% CI: 1.03-2.49). The results of this study suggest that the combination of resistance training and multinutritional supplementation may be more effective at improving muscle mass and walking speed than an intervention only based on resistance training.

Exercise training in intermittent claudication: Effects on antioxidant genes, inflammatory mediators and proangiogenic progenitor cells

Exercise training remains a therapy of choice in intermittent claudication (IC). However, too exhaustive exercise may cause ischaemic injury and inflammatory response. We tested the impact of three-month treadmill training and single treadmill exercise on antioxidant gene expressions, cytokine concentrations and number of marrow-derived proangiogenic progenitor cells (PPC) in the blood of IC patients. Blood samples of 12 patients were collected before and after training, before and 1, 3 and 6 hours after the single exercise. PPCs were analysed with flow cytometry, cytokine concentrations were checked with Milliplex MAP, while expression of mRNAs and miRNAs was evaluated with qRT-PCR. Treadmill training improved pain-free walking time (from 144 ± 44 seconds [s] to 311 ± 134 s, p=0.02) and maximum walking time (from 578 ± 293 s to 859 ± 423 s, p=0.01) in IC patients. Before, but not after training, the single treadmill exercise increased the number of circulating CD45dimCD34+CD133-KDR+ PPCs (p=0.048), decreased expression of HMOX1 (p=0.04) in circulating leukocytes, reduced tumour necrosis factor-α (p=0.03) and tended to elevate myeloperoxidase (p=0.06) concentrations in plasma. In contrast, total plasminogen activator inhibitor-1 was decreased by single exercise only after, but not before training (p=0.02). Both before and after training the single exercise decreased monocyte chemoattractant protein (MCP)-1 (p=0.006 and p=0.03) concentration and increased SOD1 (p=0.001 and p=0.01) expression. Patients after training had also less interleukin-6 (p=0.03), but more MCP-1 (p=0.04) in the blood. In conclusion, treadmill training improves walking performance of IC patients, attenuates the single exercise-induced changes in gene expressions or PPC mobilisation, but may also lead to higher production of some proinflammatory cytokines.

Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study.

Our main objective was to assess whether a home-based program supervised by home helpers (HH) during their normal working hours can prevent excessive sedentariness (mainly maximum walking time and distance) and preserve functional status in elderly people at risk for frailty or disability and using domestic services. A four-month, open label, randomised trial with two groups called "prevention" and "control". In the homes of study participants. The participants were all over 78 years old, lived independently at home, and received the visits of HHs at least once a week. The intervention combined a self-administered exercise program, with 10 g amino-acid supplementation under the supervision of HHs. Main outcome measures included physical activity (the PASE questionnaire), functional tests, nutritional and autonomy scores, and compliance (50% or more was considered satisfactory). Non-parametric methods were used for comparisons between the two groups. A linear regression model was fitted to assess the effect of the intervention on the relative variation of outcomes, adjusted for unbalanced baseline co-variables. One hundred and two persons (prevention n=53, control n=49) with a median age of 85 years were included. Their median Activities of Daily Living and Instrumental Activities of Daily Living (IADL) scores were 6 and 7 respectively. Twenty-three (44%) were good compliers for both interventions. The maximum walking time remained stable while decreasing by 25% in the control group (p=0.0015); and fewer participants had a worsened IADL score in the prevention group (p=0.05). The baseline IADL Score was significantly associated with good compliance to the prevention program (p=0.0011). In good compliers, maximum walking distance and maximum walking time increased by 29.15% (0.0 to 66.7) and 33.3% (-20.0 to 50.0) respectively. This study confirms the feasibility of a prevention program supervised by HHs, and some benefit from the intervention and identifies predictors for better compliance. It will help in the design of prevention trials for elderly people at risk for frailty.

Self-reported estimation of usual walking speed improves the performance of questionnaires estimating walking capacity in patients with vascular-type claudication

Most questionnaires do not estimate the usual walking speed of the patient, although it is well known that patients may experience apparently different walking capacities if walking slow or fast. We hypothesized that correcting the self-reported estimated walking capacity by a coefficient issued from the self-reported estimation of usual walking speed would significantly improve the correlation between questionnaire-estimated and treadmill-measured walking capacity. Three hundred ten consecutive patients complaining of vascular-type claudication were asked to estimate their usual walking speed in comparison to people of their age (or friends or relatives) with ratings ranging from much slower (1 pt) to much faster (5 pts), in addition to the filling out of the walking impairment questionnaire (WIQ) and the estimated ambulatory capacity by history questionnaire (EACH-Q). Corrected WIQ (WIQc) and corrected EACH-Q (EACH-Qc) scores were obtained by multiplying the scores of each questionnaire by the "usual-speed" coefficient and dividing by 5. Results for questionnaire scores were compared to maximal walking time (MWT) on a treadmill. All but four patients self-completed the usual-speed question. Median scores (25-75 centiles) were 41% (26-59) for the WIQ and 24% (11-41) for the EACH-Q. Coefficients of correlation of the three WIQ subscales and of the EACH-Q with treadmill results were significantly improved after correction by the "usual-speed" question. Overall, WIQ (mean of the three WIQ subscales) tended to improve but did not reach significance. Correcting the self-reported estimation of walking capacity by a self-reported estimation of usual walking pace significantly improves the correlation of all WIQ subscale scores and of the EACH-Q score with treadmill measurements of capacity. This confirms the interest of speed estimation in patients with peripheral arterial occlusive disease and claudication.

Factors That Delay COPD Detection in the General Elderly Population

In patients with COPD, early detection and rapid treatment are essential to prevent its progression and exacerbations. To identify factors that delay COPD detection. We conducted a cross-sectional study of elderly COPD patients and healthy subjects in rural Japan. We measured respiratory and physical function (hand grip force, maximum inspiratory pressure, maximum expiratory pressure, total trace length, and toe grasp force), walking ability, and quality of life (QOL, measured with a visual analog scale). We conducted spirometry in 408 subjects, whom we divided into 2 groups: those whose ratio of FEV(1) to forced vital capacity (FVC) was < 70% (the airway-obstruction group, n = 60), and those whose FEV(1)/FVC was ≥ 70% (the healthy-subjects group, n = 348). To avoid confounding, we then matched 60 subjects from the healthy-subjects group to the 60 in the airway-obstruction group for age, sex, height, and smoking history, so both groups had 60 subjects. Physical function was significantly inferior in the airway-obstruction group. Variables reflecting instantaneous walking ability (maximum walking speed and walking time in the 10-m hurdle walk) were significantly inferior in the airway-obstruction group, but there were no significant differences in 6-min-walk test, which reflects walking endurance, or in QOL. Walking endurance, QOL, and proximal muscle strength in the extremities of patients with COPD were well preserved, which prevented detection of COPD and hampered the subjects' motive for seeking medical care. In consequence, lack of awareness impeded the early detection of COPD. In primary healthcare for the general elderly population, spirometry is much easier to conduct than physical function tests, so we recommend that spirometry screening programs for early-stage COPD detection and staging.

Discrimination Of Health Status Based On Physical Fitness In Community-dwelling And Frail Elderly

In the progress of elderly society, it is important to live an independent life. However, in recent years the number of people who need care increases rapidly in Japan. Therefore, it is necessary to reveal physical fitness level which can live an independent life. However, researches that indicate the boundary between community-dwelling and frail elderly were not conducted enough. PURPOSE:The purpose of this study was to derive discriminant coefficient from physical fitness test results in community-dwelling and frail elderly. METHODS: The subjects were 110 older adult (78.5+/-5.7yrs). The subjects were divided into two groups: 47 community-dwelling older adults (75.3+/-4.5yrs) who could move freely without any walking devices and 63 frail elderly (80.9+/-5.3yrs) who need support or care. All subjects participated in a 8-item test battery of physical performance; functional reach (FR), grip strength (G), tandem (Ta), one leg balance with eyes open (LB-O), 30-sec chair stand test (30-C), timed up&go (U&G), 10m maximal walking time (10m-W) and maximal step (MS). It was stepwise discriminant analysis that analysis method used to calculate discriminant coefficient. RESULTS: As the results of stepwise discriminant analysis, three-item test (30-C, 10m-W, G) were extracted. Discriminant coefficient was as follows: z=0.124× (30-C)-0.215× (10m-W) +0.065× (G)-1.752. The discriminant had a discrimination rate of 91.5%. Each value, distinguish community-dwelling from frail elderly, were 30-C (16 times), 10m-W (7.1 sec) and G (20 kg). CONCLUSIONS: These results showed physical fitness level which would live an independent life, suggested that would become the goal of rehabilitation for frail elderly.

Modifications in transcutaneous oxygen pressure in ischemic limbs after successful PTA

Foot and chest transcutaneous oxygen pressure (TcPO2), the regional perfusion index (RPI = foot TcPO2/chest TcPO2), and the ankle/brachial systolic blood pressure index (ABI) were calculated before and after successful percutaneous transluminal angioplasty (PTA) in 36 limbs with intermittent claudication and in 8 with rest pain. In patients affected by intermittent claudication pain-free (PFWT) and maximum walking times (MWT) and the half-recovery time (HRT) to TcPO2 basal values after an induced ischemia were also determined. After PTA, rest pain disappeared in the 8 severely ischemic lower limbs and significant differences were observed in the RPI, which increased by 215% from 0.19 ± 0.10 to 0.60 ± 0.13 (p<0.0001). In patients with intermittent claudication the RPI and the TcPO2 HRT in particular improved significantly (p<0.0001) (RPI: from 0.68 ± 0.18 to 0.85 ± 0.20; HRT: from 120 ± 27 to 75 ± 37 s). These modifications were associated, in the 24 patients who performed a standard treadmill test, with the disappearance of claudication or with a significant improvement in their walking capacity. The ABI was not calculated in 12 limbs because the arteries could not be compressed but it significantly improved in the other limbs in the stage II peripheral arterial occlusions disease (PAOD) patients. These results indicate that substantial increases in TcPO2 parameters can be observed after successful PTA and that these measurements are an appropriate noninvasive method of assessing the results of revascularization procedures.

The effect of pain-free treadmill training on fibrinogen, haematocrit, and lipid profile in patients with claudication

To assess the effect of pain-free treadmill training on changes of plasma fibrinogen, haematocrit, lipid profile, and walking ability in patients with claudication. Randomized control trial. Sixty-eight patients with peripheral obstructive arterial disease and intermittent claudication (Fontaine stage II) were randomly assigned into the treadmill training (repetitive intervals to onset of claudication pain, three times a week) or a control group (no change in physical activity) over 3 months. Both groups performed treadmill test to assess pain-free walking time (PFWT) and maximal walking time (MWT) and had blood analyses [for haematocrit, fibrinogen, triglycerides, and cholesterol: total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL)] done at baseline and after 6 and 12 weeks of the study. Total and LDL cholesterol levels in the training group decreased (p < 0.05) by 14.8% and 20,5%, respectively. Significant (p < 0.05) HDL cholesterol increased (14.6%) and triglycerides decreased (19%) in the training group but changes of all these lipids were insignificant in the control group over the 3 months. Haematocrit and fibrinogen changes were insignificant in both groups. PFWT was prolonged by 109% and MWT increased by 54% in the training group (p < 0.01), but not in the control group. The improvement in walking time over 3 months of pain-free treadmill training parallels with progressive normalization of lipid profiles in patients with claudication.

Treadmill test is limited in elderly patients with peripheral arterial disease

To describe the applicability and the performance of the treadmill test in elderly patients with peripheral arterial disease (PAD) and without PAD (non-PAD). Fifty consecutive PAD and non-PAD elderly patients performed a progressive treadmill test. The proportion of patients who were unable to perform the test and the maximal walking distance were obtained. The proportion of patients who were unable to perform the treadmill test was similar between PAD (16.6 %) and non-PAD patients (12.5 %), P = .57. Maximal walking time for patients who performed the treadmill test was not different between PAD (232 +/- 218 s) and non-PAD patients (308 +/- 289 s), P = .37. The treadmill test is limited in almost 20 % of elderly patients with PAD and non-PAD. These results highlight the need for other forms of exercise stress tests in order to assess the peripheral limitation of patients with PAD.

The ankle-brachial index is associated with the magnitude of impaired walking endurance among men and women with peripheral arterial disease

Previous reports suggest that the severity of peripheral arterial disease (PAD), measured by the ankle-brachial index (ABI), is not associated with the magnitude of walking impairment, measured by treadmill testing. These prior studies have had small sample sizes and included only PAD participants with symptoms of intermittent claudication. We studied the association of the ABI with diverse measures of walking performance in a cross-sectional study of 156 participants with PAD with and without intermittent claudication symptoms. Outcomes included the Gardner-Skinner treadmill test, 6-minute walk, 4-meter walking velocity at usual and fastest pace, and the walking impairment questionnaire (WIQ). Adjusting for age, sex, race, comorbidities, leg symptoms, and other confounders, lower ABI values were associated with shorter distance achieved in the 6-minute walk (ABI < 0.50: 286 meters; ABI 0.50-0.70: 316 meters; ABI 0.71-0.95: 355 meters, p trend < 0.001), shorter maximal treadmill walking time (ABI < 0.50: 6.0 minutes; ABI 0.50-0.70: 6.9 minutes; ABI 0.71-0.95: 8.3 minutes, p trend = 0.009), and lower WIQ distance scores (p trend = 0.007) among PAD participants. The ABI was not associated significantly with walking velocity over 4 meters, treadmill time to onset of leg symptoms, or the WIQ speed or stair-climbing scores. In conclusion, among 156 participants with PAD with and without intermittent claudication, lower ABI values are associated significantly with poorer walking endurance, assessed by three distinct measures. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00106327.

Beta Blockers for Peripheral Arterial Disease

To quantify the potential harm of beta blockers in patients with peripheral arterial disease. All randomised controlled trials (RCTs) comparing beta blockers with placebo for the outcomes of claudication and maximal walking distance and time, calf blood flow, vascular resistance and skin temperature were searched using the Cochrane Controlled Trials Register, PubMed and CINAHL. Trials comparing different types of beta blockers were excluded. Six RCTs fulfilling the above criteria, with a total of 119 patients, were included. The beta blockers studied were atenolol, propranolol, pindolol and metoprolol. None of the trials showed a statistically significant worsening effect of beta blockers on the outcomes measured. There were no reports of any adverse events with the beta blockers studied. Currently, there is no evidence to suggest that beta blockers adversely affect walking distance in people with intermittent claudication. Beta blockers should be used with caution if clinically indicated, especially in patients with critical ischaemia where acute lowering of blood pressure is contraindicated.

Six‐year prospective study of physical fitness and incidence of disability among community‐dwelling Japanese elderly women

To identify physical fitness factors associated with occurrence of disability requiring long-term care and reviewing physical fitness factors to identify threshold values at which future care risk is expected to rise rapidly. This prospective cohort study included 74-88-year-old women who were living at home and who reported no disability in activities of daily living. The subjects completed 16 physical fitness tests, assessing walking ability, muscular strength, flexibility, agility and balance, and participated in a follow-up interview 6 years later. Among the 60 subjects who were not disabled at baseline and who participated in the 6-year follow up, 28 subjects were certified to have a disability necessitating long-term care after 6 years. Among the 16 physical fitness tests, 13 measures showed a significant association with the necessity of care. Maximum walking time and ankle dorsiflexion range of motion (ROM) were identified as main physical fitness factors associated with later necessity of care using a multiple logistic regression model. After adjustment for age, each subject's probability of occurrence of disability necessitating care was calculated using a logistic equation. The probability rose rapidly to more than 80% when 10 m maximum walking of 74-78-year-old subjects was 10 s. For 80-88-year-old subjects, the probability rose rapidly to more than 80% when the time was at 9 s. As ankle dorsiflexion ROM narrowed, the probability rose gradually. Ability to walk rapidly is an indicative main physical fitness marker for predicting the independence of elderly women.

Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication

Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease (PAD) without intermittent claudication have been established as beneficial. To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication. Randomized controlled clinical trial performed at an urban academic medical center between April 1, 2004, and August 8, 2008, involving 156 patients with PAD who were randomly assigned to supervised treadmill exercise, to lower extremity resistance training, or to a control group. Six-minute walk performance and the short physical performance battery. Secondary outcomes were brachial artery flow-mediated dilation, treadmill walking performance, the Walking Impairment Questionnaire, and the 36-Item Short Form Health Survey physical functioning (SF-36 PF) score. For the 6-minute walk, those in the supervised treadmill exercise group increased their distance walked by 35.9 m (95% confidence interval [CI], 15.3-56.5 m; P < .001) compared with the control group, whereas those in the resistance training group increased their distance walked by 12.4 m (95% CI, -8.42 to 33.3 m; P = .24) compared with the control group. Neither exercise group improved its short physical performance battery scores. For brachial artery flow-mediated dilation, those in the treadmill group had a mean improvement of 1.53% (95% CI, 0.35%-2.70%; P = .02) compared with the control group. The treadmill group had greater increases in maximal treadmill walking time (3.44 minutes; 95% CI, 2.05-4.84 minutes; P < .001); walking impairment distance score (10.7; 95% CI, 1.56-19.9; P = .02); and SF-36 PF score (7.5; 95% CI, 0.00-15.0; P = .02) than the control group. The resistance training group had greater increases in maximal treadmill walking time (1.90 minutes; 95% CI, 0.49-3.31 minutes; P = .009); walking impairment scores for distance (6.92; 95% CI, 1.07-12.8; P = .02) and stair climbing (10.4; 95% CI, 0.00-20.8; P = .03); and SF-36 PF score (7.5; 95% CI, 0.0-15.0; P = .04) than the control group. Supervised treadmill training improved 6-minute walk performance, treadmill walking performance, brachial artery flow-mediated dilation, and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication. Lower extremity resistance training improved functional performance measured by treadmill walking, quality of life, and stair climbing ability. clinicaltrials.gov Identifier: NCT00106327.

Supervised and home-based exercise training for patients with intermittent claudication

Home-based exercise training, applied as the primary treatment in patients with intermittent claudication, has produced inconsistent effects on walking capacity in previous published studies. The aim of the present study was to evaluate whether a home-based exercise training program could maintain improved walking capacity and other functional variables achieved through a supervised exercise training program. The present design was a 48-week self-controlled study. The first 12-week period was a control stage in which no prescribed exercise program was provided, the second 12-week period was a supervised treadmill-walking training program and the following 24-week period was a home-based exercise program. Twenty-two subjects with intermittent claudication were recruited initially; 15 of them (14 men and one woman) completed the whole program. Walking capacity, peak oxygen uptake, walking economy and ankle-brachial index were measured at baseline and at 12, 24 and 48 weeks. There was no significant change in the measured variables after the control stage. The 12-week supervised treadmill-walking training program significantly increased pain-free walking time, maximal walking time and peak oxygen uptake. Walking economy was also significantly improved. These improvements were successfully maintained after 24 weeks of home-based training. The results indicated that 12 weeks of supervised treadmill-walking training followed by a home-based training program is an effective model of exercise rehabilitation for patients with intermittent claudication.

Effect of Ginkgo biloba (EGb 761) on Treadmill Walking Time Among Adults With Peripheral Artery Disease

Medical therapies for treatment of peripheral artery disease (PAD) are limited. Ginkgo biloba has been reported to increase maximal and pain-free walking distance among patients with PAD; however, the evidence is inconsistent. The objective of this study was to compare the effects of 300 mg/d of Ginkgo biloba (EGb 761) versus placebo on treadmill walking time and related cardiovascular measures among patients with PAD. A double-blind, placebo-controlled, parallel design trial with a 4-month duration was used. Participants were 62 adults, aged 70 +/- 8 years (mean +/- SD), with claudication symptoms of PAD. The primary study outcomes were maximal and pain-free walking time on a treadmill. Secondary outcomes included flow-mediated vasodilation, a measure of antioxidant status as assessed by determining antibody levels to epitopes of oxidized low-density lipoprotein, and questionnaires addressing walking impairment and quality of life. Maximal treadmill walking time increased by 20 +/- 80 and 91 +/- 242 seconds in the placebo and the EGb 761 groups, respectively (P = .12). Pain-free walking time increased by 15 +/- 31 and 21 +/- 43 seconds, respectively (P = .28). No significant differences were detected between groups for any of the secondary outcomes. In older adults with PAD, Ginkgo biloba produced a modest but insignificant increase in maximal treadmill walking time and flow-mediated vasodilation. These data do not support the use of Ginkgo biloba as an effective therapy for PAD, although a longer duration of use should be considered in any future trials.

Reduced arterial stiffness may contribute to angiotensin-converting enzyme inhibitor induced improvements in walking time in peripheral arterial disease patients

Claudication is a debilitating consequence of peripheral arterial disease. Evidence is accumulating to suggest that large artery stiffness may influence peripheral perfusion and walking time through effects on peripheral hemodynamics as well as microvascular structure and function. We have previously shown that the angiotensin-converting enzyme inhibitor ramipril increased systemic arterial compliance by 64%, and increased maximum walking time by over 200% in patients with peripheral arterial disease. In the current analysis in the same patient cohort, we hypothesized that this relationship may, in part, be causal. Forty patients with peripheral arterial disease [66 +/- 4 years (mean +/- SD); n = 20 per group] were randomized to ramipril, 10 mg once daily, or placebo for 24 weeks in a double-blind study. Maximum walking time was recorded during a standard treadmill test. Indices of arterial stiffness were assessed globally by systemic arterial compliance and augmentation index and regionally via central pulse wave velocity. Ramipril increased maximum walking time by 243% and improved arterial stiffness parameters by between 17 and 64% (all P < 0.001 compared with placebo). There were moderately strong correlations between the pre/post intervention change in maximum walking time and the change in indices of arterial stiffness (systemic arterial compliance, r = 0.65, P < 0.001; central pulse wave velocity, r = -0.57, P < 0.001; augmentation index, r = -0.79, P < 0.001; time to pressure augmentation, r = 0.52, P = 0.001). The present data support the hypothesis that the beneficial effects of ramipril on maximum walking time observed in our peripheral arterial disease population are, at least partly, a consequence of reduced arterial stiffness.

Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease

The purpose of the study was to examine the effects of a 12-month exercise program on lower limb mobility (temporal-spatial gait parameters and gait kinematics), walking performance, peak physiological responses, and physical activity levels in individuals with symptoms of intermittent claudication due to peripheral arterial disease (PAD-IC). Participants (n = 21) with an appropriate history of PAD-IC, ankle-brachial pressure index (ABI) <0.9 in at least one leg and a positive Edinburgh claudication questionnaire response were prospectively recruited. Participants were randomly allocated to either a control PAD-IC group (CPAD-IC) (n = 11) that received standard medical therapy and a treatment PAD-IC group (TPAD-IC) (n = 10), which also took part in a 12-month supervised exercise program. A further group of participants (n = 11) free of PAD (ABI >0.9) and who were non-regular exercisers were recruited from the community to act as age and mass matched controls (CON). Lower limb mobility was determined via two-dimensional video motion analysis. A graded treadmill test was used to assess walking performance and peak physiological responses to exercise. Physical activity levels were measured via a 7-day pedometer recording. Differences between groups were analyzed via repeated measures analysis of variance (ANOVA). The 12-month supervised exercise program had no significant effect on lower limb mobility, peak physiological responses, or physical activity levels in TPAD-IC compared with CPAD-IC participants. However, the TPAD-IC participants demonstrated significantly greater walking performance (171% improvement in pain free walking time and 120% improvement in maximal walking time compared with baseline). The results of this study confirm that a 12-month supervised exercise program will result in improved walking performance, but does not have an impact on lower limb mobility, peak physiological responses, or physical activity levels of PAD-IC patients.

Randomized controlled trial of supervised exercise to evaluate changes in cardiac function in patients with peripheral atherosclerotic disease

Peripheral atherosclerotic disease (PAD) is a condition characterized by low functional capacity which is associated with impaired free living, ambulation and low exercise tolerance. The purpose of this randomized controlled study was to evaluate whether changes in maximal walking time are associated with adaptations in cardiovascular function following supervised exercise. After ethics approval, 28 patients (63 +/- 11 years) completed a graded treadmill test (2 min stages, 3.2 km h(-1), with gradient increasing 2% every 2 min) until they reached level three or four on the claudication pain scale. Peak oxygen consumption was assessed on a breath-by-breath basis, by online expiratory gas analysis. Following a 40-min recovery period, peak cardiac output was measured using the non-invasive carbon dioxide rebreathing method described by Defares (J Appl Physiol, 13, 1958, 159). Peak cardiac power output was then computed using the equation described by Cooke et al. (Heart, 1998, 79, 289). Patients were randomly assigned to one of two groups: supervised, who exercised at the hospital twice weekly for 12 weeks or control, who received normal treatment which included encouragement to walk regularly. After 12 weeks, there were no significant changes in body mass, peak oxygen consumption, peak cardiac output, peak heart rate, peak cardiac power output, respiratory exchange ratio or rating of perceived exertion in both the supervised and control group. There was a significant improvement (91%) in maximal walking distance following the supervised exercise programme. Although patients' peak cardiovascular measurements were unchanged, the patients in the supervised exercise group were able to complete a higher workload at the end of the 12 weeks of exercise, for the equivalent demands on the circulation system. The findings from this study suggest that a short-term period of supervised exercise training results in an improved walking time in patients with limiting claudication because of PAD. It also demonstrated that the cardiovascular system becomes more efficient in meeting the demands of exercise. It is recommended that individuals with PAD should undertake exercise as a form of treatment.

Supervised exercise training combined with ginkgo biloba treatment for patients with peripheral arterial disease

Objectives: To evaluate whether a combination of supervised exercise training and ginkgo biloba treatment is a better treatment than exercise training alone for patients with peripheral arterial disease. Design: A 24-week double-blind, placebo-controlled ginkgo biloba trial with the first 12-week period as a non-exercise control stage and the second 12-week period as an exercise training stage. Setting: Exercise physiology laboratory. Subjects: Twenty-two subjects with peripheral arterial disease. Interventions: The subjects were randomly allocated into a ginkgo or a placebo group. During the first stage, the ginkgo group ingested standardized ginkgo biloba tablets with a daily dosage of 240 mg, while the placebo group received placebo tablets. During the second stage, all subjects engaged in a supervised treadmill-walking programme while continuing to take the same dosage of ginkgo biloba or placebo tablets. Main measures: Walking capacity on treadmill, oxygen consumption during exercise, peripheral haemodynamics and blood viscosity were measured at baseline, and after the first and the second stages of treatment. Results: The ginkgo group did not show significant changes in most of the measured variables after each stage of treatment, except that the maximal walking time was significantly increased after the combined treatment (from 236 ± 112 seconds to 557 ± 130 seconds, P < 0.001). However, similar response was also found in the placebo group after exercise training (from 384 ± 125 seconds to 820 ± 146 seconds, P < 0.001). Conclusion: Supervised exercise training combined with ginkgo biloba treatment did not produce greater beneficial effects than exercise training alone in patients with peripheral arterial disease.