Walking Performance In Patients Research Articles

The influence of a long term exercise program on lower limb movement variability and walking performance in patients with peripheral arterial disease

The purpose of this study was to examine the effects of a 12 month exercise program on lower limb movement variability in patients with peripheral arterial disease (PAD). Participants ( n = 21) with an appropriate history of PAD and intermittent claudication (IC) volunteered for this study and were randomly allocated to either a control group (CPAD–IC) ( n = 11), which received normal medical therapy and a treatment group (TPAD–IC) ( n = 10), which received normal medical therapy treatment and a 12 month supervised exercise program. All participants underwent 2D joint angular kinematic analysis during normal walking to assess lower limb movement variability and walking speed. Between-group differences were analyzed via mixed measures ANOVA. The 12 month supervised exercise program made no significant impact on the lower limb movement variability or walking speed of the TPAD–IC group as determined by either intralimb joint coordination or single joint analysis techniques. Long term supervised exercise programs do not appear to influence the lower limb movement variability of PAD–IC patients.

The influence of atorvastatin on walking performance in peripheral arterial disease

Recently it has been shown that statins can improve walking distance in patients with peripheral arterial disease. We examined whether statins used in moderate dosages with the aim of reaching the target levels for hypercholesterolemia could improve walking performance in patients with peripheral arterial disease. 37 patients with hypercholesterolemia (LDL cholesterol = 3.46 +/- 0.13 mmol/l), who had previously not been treated by statins, were randomized in a double-blind study to a group receiving either atorvastatin at 20 mg/day (N = 20) or placebo (N = 17). All patients had stable intermittent claudication (Fontaine class IIa or IIb). At baseline, after one and three months the pain-free walking distance was measured in all patients. After 3 months patients in the treated group had reached target cholesterol values (LDL cholesterol = 2,34 +/- 0.9 mmol/l), whereas no significant change in lipids was observed in the control group. The ankle-brachial pressure index (ABPI) did not change significantly in either group. After 3 months the pain-free walking distance was increased significantly (p < 0.001), but similarly in both groups (at entry: 56 (53-108) m vs 53 (53-106) m; after 3 months: 79 (53-108) m vs 106 (66-159) m, for the treated and placebo group, respectively). Therefore this effect had to be attributed to regular exercise and not to statin use. Our results show that routine treatment with statin (atorvastatin 20 mg/day), which is effective in reducing the level of cholesterol, does not produce an improvement in walking performance in patients with peripheral arterial disease.

Physiological Predictors of Maximum Treadmill Walking Performance in Patients with Intermittent Claudication

The purpose of this investigation was to identify physiological predictors of maximum treadmill walking performance (MWD) in patients with intermittent claudication. Forty-five claudicants performed a graded treadmill test to determine MWD, peak oxygen uptake, and gas exchange threshold. Calf muscle oxygenation (StO (2)) at 1 min and time to minimum StO (2) were also measured using near-infrared spectroscopy. On other occasions, peak calf blood flow, resting ankle-brachial index, and pulmonary oxygen uptake kinetics during steady-state walking were assessed. A forward stepwise multiple regression analysis was performed to determine predictors of MWD. A regression model comprising time to minimum StO (2), peak oxygen uptake, and StO (2) at 1 min explained 64% of the variation in MWD. The results suggest that cardiopulmonary fitness and the ability to match oxygen delivery to metabolic demand are important determinants of walking performance in claudicants, and that certain near-infrared spectroscopy variables might be useful in studies that evaluate the mechanisms of clinical improvement with different treatment interventions.

Daily walking performance as an independent predictor of advanced heart failure: Prediction of exercise capacity in chronic heart failure

The purpose of this study was to use an accelerometer to measure daily walking performance in patients with chronic heart failure (CHF) to investigate if this parameter is a determinant of New York Heart Association class and indicative of maximal and functional exercise capacity. Fifty patients with CHF were instructed to wear an accelerometer for 7 consecutive days while going about their daily business. Maximal and functional exercise capacity was assessed by cardiopulmonary (VO(2peak)) and 6-minute walk testing, respectively. Patients in New York Heart Association I, II, and III reached an average total walking time (TWT) of 160.6 +/- 35.8 minutes, 133.9 +/- 59.0 minutes, and 76.1 +/- 22.5 minutes per day of which 19%, 19%, and 9% where spent in the fast walking mode (>83 m/minute), respectively. The TWT correlated strongly with VO(2peak) (r = 0.72; P <.001) and 6-minute walk testing distance (r = 0.68; P <.001). The TWT and time spent in fast walking mode were the strongest determinants in discriminating moderate CHF. Daily walking performance is a clear determinant of maximal and functional exercise capacities in patients with CHF. Walking intensity in particular is an independent predictor in discriminating patients with advanced heart failure. Monitoring of daily walking performance might aid in detecting disease progression and improve clinical outcome.

Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol®

In a previous, double-blind, placebo-controlled study we evaluated the efficacy of a 3-month treatment with Pycnogenol® for 156 patients with osteoarthritis of the knee. Pycnogenol® significantly decreased joint pain and improved joint function as evaluated using the WOMAC score and walking performance of patients on a treadmill. In this study, we further investigated the anti-inflammatory and antioxidant activity of Pycnogenol® in a subset of the osteoarthritis patients presenting with elevated C-reactive protein (CRP) and plasma-free radicals. Elevated CRP levels have been suggested to be associated with disease progression in osteoarthritis. In our study, 29 subjects of the Pycnogenol® group and 26 patients in the placebo group showed CRP levels higher than 3 mg/l at baseline. Comparison of blood specimens drawn at baseline and after 3-month treatment showed that Pycnogenol® significantly decreased plasma free radicals to 70.1% of baseline values. Plasma CRP levels decreased from baseline 3.9 mg/l to 1.1 mg/l in the Pycnogenol® group whereas the control group had initial values of 3.9 mg/l which decreased to 3.6 mg/l. The CRP decrease in the Pycnogenol® was statistical significant as compared to the control group (P < 0.05). Fibrinogen levels were found to be lowered to 62.8% of initial values (P < 0.05) in response to Pycnogenol®. No significant changes for plasma free radicals, CRP and fibrinogen were found in the placebo-treated group. The decrease of systemic inflammatory markers suggests that Pycnogenol® may exert anti-inflammatory activity in osteoarthritic joints and patients did not present with other ailments or infections. The nature of the anti-inflammatory effects of Pycnogenol® with regard to CRP warrants further investigation.

Physical Performance in Peripheral Arterial Disease: A Slower Rate of Decline in Patients Who Walk More

Exercise rehabilitation programs increase treadmill walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication. However, it is unknown whether patients with PAD who walk for exercise regularly have less functional decline than those with less walking activity. To determine whether patients with PAD who report that they walk for exercise 3 or more times per week have less annual functional decline than those who walk for exercise less frequently. Prospective cohort study with a median follow-up of 36 months (interquartile range, 24 to 36 months). Academic medical center. 417 men and women with PAD. Participants were classified at baseline and annually according to the number of times they reportedly walked for exercise each week. Functional assessments (6-minute walk distance, 4-meter walking speed, summary performance score) were measured at baseline and annually. Results were adjusted for age, sex, ethnicity, comorbid conditions, body mass index, ankle-brachial index, education, leg symptoms, cigarette use, geriatric depression score, previous year's level of functioning, and patterns of missing data. Compared with those who exercised less frequently, patients who walked for exercise 3 or more times per week had a significantly smaller average annual decline in 6-minute walking distance (-48.0 feet per year compared with -56.6 feet per year for those who walked 1 to 2 times per week and -79.4 feet per year for nonexercisers; P for trend = 0.037). Patients who walked for exercise at least 3 times per week experienced a smaller average annual decline in the usual-paced 4-meter walking velocity (-0.014 m/s per year compared with -0.022 m/s per year for those who walked 1 to 2 times per week and -0.045 m/s per year for nonexercisers; P = 0.005). Similar findings were observed for the fast-paced 4-meter walk. The subset of asymptomatic patients who walked for exercise 3 or more times per week had annual declines in 6-minute walking performance (P = 0.107), normal-paced walking velocity (P = 0.065), and the summary performance score (P = 0.115); however, these declines were smaller than those observed in asymptomatic participants who walked fewer than 3 times per week. Because this was an observational study, associations reported here cannot be construed as causal relationships. Sample sizes for subgroup analyses were small, which limited statistical power. Among patients with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year. Similar trends were observed in the subset of asymptomatic patients with PAD. These findings may be particularly important for the numerous patients with PAD who do not have access to supervised walking exercise programs.

Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: A randomized controlled trial

To investigate the effects of a 24-week program of upper- and lower-limb aerobic exercise training on walking performance in patients with symptomatic peripheral arterial disease (PAD) and to study the mechanisms that could influence symptomatic improvement. After approval from the North Sheffield Local Research Ethics Committee, 104 patients (median age, 69 years; range, 50 to 85 years) with stable PAD were randomized into an upper- or lower-limb aerobic exercise training group (UL-Ex or LL-Ex), or to a nonexercise training control group. Training was performed twice weekly for 24 weeks at equivalent relative exercise intensities. An incremental arm- and leg-crank test (ACT and LCT) to maximum exercise tolerance was performed before and at 6, 12, 18, and 24 weeks of the intervention to determine peak oxygen consumption (VO(2)). Walking performance, defined as the claudicating distance (CD) and maximum walking distance (MWD) achieved before intolerable claudication pain, was assessed at the same time points by using a shuttle-walk protocol. Peak blood lactate concentration, Borg ratings of perceived exertion (RPE) and pain category ratio (CR-10) were recorded during all assessments. CD and MWD increased over time (P < .001) in both training groups. At 24 weeks, CD had improved by 51% and 57%, and MWD had improved by 29% and 31% (all P < .001) in the UL-Ex and LL-Ex groups, respectively. An increase in peak heart rate at MWD in the UL-Ex group (109 +/- 4 vs 115 +/- 4 beats/min; P < .01) and LL-Ex group (107 +/- 3 vs 118 +/- 3 beats/min; P = .01) was accompanied by an increase in the amount of pain experienced in both groups (P < .05), suggesting that exercising patients could tolerate a higher level of cardiovascular stress and an increased intensity of claudication pain before test termination after training. Patients assigned to exercise training also showed an increase in LCT peak VO2 at the 24-week time point in relation to baseline (P < .01) and control patients (P < .01), whereas ACT peak VO2 was only improved in the UL-Ex group (P < .05). Our results suggest that a combination of physiologic adaptations and improved exercise pain tolerance account for the improvement in walking performance achieved through upper-limb aerobic exercise training in patients with PAD. Furthermore, that both arm- and leg-crank training could be useful exercise training modalities for improving cardiovascular function, walking performance, and exercise pain tolerance in patients with symptomatic PAD.

The Contribution of Peripheral Muscle Function to Shuttle Walking Performance in Patients With Chronic Obstructive Pulmonary Disease

The contribution of muscle strength and mass to incremental and endurance walking performance in chronic obstructive pulmonary disease (COPD) is unknown. This study analyzes the relationship between field incremental and endurance walking performance and indices of peripheral muscle mass and strength. Eighty-five stable COPD patients (53 males; mean [SD] age = 67 [9] years; mean [SD] forced expiratory volume in 1 second [FEV1] = 35 [14] [% predicted]) were studied prior to participation in pulmonary rehabilitation. Isometric quadriceps and handgrip strength were measured. Total body and lower limb lean muscle mass were estimated using dual energy x-ray absorptiometry. Exercise performance was measured using the incremental shuttle walk test (ISWT) and the endurance (ESWT) shuttle walk test. ISWT was related to muscle strength (r = 0.467, P </= .001) but not to whole body or lower limb lean mass. There was no association between muscle strength or mass and ESWT. In a multivariate linear regression analysis, the only variables significantly contributing to ISWT were age (P < .001), FEV1 (% predicted) (P < .001) and quadriceps strength (P < .001). Variables contributing to ESWT were FEV1 (% predicted) (P < .001) and ISWT performance (P < .001). We conclude that muscle strength is related to incremental but not endurance shuttle walking performance. Muscle mass and strength are not synonymous in their effects on exercise performance in patients with COPD.

ANZ Society for Vascular Surgery: Vascular 2004, Rotorua, New Zealand, September 2004: selected abstracts

Introduction: Walking programmes are recommended as part of the initial treatment for intermittent claudication (IC). However, for many patients factors such as frailty, the severe leg discomfort associated with walking and safety concerns about exercising in public areas reduce compliance to such prescription. Thus, there is a need to identify a mode of exercise that provides the same benefits as regular walking while also offering convenience and comfort for these patients. The present study aims to provide evidence for the first time of the efficacy of a supervised cycle training programme compared with a conventional walking programme for the treatment of IC. Methods: Thus far 33 patients have been randomized to: a treadmill-training group (n = 12); a cycle-training group (n = 11); or a control group (n = 10). Training groups participated in three sessions of supervised training per week for a period of 6 weeks. Control patients received no experimental intervention. Maximal incremental treadmill testing was performed at baseline and after the 6 weeks of training. Measures included pain-free (PFWT) and maximal walking time (MWT), continuous heart rate and gas-analysis recording, and ankle-brachial index assessment. Results: In the treadmill trained group MWT increased significantly from 1016.7 523.7 to 1255.2 432.2 s (P < 0.05). MWT tended to increase with cycle training (848.72 333.18 to 939.54 350.35 s, P = 0.14), and remained unchanged in the control group (1555.1 683.23 to 1534.7 689.87 s). For PFWT, there was a non-significant increase in the treadmill-training group from 414.4 262.3 to 592.9 381.9 s, while both the cycle training and control groups displayed no significant change in this time (226.7 147.1 s to 192.3 56.8 and 499.4 503.7 s to 466.0 526.1 s, respectively). Conclusions: These preliminary results might suggest that, unlike treadmill walking, cycling has no clear effect on walking performance in patients with IC. Thus the current recommendations promoting walking based programmes appear appropriate. The present study was funded by the National Heart Foundation of Australia.

Cholesterol reduction with atorvastatin improves walking distance in patients with peripheral arterial disease

Background—Cholesterol modification reduces cardiovascular events in patients with atherosclerosis, including those with peripheral arterial disease. The purpose of this study was to determine whether cholesterol lowering with atorvastatin improves walking performance in patients with intermittent claudication. Methods and Results—This randomized, double-blind, parallel-design study included 354 persons with claudication attributable to peripheral arterial disease. Patients were treated with placebo, atorvastatin (10 mg per day), or atorvastatin (80 mg per day) for 12 months. The outcome measures included change in treadmill exercise time and patient-reported measures of physical activity and quality of life based on questionnaires. Maximal walking time after 12 months of treatment with atorvastatin did not change significantly. However, there was improvement in pain-free walking time after 12 months of treatment for the 80-mg (P0.025) group compared with placebo. A physical activity questionnaire demonstrated improvement in ambulatory ability for the 10- and 80-mg groups (P0.011), whereas 2 quality of life instruments, the Walking Impairment Questionnaire and Short Form 36 Questionnaire, did not show significant change. Conclusions—Atorvastatin improves pain-free walking distance and community-based physical activity in patients with intermittent claudication. When treated with atorvastatin, patients with peripheral arterial disease may experience improvement in symptoms to complement the anticipated reduction in cardiovascular events reported in other studies of statins. (Circulation. 2003;108:1481-1486.)

Skeletal muscle mitochondrial ATP production rate and walking performance in peripheral arterial disease.

This study tested the hypotheses that skeletal muscle mitochondrial ATP production rate (MAPR) is impaired in patients with peripheral arterial disease (PAD) and that it relates positively to their walking performances. Seven untrained patients, eight exercise-trained patients and 11 healthy controls completed a maximal walking test and had muscle sampled from the gastrocnemius medialis muscle. Muscle was analysed for its MAPR in the presence of pyruvate, palmitoyl-L-carnitine or both, as well as citrate synthase (CS) activity. MAPRs were not different between untrained PAD and controls. In contrast, MAPRs (pyruvate) were significantly higher in trained PAD vs. controls. MAPR (pyruvate combinations) was also significantly higher in trained than untrained PAD muscle. MAPR and CS activity were highly correlated with walking performance in patients, but not in controls. These data do not support the hypothesis that isolated mitochondria are functionally impaired in PAD and demonstrate that the muscle mitochondrial capacity to oxidize carbohydrate is positively related to walking performance in these patients.

Functional self-efficacy, perceived gait ability and perceived exertion in walking performance of individuals with low back pain

The purpose of this study was to examine psychological and perceptual factors that influence walking in individuals with low back pain (LBP). In Study 1 59 subjects with LBP recruited from an orthopedic surgeon participated. Perceived gait ability was measured with the Distorted Ambulation subscale of Pain Behavior Checklist (DAS-PBCL). The psychological factor of functional self-efficacy (FSE) was assessed on the FSE scale. These scales were completed before performing a 50-foot speed walk (50 FT WALK) and a 5-minute distance walk (5 MIN WALK) tests. DAS-PBCL had stronger correlations with walking performance ( r = 0.11 to 0.58) than FSE ( r = 0.03 to 0.49). DAS-PBCL had a stronger relationship with 50 FT WALK ( r = 0.18 to 0.58) than 5 MIN WALK ( r = 0.11 to 0.50). In Study 2 48 healthy pain-free subjects and an independent sample of 40 subjects with LBP referred from an orthopedic surgeon participated. They completed the 5 MIN WALK followed by the modified Borg's rating of perceived exertion scale (CR10). Subjects with LBP walked a significantly shorter distance ( t = 4.69, p<.005) but perceived a similar amount of exertion (Mann-Whitney U = 861.5, p =. 40) compared with those without LBP. Perceived gait ability appears to account for more variability in walking performance than functional self-efficacy of walking in individuals with LBP. Perceived gait ability, in particular, accounted for more variance in walking speed than in walking endurance. Individuals with LBP also experience more exertion during walking than those without LBP. These results suggest that clinicians may need to consider patients' perceptions of gait ability and exertion when assessing walking performance in patients with LBP.

Six-minute walking performance in patients with moderate-to-severe heart failure; is it a useful indicator in clinical practice?

The 6-min walk test has been incorporated into studies on the efficacy of new therapies and into prognostic stratification for chronic heart failure patients. Firm conclusions on the usefulness of the test in clinical practice are still lacking. The aim of this study was to investigate (1) the correlation between walk test performance and standard indices of cardiac function and exercise capacity, and (2) the prognostic value of the walk test with respect to peak VO2 and NYHA class. Three hundred and fifteen chronic heart failure patients (age: 53+/-9 years, NYHA class: II (182), III (133)) underwent a functional evaluation and a 6-min walk test. Of these, 270 were followed-up for a minimum of 6 months (mean 387+/-177 days). Walked distance was 396+/-92 m. There was no significant correlation between distance walked and central haemodynamic data. Functional capacity, as measured by ergometry, correlated moderately with distance walked (duration: r=0.48, peak VO2: r=0.59, anaerobic threshold: r=0.54; all P<0.001). During follow-up, 46 patients died from cardiovascular causes and 12 were urgently transplanted. Either of these events were considered end points of the study. Survival analysis was performed from a continuous walk test and peak VO2 measurements or after categorization of (a) quartile segmentation, (b) cut-off points from the literature and (c) thresholds from receiver operating characteristic curves. At univariate survival analysis (Cox regression), the association of the walk test with survival was of significance (P=0.03, continuous variable), or borderline significance (0.05< or =P< or =0.1, after categorization). Peak VO2 was always significant, independent of the scale used (0.005< or =P< or =0.03). The strongest association was found for NYHA class (P<0.001), which showed the highest sensitivity and specificity for the prediction of the event (0.64 and 0.65, respectively). When walk test performance, continuous or categorized, was entered into a multivariate model with NYHA class or peak VO2, it lost any significant association with survival (P>0.76 in all models with NYHA class and P>0.27 in all models with peak VO2). In moderate-to-severe chronic heart failure patients, the 6-min walk test is not related to cardiac function and only moderately related to exercise capacity. Walking performance does not provide prognostic information which can complement or substitute for that provided by peak VO2 or NYHA class. Hence the test is of limited usefulness as a decisional indicator in clinical practice.

Effects of Immobilization on Plantar-Flexion Torque, Fatigue Resistance, and Functional Ability Following an Ankle Fracture

The goal of this investigation was to study the recovery of ankle plantar-flexor peak torque, fatigue resistance, and functional ability (stair climbing, walking) following cast immobilization in patients with ankle fractures. The participants were 10 patients who underwent open reduction-internal fixation and 8 weeks of cast immobilization following a fracture of the ankle mortise and 10 age- and sex-matched, noninjured comparison subjects. Plantar-flexor torque and fatigue resistance were measured at 1, 5, and 10 weeks of rehabilitation using an isokinetic dynamometer. Ankle plantar-flexor peak torque and fatigue resistance were correlated to timed ambulation, timed stair climbing, and unilateral heel-rises. Following immobilization, plantar-flexor peak torque was decreased at all angular speeds and positions. The decrease in peak torque was associated with an increase in fatigue resistance. With rehabilitation, ankle plantar-flexor torque and fatigue resistance normalized. Regression analysis revealed a strong relationship between plantar-flexor peak torque and functional measures. By 10 weeks post-immobilization, peak torque, fatigue resistance, and all measures of functional performance had returned to control levels. The decrease in muscle performance, functional ability, and fatigue resistance induced by 8 weeks of cast immobilization can be reversed with 10 weeks of supervised physical therapy. In addition, this study demonstrated that ankle-plantar flexor torque is a good predictor of stair-climbing and walking performance in patients with ankle fractures.

Experimental Model of Short-Time Exercise-Induced Preconditioning in POAD Patients

Regular physical exercise improves walking performance in patients affected with peripheral obliterative arterial disease (POAD). The mechanisms underlying the phenomenon are still controversial. In order to verify the hypothesis that physical conditioning of lower limbs on a treadmill and ischemic preconditioning of the heart could share some biological aspects, 14 POAD subjects underwent a training program on the treadmill consisting of five repeated submaximal exercises at five-minute and two-hour intervals preceding the maximal tolerance test. Moreover, a protocol with two daily submaximal walking exercises over one week was also performed. Pain-free and total walking distance were measured before and after they performed the program. Moreover, plasma levels of adenosine and adenosine triphosphate (ATP) were measured and polymorphonuclear (PMN) leukocyte activity was studied together with rheologic parameters. Pain-free distance was prolonged by 15.4% and 14.3%, and total distance was prolonged by 23.1% and 26.9%, in the exercises with five-minute and two-hour intervals, respectively. After one week of daily exercises, the onset of pain and the end of the test were delayed by 24% and 43.7%, respectively. An improvement in blood rheology and a reduced PMN reactivity were also observed with the three protocols, associated with an increase in plasma levels of adenosine and ATP. Similarly to ischemic preconditioning in the heart, the possibility is suggested that an adenosine-mediated mechanism may contribute to the development of physical conditioning in treadmill-trained POAD patients.

Effect of Propionyl-L-Carnitine on Quality of Life in Intermittent Claudication

A double-blind, dose titration study was designed to assess the efficacy of propionyl-L-carnitine in intermittent claudication. The effect on walking capacity was described in a previous article. This study reports on the effect on quality of life, assessed by the McMaster Health Index Questionnaire (MHIQ). After 24 weeks of treatment, the global MHIQ score did not show any difference from baseline in patients randomized to placebo (n = 102). Conversely, it increased from 0.59 ± 0.12 to 0.64 ± 0.12 in those taking propionyl-L-carnitine (n = 85). Analysis of variance showed a significant difference between treatments (p = 0.018). Stepwise multiple regression analysis identified baseline maximal walking capacity (cutoff point 250 m) as a predictor of treatment outcome. In patients walking <250 m, propionyl-L-carnitine significantly improved physical function (p = 0.027), emotional function (p = 0.002), and global MHIQ score (p = 0.002) compared with placebo. Also, for maximal walking capacity, group difference significantly favored propionyl-L-carnitine (p = 0.009). In patients with baseline maximal walking capacity ≥250 m, propionyl-L-carnitine did not affect the MHIQ scores, nor improve walking performance. These data indicate that propionyl-L-carnitine exerts beneficial effects on quality of life and walking performance in patients with more severely limited walking capacity.The results of this double-blind, dose-titration study indicate that propionyl-L-carnitine improves quality of life and maximal walking capacity in patients with intermittent claudication. By using a clinically relevant parameter, which is a baseline maximal walking capacity <250 m, a target population was defined in whom trial results became highly significant.

Treadmill Self-Efficacy and Walking Performance in Patients With COPD

As part of a larger ongoing study of nurse-coached practice with dyspnea, 52 subjects (25 men, 27 women) with moderate to severe COPD exercised on a treadmill three times a week for 4 weeks. Subjects were randomized into a coached exercise group, which received nurse coaching during exercise, and a

Blood Flow Properties and Walking Performance in Chronic Arterial Occlusive Disease

Recent investigations suggest an interdependence between blood fluidity and walking performance in patients with peripheral arterial occlusive disease (PAOD). Therefore, various blood fluidity variables (erythrocyte aggregation, erythrocyte flexibility, plasma viscosity, plasma proteins) were studied in groups of healthy subjects and claudicants with severe PAOD (exhausted perfusion reserve) receiving intravenous treatment with Trental (600 mg Pentoxifylline b.i.d., 21 days). Erythrocyte flexibility (expressed by filterability through micropore filters), red cell aggregation and plasma viscosity deteriorate with progression of disease especially in Stage IIb and III Fontaine classification, with walking distance below 150 m. Trental treatment resulted in patients with advanced POAD stages in improvement of red cell filterability, red cell aggregation, decrease of plasma viscosity, increase in absolute walking distance and relief from rest pain, suggesting that such patients are accessible to conservative treatment with hemorheologically active agents.