Exercise Rehabilitation Improves Functional Outcomes and Peripheral Circulation in Patients with Intermittent Claudication: A Randomized Controlled Trial

OBJECTIVE: To determine the effects of a 6‐month exercise program on ambulatory function, free‐living daily physical activity, peripheral circulation, and health‐related quality of life (QOL) in disabled older patients with intermittent claudication. DESIGN: Prospective, randomized controlled trial....

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Published in:Journal of the American Geriatrics Society (JAGS) 2001-06, Vol.49 (6), p.755-762
Main Authors: Gardner, Andrew W., Katzel, Leslie I., Sorkin, John D., Bradham, Douglas D., Hochberg, Marc C., Flinn, William R., Goldberg, Andrew P.
Format: Article
Language:English
Subjects:
Activities of Daily Living
Aged
ambulation
Biological and medical sciences
Blood and lymphatic vessels
Blood Circulation
Cardiology. Vascular system
Cardiovascular system
circulation
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Elderly people
Exercise
exercise rehabilitation
Exercise Test
Exercise Therapy - methods
Exercise Therapy - standards
Female
Functional performance
Geriatric Assessment
Handicapped people
Health Status
Humans
Intermittent claudication
Intermittent Claudication - classification
Intermittent Claudication - diagnosis
Intermittent Claudication - physiopathology
Intermittent Claudication - psychology
Intermittent Claudication - rehabilitation
Investigative techniques of hemodynamics
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Older people
Peripheral arterial disease
peripheral arterial occlusive disease
Plethysmography
Prospective Studies
Quality of Life
Rehabilitation
Severity of Illness Index
Surveys and Questionnaires
Time Factors
Treatment Outcome
Walking
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Summary:OBJECTIVE: To determine the effects of a 6‐month exercise program on ambulatory function, free‐living daily physical activity, peripheral circulation, and health‐related quality of life (QOL) in disabled older patients with intermittent claudication. DESIGN: Prospective, randomized controlled trial. SETTING: University Medical Center and Veterans Affairs Medical Center, Baltimore, Maryland. PARTICIPANTS: Thirty‐one of 61 patients with Fontaine stage II peripheral arterial occlusive disease (PAOD) were randomized to exercise rehabilitation and 30 to usual‐care control. Three patients from the exercise group and six patients from the control group dropped out, leaving 28 and 24 patients, respectively, completing the study in each group. INTERVENTION: Six months of exercise rehabilitation. MEASUREMENTS: Treadmill distance walked to onset of claudication and to maximal claudication, ambulatory function, peripheral circulation, perceived QOL, and daily physical activity. RESULTS: Compliance with the exercise program was 73% of the possible sessions. Exercise rehabilitation increased treadmill distance walked to onset of claudication by 134% (P < .001) and to maximal claudication by 77% (P < .001), walking economy by 12% (P = .003), 6‐minute walk distance by 12% (P < .001), and maximal calf blood flow by 30% (P < .001). Changes in distance walked to maximal pain correlated with changes in walking economy (r = −.50, P = .013) and changes in maximal calf blood flow (r = .38, P = .047). Exercise rehabilitation increased accelerometer‐derived daily physical activity by 38% (P < .001); this change correlated with the change in distance walked to maximal pain (r = .45, P = .020). These improvements were significantly better than the changes in the control group (P < .05). CONCLUSION: Improvements in claudication following exercise rehabilitation in older PAOD patients are dependent on improvements in peripheral circulation and walking economy. Improvement in treadmill claudication distances in these patients translated into increased accelerometer‐derived physical activity in the community, which enabled the patients to become more functionally independent. J Am Geriatr Soc 49:755–762, 2001.
ISSN:0002-8614
1532-5415
DOI:10.1046/j.1532-5415.2001.49152.x