Cost-effectiveness of exercise therapy in patients with intermittent claudication: supervised exercise therapy versus a 'go home and walk' advice. Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication. Gender differences following supervised exercise therapy in patients with intermittent claudication. Long-term effects of structured home-based exercise program on functional capacity and quality of life in patients with intermittent claudication. The effect of supervised exercise therapy on physical activity and ambulatory activities in patients with intermittent claudication. A randomised controlled trial of supervised exercise regimens and their impact on walking performance, skeletal muscle mass and calpain activity in patients with intermittent claudication. SUPERvised exercise therapy or immediate PTA for intermittent claudication in patients with an iliac artery obstruction--a multicentre randomised controlled trial; SUPER study design and rationale. Comparison of the effect of upper body-ergometry aerobic training vs treadmill training on central cardiorespiratory improvement and walking distance in patients with claudication. A primary care walking exercise program for patients with intermittent claudication. Efficacy of arm-ergometry versus treadmill exercise training to improve walking distance in patients with claudication Does supervised exercise offer adjuvant benefit over exercise advice alone for the treatment of intermittent claudication? A randomised trial. Peripheral arterial disease and intermittent claudication: efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home. Supervised exercise therapy for intermittent claudication in daily practice. A non-randomised controlled trial of the clinical and cost effectiveness of a Supervised Exercise Programme for claudication. Supervised exercise therapy for intermittent claudication in a community-based setting is as effective as clinic-based. A feasibility double-blind randomized placebo-controlled trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication. The relationship of walking distances estimated by the patient, on the corridor and on a treadmill, and the Walking Impairment Questionnaire in intermittent claudication. Nordic pole walking improves walking capacity in patients with intermittent claudication: a randomized controlled trial The effects of exercise training on walking function and perception of health status in elderly patients with peripheral arterial occlusive disease. Exercise rehabilitation improves functional outcomes and peripheral circulation in patients with intermittent claudication: a randomized controlled trial. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. Agreements and discrepancies between the estimated walking distance, nongraded and graded treadmill testing, and outside walking in patients with intermittent claudication. Strength training increases walking tolerance in intermittent claudication patients: randomized trial. Experimental Model of Pain-Free Treadmill Training in Patients with Claudication A pilot exercise intervention to improve lower extremity functioning in peripheral arterial disease unaccompanied by intermittent claudication. Physiological and functional impact of an unsupervised but supported exercise programme for claudicants. Red Blood Cell Deformability in Patients With Claudication After Pain-free Treadmill Training Changes in pain-free walking based on time in accommodating pain-free exercise therapy for peripheral arterial disease. Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication: A Randomized Clinical Trial. Hospital vs Home-Based Exercise Rehabilitation for Patients with Peripheral Arterial Occlusive Disease Exercise training improves functional status in patients with peripheral arterial disease. Six-minute walk test closely correlates to "real-life" outdoor walking capacity and quality of life in patients with intermittent claudication. 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. Efficacy of Quantified Home-Based Exercise and Supervised Exercise in Patients With Intermittent Claudication: A Randomized Controlled Trial Effects of home versus supervised exercise for patients with intermittent claudication. Influence of the Physical Training on Muscle Function and Walking Distance in Symptomatic Peripheral Arterial Disease in Elderly Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response. Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication. Impact of a 4-Week Treatment with Prostaglandin E1 on Health-Related Quality of Life of Patients with Intermittent Claudication Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. Optimizing supervised exercise therapy for patients with intermittent claudication. Local Versus Systemic Mechanisms Underlying Supervised Exercise Training for Intermittent Claudication Value of a supervised exercise program for the therapy of arterial claudication. The adjuvant benefit of angioplasty in patients with mild to moderate intermittent claudication (MIMIC) managed by supervised exercise, smoking cessation advice and best medical therapy: results from two randomised trials for stenotic femoropopliteal and aortoiliac arterial disease. Effects of a 6-month exercise program pilot study on walking economy, peak physiological characteristics, and walking performance in patients with peripheral arterial disease Increasing exercise tolerance of persons limited by claudication pain using polestriding. Treatment of intermittent claudication with beraprost sodium, an orally active prostaglandin I2 analogue: a double-blinded, randomized, controlled trial. Community-based walking exercise for peripheral artery disease: An exploratory pilot study Walking training for intermittent claudication in diabetes. Walking training at the heart rate of pain threshold improves cardiovascular function and autonomic regulation in intermittent claudication: A randomized controlled trial. Exercise for intermittent claudication Comparison of two treadmill training programs on walking ability and endothelial function in intermittent claudication. Effect of treadmill training on endothelial function and walking abilities in patients with peripheral arterial disease. Effects of a Home-Based Walking Intervention on Mobility and Quality of Life in People With Diabetes and Peripheral Arterial Disease Long-Term Evaluation of Indobufen in Peripheral Vascular Disease Step‐Monitored Home Exercise Improves Ambulation, Vascular Function, and Inflammation in Symptomatic Patients With Peripheral Artery Disease: A Randomized Controlled Trial Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial. The vascular nurse in practice: Results of prescribed exercise training in patients with intermittent claudication. The effect of exercise intensity on the response to exercise rehabilitation in patients with intermittent claudication. Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication. Cholesterol Reduction With Atorvastatin Improves Walking Distance in Patients With Peripheral Arterial Disease Effectiveness of a New Exercise Program after Lower Limb Arterial Blood Flow Surgery in Patients with Peripheral Arterial Disease: A Randomized Clinical Trial Home-based treadmill training for individuals with Parkinson’s disease: a randomized controlled pilot trial Exercise training in intermittent claudication. Benefit of exercise conditioning for patients with peripheral arterial disease. Short-term effects of cycle and treadmill training on exercise tolerance in peripheral arterial disease. Randomised controlled trial of percutaneous transluminal angioplasty for intermittent claudication. Home-based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients Additional supervised exercise therapy after a percutaneous vascular intervention for peripheral arterial disease: a randomized clinical trial. Minimal clinically important differences in treadmill, 6-minute walk, and patient-based outcomes following supervised and home-based exercise in peripheral artery disease Progenitor cell release plus exercise to improve functional performance in peripheral artery disease: the PROPEL Study. The ischemic window: a method for the objective quantitation of the training effect in exercise therapy for intermittent claudication. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Is intermittent claudication improved by percutaneous transluminal angioplasty? A randomized controlled trial. Optimal exercise program length for patients with claudication. PoleStriding exercise and vitamin E for management of peripheral vascular disease. Brief Communication: Ramipril Markedly Improves Walking Ability in Patients with Peripheral Arterial Disease Treatment of intermittent claudication with pentoxifylline: a 12-month, randomized trial--walking distance and microcirculation. Impact of a walking program in people with down syndrome. Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial A randomized control trial of a supervised versus a self-directed exercise program for allogeneic stem cell transplant patients. Improvement of the walking ability in intermittent claudication due to superficial femoral artery occlusion with supervised exercise and pneumatic foot and calf compression: a randomised controlled trial. Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication. Functional improvements following StairMaster vs. treadmill exercise training for patients with intermittent claudication. The improvement of walking abilities and endothelial function after the supervised training treadmill program (STTP) in patients with peripheral artery disease (PAD) is not related to prostacyclin and thromboxane release. A Randomized Controlled Trial of Allopurinol in Patients With Peripheral Arterial Disease The effects of physical training and flunarizine on walking capacity in intermittent claudication. Treadmill versus shuttle walk tests of walking ability in intermittent claudication. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Differential lipogenic effects of cilostazol and pentoxifylline in patients with intermittent claudication: potential role for interleukin-6. Body-weight-supported treadmill rehabilitation after stroke. The effect of supervised exercise and cilostazol on coagulation and fibrinolysis in intermittent claudication: a randomized controlled trial. Benefits of Low-Intensity Pain-Free Treadmill Exercise on Functional Capacity of Individuals Presenting With Intermittent Claudication Due to Peripheral Arterial Disease The effects of prostaglandin E-1 in patients with intermittent claudication.
OBJECTIVES The Exercise Therapy in Peripheral Arterial Disease ( EXITPAD ) study has shown supervised exercise therapy ( SET ) to be more effective regarding walking distance and quality of life than a ' go home and walk ' advice ( WA ) for patients with intermittent claudication . The present study aims to assess the cost-effectiveness of SET versus WA . PATIENTS AND METHODS Data from the EXITPAD study , a 12-month r and omised controlled trial in 304 patients with claudication , was used to study the proportion of costs to walking distance and quality of life . Two different incremental cost-effectiveness ratios ( ICERs ) were calculated for SET versus WA : costs per extra metre on the treadmill test , and costs per quality -adjusted life year ( QALY ) . QALYs were based on utilities derived from the EuroQoL-5 dimensions ( EQ-5D ) . RESULTS Mean total costs were higher for SET than for WA ( 3407 versus 2304 Euros ) , mainly caused by the costs of exercise therapy . The median walking distance was 620 m for SET and 400 m for  WA . QALYs were 0.71 for SET and 0.67 for WA . All differences were statistically significant . The ICER for cost per extra metre on the 12-month treadmill test was € 4.08 . For cost per QALY , the ICER was € 28,693 . CONCLUSION At a willingness-to-pay threshold of € 40,000 per QALY , SET likely is a cost-effective therapeutic option for patients with claudication OBJECTIVE 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 . METHODS This multicenter r and omized trial was set in vascular surgery outpatient clinics and included 304 patients with intermittent claudication . Patients were r and omized 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 Question naire ( WIQ ) and Short-Form 36 ( SF-36 ) Health Survey after 12 months . RESULTS 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 . CONCLUSIONS 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 OBJECTIVE Prevalence of peripheral arterial disease is equal in men and women . However , women seem to suffer more from the burden of disease . Current studies on gender-related outcomes following supervised exercise therapy ( SET ) for intermittent claudication ( IC ) yield conflicting results . METHODS A follow-up analysis was performed on data from the 2010 Exercise Therapy in Peripheral Arterial Disease ( EXITPAD ) study , a multicenter r and omized controlled trial including IC patients receiving SET or a walking advice .  The SET program was supervised by physiotherapists and included interval-based treadmill walking approximating maximal pain combined with activities such as cycling and rowing . Patients usually started with three 30-minute sessions a week . Training frequency was adapted during the following year on the basis of individual needs . The primary outcome was gender differences regarding the change in absolute claudication distance ( ACD ) after SET . ACD was defined as the number of meters that a patient had covered just before he or she was forced to stop walking because of intolerable pain . Secondary outcomes were gender differences in change of functional walking distance , quality of life , and walking (dis)ability after SET . Walking distances were obtained by  st and ardized treadmill testing  according to the Gardner-Skinner protocol . Quality of life was measured by the 36-Item Short Form Health Survey , and walking (dis)ability was determined by the Walking Impairment Question naire ( WIQ ) . Measurements were performed at baseline and after 3 , 6 , 9 , and 12 months . Only patients who met the 12-month follow-up measure were included in the analysis . RESULTS A total of 113 men and 56 women were available for analysis . At baseline , groups were similar in terms of clinical characteristics and ACD walking distances ( men , 250 meters ; women , 270 meters ; P = .45 ) . ACD improved for both sexes . However , ACD increase was significantly lower for women than for men during the first 3 months of SET ( Δ 280 meters for men vs Δ 220 meters for women ; P = .04 ) . Moreover , absolute walking distance was significantly shorter for women compared with men after 1 year ( 565 meters vs 660 meters ; P = .032 ) . Women also reported less on several WIQ subdomains , although total WIQ score was similar ( 0.69 for men vs 0.61 for women ; P = .592 ) . No differences in quality of life  after SET were observed . CONCLUSIONS Women with IC benefit less during the first 3 months of SET and have lower absolute walking distances  after 12 months of follow-up compared with men . More research is needed to determine whether gender-based IC treatment strategies are required OBJECTIVES To evaluate effects of a structured home-based exercise program on functional capacity and quality of life ( QoL ) in patients with intermittent claudication ( IC ) after 1-year follow-up , and to compare these results with those from a concurrent control group who received supervised exercise training ( SET ) . DESIGN Comparative longitudinal cohort study . SETTING Referral center . PARTICIPANTS Patients ( N=142 ) with IC . INTERVENTIONS Structured home-based exercise training or SET . MAIN OUTCOME MEASURES The maximum ( pain-free ) walking distance and the ankle-brachial index ( ABI ) ( at rest and postexercise ) were measured at baseline and after 6 and 12 months ' follow-up . Additionally , QoL was evaluated using a self-administered question naire consisting of the Euroqol-5D ( scale 0 - 1 ) , rating scale ( scale 0 - 100 ) , Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ; scale 0 - 100 ) , and the Vascular Quality of Life Question naire ( VascuQol ; scale 1 - 7 ) . Comparison of the groups was performed with adjustment for the nonr and omized setting using propensity scoring . RESULTS One hundred forty-two patients with IC started the  structured home-based exercise program , of whom 95 ( 67 % ) completed 12 months ' follow-up . The mean relative improvement compared with baseline was statistically significant after 12 months ' follow-up for the maximum and pain-free walking distance ( 342 % , 95 % confidence interval [ CI ] , 169 - 516 ; P<.01 and 338 % , 95 % CI , 42 - 635 ; P=.03 , respectively ) and for the ABI postexercise ( mean change , .06 ; 95 % CI , .01-.10 ; P=.02 ) . For the QoL outcomes , the improvement compared with baseline was statistically significant after 12 months for the VascuQol ( mean change , .42 ; 95 % CI , .20-.65 ; P<.01 ) and for the SF-36 physical functioning ( mean change , 5.17 ; 95 % CI , .77 - 9.56 ; P=.02 ) . Compared with the structured home-based exercise program , patients in the control group showed significantly better results in the mean relative improvement of maximum and pain-free walking distance and change in the ABI at rest after 12 months ' follow-up . CONCLUSIONS Structured home-based exercise training is effective in improving both functional capacity and QoL in patients with IC and may be considered as a feasible and valuable alternative toSET , since supervised exercise programs are not often available OBJECTIVE / BACKGROUND Intermittent claudication ( IC ) is associated with a reduction in physical activity ( PA ) and a more rapid functional decline leading to a higher mortality rate compared with healthy individuals . Supervised exercise therapy ( SET ) is known to increase the walking capacity of patients with IC . However , it is unclear whether SET increases PA . The aim of this study was to investigate the effect of SET on PA levels and ambulatory activities in patients with IC . METHODS Patients newly diagnosed with IC were requested to wear an activity monitor 1 week prior to and 1 week immediately after 3 months of SET . The primary outcome was the percentage of patients meeting the minimum recommendations of PA ( American College of Sports Medicine [ACSM]/American Heart Association [ AHA ] recommendation for public health of ≥ 67 metabolic equivalents [METs]/min/day , in bouts of ≥ 10 min ) at baseline and after 3 months of SET . Additionally , daily PA level ( METs/min ) , duration of ambulatory activities , daily number of steps , pain free walking distance ( PFWD ) , maximal walking distance ( MWD ) , and Short Form Health Survey ( SF-36 ) health surveys were compared before and after SET . RESULTS Data from 41 participants were available for analysis . A higher number of participants met the ACSM minimum recommendation for PA at the 3 month follow up ( baseline : 43 % ; 3 months : 63 % ; p = .003 ) . Despite significant increases in PFWD ( baseline : 210 m ; 3 months : 390 m ; p = .001 ) , MWD ( baseline : 373 m ; 3 months : 555 m ; p = .002 ) and physical functioning score ( SF-36 )  following SET , no increase in the mean daily PA level was found ( 395 ± 220 vs. 411 ± 228 METs/min ; p = .43 ) . Furthermore , the total number of steps and time spent in ambulatory activities did not change following SET . CONCLUSION Three months of SET for IC leads to more patients meeting the ACSM/AHA public health minimum recommendations for PA . Assessment of PA could be incorporated as an outcome parameter in future research comparing different treatment modalities for peripheral arterial disease OBJECTIVES Supervised exercise training ( SET ) is recommended for patients with intermittent claudication ( IC ) . The optimal exercise programme has not been identified , and the potential adverse effects of exercise on these patients warrant consideration . Calpain proteases have been linked with tissue atrophy following ischaemia-reperfusion injury . High calpain activity may therefore cause muscle wasting in claudicants undergoing SET , and skeletal muscle mass ( SMM ) is integral to healthy ageing . This study assesses the impact of ( 1 ) treadmill-based SET alone ; and ( 2 ) treadmill-based SET combined with resistance training on pain-free walking distance ( PFWD ) , SMM , and calpain activity . METHODS Thirty-five patients with IC were r and omised to 12 weeks of treadmill only SET ( group A ) , or combined treadmill and lower-limb resistance SET ( group B ) . PFWD via a 6-minute walking test , SMM via dual energy X-ray absorptiometry , and calpain activity via biopsies of gastrocnemius muscles were analysed . RESULTS Intention-to-treat analyses revealed PFWD improved within group A ( 160 m to 204 m , p = .03 ) , but not group B ( 181 m to 188 m , p = .82 ) . There was no between group difference ( p = .42 ) . Calpain activity increased within group A ( 1.62 × 10(5 ) fluorescent units [ FU ] to 2.21 × 10(5 ) FU , p = .05 ) , but not group B. There was no between group difference ( p = .09 ) . SMM decreased within group A ( -250 g , p = .11 ) and increased in group B ( 210 g , p = .38 ) ( p = .10 between groups ) . Similar trends were evident for per protocol analyses , but , additionally , change in SMM was significantly different between groups ( p = .04 ) . CONCLUSIONS Neither exercise regimen was superior in terms of walking performance . Further work is required to investigate the impact of the calpain system on SMM in claudicants undertaking SET INTRODUCTION Treatment of intermittent claudication ( IC ) due to peripheral arterial disease ( PAD ) is aim ed at improving walking distance and includes secondary prevention of cardiovascular disease . Both supervised exercise therapy ( SET ) and percutaneous transluminal angioplasty ( PTA ) have proven to be effective in increasing maximum and pain-free walking distance in IC . However , the optimal treatment strategy in patients with IC due to iliac artery stenosis or occlusion remains unclear . OBJECTIVE To compare the ( cost- ) effectiveness of initial PTA versus initial SET in patients with disabling IC due to an iliac artery obstruction . DESIGN In a multicentre r and omised controlled trial 400 consecutive patients with IC will be r and omly assigned to PTA ( with additional stent placement on indication ) or SET . Primary outcomes are maximum walking distance and health-related quality of life measured using the disease-specific VascuQol instrument after 1 year . Secondary outcomes are pain-free walking distance , functional status , generic quality of life , complications related to each of the interventions , additional interventions , treatment failures and costs ( cost-effectiveness and cost-utility ) after 1 year . CONCLUSION AND IMPLICATION S Based on the results of this proposed large study well-founded adjustments of existing guidelines on the treatment of iliac artery occlusive disease can be implemented ( Clinical Trials.gov NCT01385774 ; Nederl and s Trial Register NTR2776 ) BACKGROUND Supervised treadmill-walking exercise programs have been proven to be a highly effective in improving walking distance in peripheral arterial disease ( PAD ) patients with lifestyle-limiting claudication . Limited information is available on the contributions of central cardiorespiratory functions for improving these patients ' walking capacity with exercise training . METHODS This study r and omized 28 participants ( 21 men ; age , 65.6 years ; 92.7 % smoking history , 36.6 % with diabetes ) with lifestyle-limiting PAD-related claudication to 3 hours/week of supervised exercise training for 12 weeks  , using arm-ergometry ( n = 10 ) or treadmill-walking ( n = 10 ) vs a usual-care control group ( n = 8) . Cardiorespiratory function measurements were assessed before and after training at a submaximal workload and at the onset of claudication ( pain-free walking distance [ PFWD ] ) and at maximal walking distance [ ( MWD ] ) . Changes in these functions from baseline were analyzed among the groups with analysis of covariance . Associations between variables were determined by Pearson 's partial correlations . RESULTS The mean baseline demographic , medical , and exercise variables were similar among the groups . There were similar significant differences in the submaximal double product ( heart rate × systolic blood pressure ) and at MWD , ventilatory threshold , ventilatory oxygen uptake ( VO(2 ) ) at onset of claudication , and VO(2 ) peak in response to training in both exercise groups vs the control group . Statistically significant , moderate correlations ( r = 0.60 - 0.68 ) were found between changes in all cardiorespiratory variables and changes in PFWD or MWD . CONCLUSION Improvements in cardiorespiratory function after arm-ergometry or treadmill-training were significantly associated with improvements in both PFWD and MWD , providing supporting evidence of systemic contributions to exercise training-related improvements in walking capacity seen in patients with claudication PURPOSE In a pilot study , the hypothesis was tested that a home-based walking exercise program with structured coaching would improve walking performance and adherence in patients with intermittent claudication ( IC ) . METHODS Thirty-one IC patients with a rest ankle-brachial pressure index < 0.90 started a 24-wk walking program in the home environment . They were coached according to the Health Counseling Model ( HCM ) . Patients were instructed to walk at least 9 bouts.wk-1 and to walk through the pain . The main effect measures were pain-free ( initial claudication distance ( ICD ) ) and maximum walking distance ( absolute claudication distance ( ACD ) ) measured with a grade d treadmill test , a corridor exercise test , a  walking-diary  , and the score on the Walking Impairment Question naire ( WIQ ) . RESULTS Twenty-four participants completed the program . The reported walking frequency was 7.4 times.wk-1 . The average ICD improved from 289 m ( 95 % CI , 209 - 369 ) to 347 m ( 95 % CI , 244 - 449 ) ( P < 0.05 ) and from 241 m ( 95 % CI , 171 - 310 ) to 373 m ( 95 % CI , 273 - 472 ) on the treadmill and the corridor test , respectively . The average ACD improved from 490 m ( 95 % CI , 397 - 583 ) to 544 m ( 95 % CI , 438 - 650 ) and from 564 m ( 95 % CI , 412 - 717 ) to 726 m ( 95 % CI , 546 - 906 ) ( P < 0.01 ) on the treadmill and the corridor test , respectively . The average maximum distance reported in the walking-diary improved from 957 m ( 95 % CI , 291 - 1623 ) to 1294 m ( 95 % CI , 646 - 1941 ) . The score of the walking distance on the WIQ improved from 57 % ( 95 % CI , 42 - 71 % ) to 60 % ( 95 % CI , 46 - 74 % ) . CONCLUSION IC patients improved their average ICD and ACD . The walking exercise program in the home environment with coaching according to the HCM seems a promising intervention to be tested in a r and omized controlled trial Abstract The efficacy of treadmill walking training to improve pain-free ( PFWD ) and maximal ( MWD ) walking distance in patients with claudication is well documented . The effects of aerobic arm-ergometry to improve PFWD and MWD compared to treadmill walking or usual care are not known . Forty-one participants ( 29 male , 12 female , mean age 67.7 years , 92.7 % smoking history , 36.6 % with diabetes ) with lifestyle-limiting claudication were r and omized to 12 weeks of 3 hours/week of supervised exercise training using either arm-ergometry , treadmill walking , or a combination , versus control .  PFWD and MWD were assessed before and after training , and after 12 weeks of follow-up . The 12-week MWD increased significantly in the arm-ergometry ( + 53 % ) , treadmill ( + 69 % ) , and combination ( + 68 % ) groups ( p < 0.002 versus control ) . The 24-week MWD was maintained in the arm-ergometry ( p = 0.009 ) and treadmill ( p = 0.019 ) groups , whereas the combination group declined ( p = 0.751 ) versus control . The 12-week PFWD increased significantly in the arm-ergometry group ( + 82 % ; p = 0.025 versus control ) . Change in PFWD in treadmill ( + 54 % ; p = 0.196 versus control ) and combination ( + 60 % ; p = 0.107 versus control ) groups did not reach statistical significance . PFWD improvement was maintained in the arm-ergometry group after a 12-week follow-up ( + 123 % ; p = 0.011 versus control ) . In conclusion , these pilot data demonstrate for the first time that dynamic arm exercise training can improve walking capability in people with peripheral arterial disease (PAD)-induced claudication compared to participants receiving usual care and that improvement was not different from that seen with treadmill walking exercise training . Dynamic arm exercise may be a therapeutic exercise option for patients with PAD OBJECTIVE Exercise advice is the main treatment for symptom relief in the UK for patients with mild to moderate Intermittent Claudication ( IC ) . Would a weekly exercise and motivation class for 6 months offer adjuvant benefit over written and verbal exercise advice alone ? PATIENTS AND METHODS Fifty-nine patients attending a regional vascular centre for whom IC was the main factor affecting mobility were r and omised to either exercise advice alone ( n=30 ) or exercise advice with a once a week 45 min supervised exercise/motivation class ( n=29 ) . The mean age was 68 years . Baseline and 6-month assessment included a Quality of Life Question naire -- the Short-Form-36 , the Charing Cross Symptom Specific Claudication Question naire ( CCCQ ) and treadmill walking distance ( 3.5 km/h 12 % ) . RESULTS At 6-month follow-up the supervised exercise group had improved their treadmill walking by 129 % compared to 69 % in the advice alone group ( p=0.001 ) . This significant improvement was maintained at the subsequent 9 and 12-month follow-up assessment s. By the 9-month stage the advice only group CCCQ score had improved 16 % from baseline , while the supervised exercise group had a significantly better 43 % improvement in base line score ( p<0.05 ) . Self reported frequency of walks was higher in the exercise class group being significant for improvement in CCCQ score . CONCLUSION A weekly , supervised exercise and motivation class for a 6-month period provides a significant improvement in patients ' symptoms , quality of life , and distance walked compared with advice alone and this improvement continues after attendance at class has ceased OBJECTIVE To compare the effect of two training programmes and advice to exercise at home on physiological adaptations in patients with peripheral arterial disease ( PAD ) . DESIGN 30 patients with a typical history of PAD and intermittent claudication were r and omised to either an upper body strength training programme ( UBST ) , a dynamic ( walking , cycling , circuit ) conventional exercise rehabilitation programme ( CER ) , or advice to ' walk as much as possible at home ' ( CONT ) . Before and after intervention groups performed a st and ard grade d treadmill exercise test ( GTET ) and a 6-minute walk test ( SMWT ) to determine peak physiological parameters and walking distances . Maximal walking distance ( MWD ) , pain-free walking distance ( PFWD ) , peak oxygen uptake ( VO2 ) , heart rate and perceived pain were measured . RESULTS MWD on the GTET increased significantly in the CER group compared with the CONT and UBST groups ( 93.9 + /- 79 % v. 7.0 + /- 19.8 % v. 7.3 + /- 46 % ; CER v. UBST v. CONT p = 0.003 ) . Similarly , peak VO2 increased with CER compared with the CONT and UBST groups ( 28.4 + /- 20 v. -6.2 + /- 15 v. -1.0 + /- 21 % ; CER v. UBST v. CONT p = 0.004 ) . During the SMWT the CER and UBST groups improved in PFWD compared with the CONT group ( 37 + /- 47 % v. 27 + /- 71 % v. -30 + /- 29 % ; CER v. UBST v. CONT p = 0.03 ) , and perceived pain decreased in the CER group compared with the UBST group ( -24 + /- 39 % v. 27 + /- 48 % ; CER v. UBST p = 0.01 ) . CONCLUSION CER improves physiological parameters and walking distances more than UBST does . CER is effective within 6 weeks . Verbal encouragement to exercise is an ineffective form of management OBJECTIVE This study describes the results and functioning of community-based supervised exercise therapy ( SET ) at one year of follow-up . METHODS We conducted a prospect i ve cohort study of community-based SET in regional physiotherapeutic practice s. Consecutive patients with intermittent claudication referred for community-based SET were included . Exclusion criteria for SET were pain at rest or tissue loss . All patients received a diagnostic workup consisting of an ankle-brachial index at rest and after exercise . Interventions were exercise therapy according to the guidelines of the Royal Dutch Society for Physiotherapy . The primary outcome measurement was the increase in absolute claudication distance ( ACD ) , assessed using a st and ardized treadmill protocol by a physiotherapist at baseline and at four , 12 , 26 , and 52 weeks of SET . RESULTS From January 2005 through September 2006 , 349 patients were referred by vascular surgeons for community-based SET . A total of 272 patients with intermittent claudication began the program . Of the 349 initially referred patients , 52 could not perform a st and ard treadmill test but did start community-based SET at a lower level , and 25 patients never started the program . At one year , 129 of the original 272 patients who began community-based SET  ( 47.4 % ) were available for analysis of walking distance . In the interim , 143 patients discontinued the program for the following reasons : satisfaction with the acquired walking distance ( n = 19 ) ; unsatisfying results ( n = 26 ) ; not motivated ( n = 22 ) ; (non)vascular intercurrent disease ( n = 48 ) ; and other reasons ( n = 28 ) . ACD increased significantly from a median of 400 m at baseline to 1100 m after 12 months of follow-up ( P < .001 ) , corresponding to a median increase of 107.8 % . CONCLUSION Community-based SET seems as effective as SET in a hospital-based approach in improving walking distance , however , it has a high dropout rate OBJECTIVES The main aims of treatment in patients with intermittent claudication ( IC ) are to improve the clinical indicators of lower limb ischaemia and patients ' quality of life ( QoL ) . The aims of this study were assess the clinical and cost effectiveness of a supervised exercise programme ( SEP ) in patients with IC . DESIGN Non-r and omised , controlled trial . SETTING University teaching hospital . PATIENTS AND METHODS Two groups of patients with IC were studied . Seventy patients were sequentially recruited before and after the establishment of a Supervised Exercise Programme at our unit . Thirty-seven patients ( median age 69 years , 26 men ) received  conservative medical therapy ( CMT ) and 33 patients ( median age 67 years , 22 men ) received CMT plus a 3 month SEP of graduated physical exercise for sixty minutes , three times each week . Patients were assessed prior to and at 6 months following treatment . At each assessment patient reported walking distances ( PRWD ) , treadmill claudication and maximal distances ( ICD and MWD ) , ankle brachial pressure indices ( ABPI ) pre & post exercise and patient reported QoL using the SF36 question naire were assessed . RESULTS Prior to intervention the two groups were well matched . Following treatment , CMT patients demonstrated no significant change in PRWD or ICD but did record a small but significant improvement in MWD .  CMT was also associated with a negative effect size in the SF36 index and in 7 of the 8 SF36 QoL domains , effect size > -0.5 for the domains of Physical Function and Emotional Role . SEP patients demonstrated significant improvement in PRWD , ICD and MWD . SEP was associated with a positive effect size in the SF36 index and in 2 SF36 QoL domains but a negative effect size in a further 2 domains . However , all QoL effect sizes following SEP were < + /-0.5 . Intergroup differences in effect sizes were > 0.5 for the SF36 domains of Physical Function , Physical Role , Emotion Role and SF36 index . SEP result ed in a 0.027 quality adjusted life year ( QALY ) gain over CMT in the first year post-treatment thus the cost/QALY gained of SEP is pound1780 at 1 year . CONCLUSIONS Compared to CMT , SEP increases walking distances , improves QoL and is a highly cost-effective treatment for IC OBJECTIVE This cohort study was conducted to determine the effect on walking distances of supervised exercise therapy provided in a community-based setting . METHODS The study included all consecutive patients presenting at the vascular outpatient clinic with intermittent claudication , diagnosed by a resting ankle brachial index<0.9 , who had no previous peripheral vascular intervention for peripheral arterial disease , no major amputation , and sufficient comm and of the Dutch language . The exclusion criterion was the inability to walk the baseline treadmill test for a minimum of 10 m. The intervention was a supervised exercise therapy in a community-based setting . A progressive treadmill test at baseline and at 1 , 3 , and 6 months of follow-up measured initial claudication distance and absolute claudication distance . Changes were calculated using the mean percentages of change . RESULTS From January through October 2005 , 93 consecutive patients with claudication were eligible . Overall , 37 patients discontinued the supervised exercise therapy program . Eleven stopped because of intercurrent diseases , whereas for 10 , supervised exercise therapy did not lead to adequate improvement and they underwent a vascular intervention . Three patients quit the program , stating that they were satisfied with the regained walking distance and did not require further supervised exercise therapy . Ten patients were not motivated sufficiently to continue the program , and in three patients , a lack of adequate insurance coverage was the reason for dropping out . Data for 56 patients were used and showed a mean percentage increase in initial claudication distance of 187 % after 3 months and 240 % after 6 months . The mean percentage of the absolute claudication distance increased 142 % after 3 months and 191 % after 6 months . CONCLUSION Supervised exercise therapy in a community-based setting is a promising approach to providing conservative treatment for patients with intermittent claudication BACKGROUND Intermittent claudication is the most common symptom of peripheral arterial disease . Previous research has suggested that extracorporeal shockwave therapy ( ESWT ) may induce angiogenesis in treated tissue . The objective of this feasibility pilot trial was to assess the safety , tolerability , and efficacy of ESWT as a novel treatment . METHODS Patients with unilateral claudication were r and omized to receive ESWT or sham treatment to the calf muscle three times per week for 3 weeks . Primary outcomes were pain-free walking distance ( PFWD ) and maximum walking distance ( MWD ) . Secondary outcomes included safety and tolerability of ESWT treatment , ankle-brachial index before and after exercise , and quality of life assessed using generic ( 36-Item Short Form Health Survey , EuroQol-5 Dimension 3-Level ) and disease-specific ( Vascular Quality of Life ) instruments . Participants were assessed at baseline and 4 , 8 , and 12 weeks after treatment . Feasibility outcomes included recruitment and attendance rates for treatment and follow-up . RESULTS Thirty patients were recruited in total . Statistically significant ( P < .05 ) improvements at all time points were observed in the active treatment group for both MWD and PFWD compared with the sham treatment group . PFWD improved by 276 % in the active group and MWD improved by 167 % in the active group at 12 weeks after treatment . There were no immediate or delayed treatment safety concerns or documented adverse effects of treatment with ESWT in this trial . CONCLUSIONS ESWT is safe and well tolerated when it is applied to the calf and demonstrated significant improvements in walking distances . Current conservative management of intermittent claudication includes supervised exercise . The early results with ESWT as an alternative , noninvasive treatment option show great potential . The mechanism of action , durability of the clinical effect , and cost-effectiveness of ESWT for claudication require further investigation OBJECTIVE Physicians and patients consider the limited walking distance and perceived disability when they make decisions regarding ( invasive ) treatment of intermittent claudication ( IC ) . We investigated the relationship between walking distances estimated by the patient , on the corridor and on a treadmill , and the  Walking Impairment Question naire ( WIQ ) in patients with IC due to peripheral arterial disease . METHODS This was a single-center , prospect i ve observational cohort study at a vascular laboratory in a university hospital in the Netherl and s. The study consisted of 60 patients ( 41 male ) with a median age of 64 years ( range , 44 - 86 years ) with IC and a walking distance ≤ 250 m on a st and ardized treadmill test .  Main outcome measures were differences and Spearman rank correlations between pain-free walking distance , maximum walking distance ( MWD ) estimated by the patient , on the corridor and on a st and ardized treadmill test , and their correlation with the WIQ . RESULTS The median patients ' estimated , corridor , and treadmill MWD were 200 , 200 , and 123 , respectively ( P < .05 ) . Although the median patients ' estimated and corridor MWD were not significantly different , there was a difference on an individual basis . The correlation between the patients ' estimated and corridor MWD was moderate ( r = 0.61 ; 95 % confidence interval [ CI ] , 0.42 - 0.75 ) . The correlation between patients ' estimated and treadmill MWD was weak ( r = 0.39 ; 95 % , CI 0.15 - 0.58 ) . Respective correlations for the pain-free walking distance were comparable . The patients ' estimated MWD was moderately correlated with WIQ total score ( r = 0.63 ; 95 % , CI 0.45 - 0.76 ) and strongly correlated with WIQ distance score ( r = 0.81 ; 95 % CI , 0.69 - 0.88 ) . The correlation between the corridor MWD and WIQ distance score was moderate ( r = 0.59 ; 95 % CI , 0.40 - 0.74 ) . CONCLUSIONS Patients ' estimated walking distances and on a treadmill do not reflect walking distances in daily life . Instruments that take into account the perceived walking impairment , such as the WIQ , may help to better guide and evaluate treatment decisions Abstract Purpose : The aim of the study was to compare the efficacy of Nordic pole walking ( NPW ) training with traditional treadmill training ( TT ) on a claudication ( CD ) and maximum walking distance ( MWD ) in patients with peripheral arterial disease ( PAD ) . Method : Patients with intermittent claudication ( IC ) ( n = 70 ; age=68.27 ) in the Fontaine class II were r and omized into a two three-month rehabilitation programs performed three times per week . TT were finished by 31 patients , NPW by 21 . Walking capacity was measured by an  exercise treadmill test ( ETT ) with the Gardner – Skinner protocol ( before and after the program ) and  six minute walk test ( 6MWT ) ( before , during and after the program ) . Results : In an ETT both groups reached significant increase in CD and MWD ( p ≤ 0.005 ) . In 6MWT NPW group reached significant increase in both CD ( p = 0.001 ) and MWD ( p = 0.001 ) , whereas the TT group only in MWD ( p = 0.001 ) . Conclusions : NPW has been shown to be as effective as the st and ard TT and is much less expensive . It should be the preferred method of exercise for PAD patients with IC . Implication s for Rehabilitation Nordic walking training is a valuable form of rehabilitation for peripheral arterial disease ( PAD ) patients with intermittent claudication ( IC ) . Nordic walking has been shown to be as efficient as traditional treadmill training . It is however more cost-effective method of rehabilitation in PAD patients OBJECTIVE To determine the effects of 12-week exercise programme on ambulatory function , free-living daily physical activity and health-related quality of life in disabled older patients with intermittent claudication . DESIGN Prospect i ve , r and omized controlled trial . SETTING University Medical Center and Veterans Affairs Medical Center , Taipei , Taiwan . SUBJECTS Thirty-two of 64 patients with Fontaine stage II peripheral arterial occlusive disease ( PAOD ) were r and omized to exercise training and 32 to usual care control .  Five patients from the exercise group and six patients from the control group dropped out , leaving 27 and 26 patients , respectively , completing the study in each group . INTERVENTIONS Twelve weeks of treadmill exercise training . MAIN OUTCOME MEASURES Treadmill walking time to onset of claudication pain and to maximal claudication pain , 6-min walk distance , self-reported ambulatory ability and perceived health-related quality of life ( QOL ) . RESULTS Compliance of exercise programme was 83 % of the possible sessions . Exercise training increased treadmill walking time to onset of claudication pain by 88 % ( P < 0.001 ) , time to maximal pain by 70 % ( P < 0.001 ) , and 6-min walk distance by 21 % ( P < 0.001 ) . SUBJECTS Perception of health-related QOL improved from 12 % to 178 % in the exercise group . These improvements were significantly better than the changes in the control group ( P < 0.05 ) . CONCLUSIONS Significant improvements in claudication following 12-week exercise training in elderly PAOD patients were observed . Increase in treadmill walking time to maximal claudication pain in these patients translated into the improvement of perceived physical health , which enabled the patients to become more functionally independent 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 Prospect i ve , r and omized controlled trial . SETTING University Medical ( Center and Veterans Affairs Medical Center , Baltimore , Maryl and . PARTICIPANTS Thirty-one of 61 patients with Fontaine stage II peripheral arterial occlusive disease ( PAOD ) were r and omized 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 CONTEXT Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease ( PAD ) without intermittent claudication have been established as beneficial . OBJECTIVE To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication . DESIGN , SETTING , AND PARTICIPANTS R and omized 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 r and omly assigned to supervised treadmill exercise , to lower extremity resistance training , or to a control group .  MAIN OUTCOME MEASURES Six-minute walk performance and the short physical performance battery . Secondary outcomes were brachial artery flow-mediated dilation , treadmill walking performance , the Walking Impairment Question naire , and the 36-Item Short Form Health Survey physical functioning ( SF-36 PF ) score . RESULTS 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 . CONCLUSIONS 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 . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00106327 BACKGROUND Disease severity in patients with intermittent claudication ( IC ) is often assessed using walking distances and treadmill tests . The aim of this study was to determine the agreement between walking distance as estimated by the patient , as measured during outside walking , and as determined using a non grade d treadmill protocol ( NGTP ) , and an incremental grade d ( Gardner-Skinner ) treadmill protocol ( GSP ) . METHODS In this prospect i ve observational study , 30 patients with IC estimated their maximal walking distance ( MWD ) and completed a  " Walking Impairment Question naire " ( WIQ ) .  Outside walking was determined using a measuring wheel and a GSP controlled device . Primary outcomes were differences in MWD and variability ( coefficient of variation , COV ) . Secondary outcomes were results of WIQ and differences in walking speed . RESULTS Estimated walking distance was significantly higher than MWD as objective ly measured during outside walking ( 400 m vs. 309 m , respectively , P = 0.02 ) . A substantial variability ( COV = 55 % ) was found between both parameters . A small 35-m MWD difference between outside walking and GSP was found with a substantial scatter ( COV = 42 % ) . In contrast , a much larger 122-m MWD difference was present between outside walking and NGTP ( COV = 89 % ) . Patients walked significantly faster in the open air than on treadmills ( median outside walking speed = 3.8 km/hr , GSP = 3.2 km/hr , NGTP = 2.8 km/hr ; P < 0.001 ) . CONCLUSIONS An incremental grade d ( Gardner-Skinner ) treadmill protocol demonstrated the best agreement to outside walking . Discrepancies between treadmill tests and outside walking may be explained by a difference in walking speed . A single determination of a walking distance is a poor reflection of true walking capacity OBJECTIVE To analyze the effects of strength training ( ST ) in walking capacity in patients with intermittent claudication ( IC ) compared with walking training ( WT ) effects . METHODS Thirty patients with IC were r and omized into ST and WT . Both groups trained twice a week for 12 weeks at the same rate of perceived exertion . ST consisted of three sets of 10 repetitions of whole body exercises . WT consisted of 15 bouts of 2-minute walking . Before and after the training program walking capacity , peak VO(2 ) , VO(2 ) at the first stage of treadmill test , ankle brachial index , ischemic window , and knee extension strength were measured . RESULTS ST improved initial claudication distance ( 358 + /- 224 vs 504 + /- 276 meters ; P < .01 ) , total walking distance ( 618 + /- 282 to 775 + /- 334 meters ; P < .01 ) , VO(2 ) at the first stage of treadmill test ( 9.7 + /- 2.6 vs 8.1 + /- 1.7 mL.kg(-1).minute ; P < .01 ) , ischemic window ( 0.81 + /- 1.16 vs 0.43 + /- 0.47 mm Hg minute meters(-1 ) ; P = .04 ) , and knee extension strength ( 19 + /- 9 vs 21 + /- 8 kg and 21 + /- 9 vs 23 + /- 9 ; P < .01 ) . Strength increases correlated with the increase in initial claudication distance ( r = 0.64 ; P = .01 ) and with the decrease in VO(2 ) measured at the first stage of the treadmill test ( r = -0.52 ; P = .04 and r = -0.55 ; P = .03 ) . Adaptations following ST were similar to the ones observed after WT ; however , patients reported lower pain during ST than WT ( P < .01 ) . CONCLUSION ST improves functional limitation similarly to WT but it produces lower pain , suggesting that this type of exercise could be useful and should be considered in patients with IC Mika P , Spodaryk K , Cencora A , Unnithan VB , Mika A : Experimental model of pain-free treadmill training in patients with claudication . Am J Phys Med Rehabil 2005;84:756–762 . Objective : Treadmill training in claudication is often based on walking exercise to a pain threshold or longer to the maximum muscle pain of the lower limbs . This kind of exercise may cause an inflammatory response . The purpose of this study was to determine whether pain-free treadmill training using walking exercise to 85 % of the distance to onset of claudication pain can significantly improve pain-free walking distance in patients with intermittent claudication and to evaluate whether this kind of program may induce an inflammatory response leading to the progression of atherosclerosis . Design : A total of 98 patients aged 50–70 yrs with stable intermittent claudication were r and omized into a supervised treadmill training program or a comparison group . Patients in the treatment group participated in 12 wks of supervised treadmill training . We examined the effects of 12 wks of pain-free treadmill training on pain-free walking distance , total leukocyte count , neutrophil count , and microalbuminuria in patients with claudication . Results : A total of 80 participants completed the program .  Exercise rehabilitation increased the time to onset of claudication pain by 119.2 % , from 87.4 ± 38 m to 191.6 ± 94.8 m ( P < 0.001 ) . There was no increase in total leukocyte count , neutrophil count , or microalbuminuria after 12 wks of treadmill exercise ( P > 0.05 ) Conclusion : A pain-free training program can be used in the treatment of claudication as a low-risk program , increasing walking ability without potential harmful effects of ischemia – reperfusion injury PURPOSE A pilot study was conducted to test the feasibility of supervised treadmill exercise training to improve functioning in study participants with peripheral arterial disease who did not have classical symptoms of intermittent claudication . METHODS For this study , 32 men and women with peripheral arterial disease but no symptoms of claudication were r and omized to exercise training or usual care .  The intervention was a 12-week supervised treadmill walking program . Outcomes included 6-minute walk distance , maximum treadmill walking distance , and 4-meter walking velocity . Participant-reported community walking ability was measured with the Walking Impairment Question naire ( WIQ ) . Inflammatory blood factor levels also were measured . RESULTS Altogether , 25 participants who completed follow-up testing were included in intention-to-treat analyses . Of 24 participants ( 58 % ) r and omized to exercise , 14 completed the entire exercise training program . The participants r and omized to the intervention showed greater improvement in their WIQ walking speed score than the control subjects ( P = .05 ) . The participants r and omized to the intervention showed improvements in their 6-minute walk distance ( 1134 + /- 347 vs 1266 + /- 295 feet ; P = .03 ) , maximal treadmill walking distance ( 389 + /- 248 vs 585 + /- 293 feet ; P < .001 ) , WIQ distance score ( 52.3 + /- 29.1 vs 63.1 + /- 25.1 ; P = .002 ) , and WIQ speed score ( 48.7 + /- 26.8 vs 59.7 + /- 22.7 ; P = .008 ) . The participants r and omized to the control condition showed improvements in maximal treadmill walking distance ( 362 + /- 180 vs 513 + /- 237 feet ; P = .014 ) . There were no significant changes in the inflammatory blood factors after exercise . CONCLUSIONS This pilot study demonstrated that a supervised treadmill walking program may be feasible and may improve functioning for individuals with peripheral arterial disease who do not have classical symptoms of intermittent claudication . Further study is needed with a larger sample to identify optimal exercise methods that improve lower extremity functioning in men and women with peripheral arterial disease who do not have intermittent claudication OBJECTIVES To evaluate an unsupervised home-based exercise programme for physiological , functional , and quality of life impact in patients with symptomatic peripheral arterial disease . DESIGN Prospect i ve cohort with exercise intervention . MATERIAL S Human performance laboratory with non-invasive haemodynamic assessment facilities . METHODS Forty-seven patients with symptomatic peripheral arterial disease ( mean age 67.6+/-7 years , 33 males ) participated in an unsupervised home-based exercise programme .  Heart rate ( HR ) , ankle brachial blood pressure index ( ABPI ) , leg blood flow ( BF ) , and blood lactate were measured before and after a grade d treadmill walk at baseline and after the 12-week exercise programme .  Maximum walking distance ( MWD ) during the treadmill walk was measured at baseline and 12 weeks . Exercise compliance , functional parameters , and quality of life ( VascuQoL ) were assessed by question naire . RESULTS MWD , leg BF , and VascuQoL scores increased significantly , while resting HR , exercise HR , and end of walk rate-pressure-product ( RPP ) decreased significantly after 12 weeks . Exercise compliance was significantly correlated with increase in MWD ( r=0.89 , p<0.001 ) and QOL score improvement ( r=0.61 , p<0.001 ) . CONCLUSIONS This supported but unsupervised exercise programme generated improvements in walking distance and leg blood flow without detectable increases in cardiorespiratory work . Exercise compliance is related to MWD and VascuQoL score in a dose-response manner Objectives To assess the effect of pain-free treadmill training on red blood cell deformability and walking distance in patients with claudication . Design R and omized-controlled trial of exercise training . Setting Patients were recruited from the primary care , vascular outpatient clinic . Patients A total of 60 patients with peripheral arterial occlusive disease ( stage II according to Leriche-Fontaine ) were r and omized into the treadmill program or a control group .  Fifty-five patients completed the study ( 27 in the exercising group and 28 in the control group ) . Interventions Patients in the exercising group were walking on the treadmill 3 times a week for 3 months . Each session consisted of 1 hour repetitive walking [ performed to 85 % of the pain-free walking time ( PFWT ) ] was supervised by a qualified physiotherapist . Main Outcome Measurements Changes in erythrocyte deformability and treadmill walking performance ( PFWT , maximal walking time ) were assessed in both groups before the study and after 3 months . Results After 3 months of treadmill training , red blood cell deformability in the exercising group significantly increased ( P<0.01 ) . No significant changes were seen in the erythrocyte deformability in the control group . PFWT was prolonged by 102 % from 191±34 to 386±60 seconds ( P<0.01 ) , and maximal walking time increased by 49 % from 438±62 to 656±79 seconds ( P<0.01 ) in the exercising group , whereas these changes were insignificant in the control group . Conclusions A significant improvement of walking ability over 3 months of pain-free treadmill training is associated with a significant increase in red cell deformability in patients with claudication Symptoms of intermittent claudication ( IC ) can be relieved by lifestyle modification , medications , and walking exercises . The intensity of the walking exercise is still debatable . The goal of this study was to determine the effects of accommodating pain-free walking exercise therapy program length on pain-free walking . A descriptive , longitudinal study with repeated measures of exercise capacity was conducted . An IC question naire was administered to assess IC signs , symptoms , and lifestyle . Walking was performed on a treadmill for 30 to 50 minutes below the participant 's individualized walking pain threshold . The study included patients diagnosed with IC due to peripheral arterial disease . All participants were r and omly assigned to three groups . Group A ( n = 28 ) participated in the walking program for 2 - 9 weeks , group B ( n = 30 ) for 10 - 14 weeks , and group C ( n = 26 ) for 15 - 94 weeks . The main outcome measure of the study was to determine changes in exercise capacity : walking distance ( miles ) , walking duration ( minutes ) , and walking speed ( mph ) . Group A increased the amount of distance , duration , and speed walked from pretest to posttest by 80 % ( P < .001 ) , 27 % ( P < .001 ) , and 37 % ( P < .001 ) , respectively . Group B increased the amount of distance , duration , and speed walked from pretest to posttest by 122 % ( P < .001 ) , 56 % ( P < .001 ) , and 43 % ( P < .001 ) , respectively . Group C increased the amount of distance , duration , and speed walked from pretest to posttest by 26 % ( P = .002 ) , 22 % ( P = .002 ) , and 5 % ( P = .541 ) respectively . We reached the conclusion that a walking program of 10 - 14 weeks is optimal for achieving the best improvements in walking distance , duration , and speed IMPORTANCE Supervised exercise is recommended as a first-line treatment for intermittent claudication .  Combination therapy of endovascular revascularization plus supervised exercise may be more promising but few data comparing the 2 therapies are available . OBJECTIVE To assess the effectiveness of endovascular revascularization plus supervised exercise for intermittent claudication compared with supervised exercise only . DESIGN , SETTING , AND PARTICIPANTS R and omized clinical trial of 212 patients allocated to either endovascular revascularization plus supervised exercise or supervised exercise only . Data were collected between May 17 , 2010 , and February 16 , 2013 , in the Netherl and s at 10 sites . Patients were followed up for 12 months and the data were analyzed according to the intention-to-treat principle . INTERVENTIONS A combination of endovascular revascularization ( selective stenting ) plus supervised exercise ( n = 106 ) or supervised exercise only ( n = 106 ) . MAIN OUTCOMES AND MEASURES The primary end point was the difference in maximum treadmill walking distance at 12 months between the groups . Secondary end points included treadmill pain-free walking distance , vascular quality of life ( VascuQol ) score ( 1 [ worst outcome ] to 7 [ best outcome ] ) , and 36-item Short-Form Health Survey ( SF-36 ) domain scores for physical functioning , physical role functioning , bodily pain , and general health perceptions ( 0 [ severe limitation ] to 100 [ no limitation ] ) . RESULTS Endovascular revascularization plus supervised exercise ( combination therapy ) was associated with significantly greater improvement in maximum walking distance ( from 264 m to 1501 m for an improvement of 1237 m ) compared with the supervised exercise only group ( from 285 m to 1240 m for improvement of 955 m ) ( mean difference between groups , 282 m ; 99 % CI , 60 - 505 m ) and in pain-free walking distance ( from 117 m to 1237 m for an improvement of 1120 m vs from 135 m to 847 m for improvement of 712 m , respectively ) ( mean difference , 408 m ; 99 % CI , 195 - 622 m ) . Similarly , the combination therapy group demonstrated significantly greater improvement in the disease-specific VascuQol score ( 1.34 [ 99 % CI , 1.04 - 1.64 ] in the combination therapy group vs 0.73 [ 99 % CI , 0.43 - 1.03 ] in the exercise group ; mean difference , 0.62 [ 99 % CI , 0.20 - 1.03 ] ) and in the score for the SF-36 physical functioning ( 22.4 [ 99 % CI , 16.3 - 28.5 ] vs 12.6 [ 99 % CI , 6.3 - 18.9 ] , respectively ; mean difference , 9.8 [ 99 % CI , 1.4 - 18.2 ] ) . No significant differences were found for the SF-36 domains of physical role functioning , bodily pain , and general health perceptions . CONCLUSIONS AND RELEVANCE Among patients with intermittent claudication after 1 year of follow-up , a combination therapy of endovascular revascularization followed by supervised exercise result ed in significantly greater improvement in walking distances and health-related quality -of-life scores compared with supervised exercise only . TRIAL REGISTRATION Netherl and s Trial Registry Identifier : NTR2249 Supervised , hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease . However , it has been suggested that unsupervised , home-based exercise programs , which have been relatively little evaluated , would be equally efficacious as compared with hospital-based programs . The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise perfor mance more than a home-based program . Of 20 consecutively enrolled patients with claudication , 10 were r and omly placed into a supervised , hospital-based program and 10 into an unsupervised , home-based program for a three-month period .  Exercise perfor mance was evaluated by treadmill testing using a grade d protocol . In addition , func tional status was evaluated by the Walking Impairment Question naire ( WIQ ) and the Medical Outcomes Study SF-20 question naire ( MOS ) . Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit . Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with ( continued on next page ) the program . Patients in the hospital-based group improved peak walking time by 137 % , pain-free walking time by 150 % , and peak oxygen consumption by 19 % ( all P<0.05 ) . Patients reported an improved walking distance and speed according to WIQ data ( both P<0.05 ) . In addition , the MOS physical functioning score in the hospital-based group improved by 20 percentage points ( P<0.05 ) . In contrast , patients in the home-based program did not improve exercise performance measured on the treadmill . Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home- based program ( P<0.05 ) . The ability to walk distances was the only question naire measure that improved in persons who received the home-based program ( P<0.05 ) . Preliminary results suggest that a supervised , hospital-based program is more effective for improving treadmill exercise performance than an unsupervised , home-based program PURPOSE In patients with intermittent claudication ( IC ) a structured walking exercise program improves exercise performance . However , few studies have evaluated the effects of exercise training on functional status during daily activities . We hypothesized that a supervised exercise training program would improve functional status in patients with IC , with 24 weeks of training more beneficial than 12 weeks . A secondary aim was to evaluate the effects of strength training and combinations of strength and treadmill training on functional status . METHODS Twenty-nine men with disabling IC were r and omized to 12 weeks of either supervised treadmill training ( 3 hr/wk at a work intensity sufficient to produce claudication ) , strength training ( 3 hr/wk of resistive training of six muscle groups of each leg ) , or to a nonexercising control group .  Functional status was assessed by question naires characterizing walking ability ( Walking Impairment Question naire , WIQ ) , habitual physical activity level ( Physical Activity Recall , PAR ) , and physical , social , and role functioning , well-being , and overall health ( Medical Outcomes Study SF-20 , MOS ) . Patients alos had their activity levels monitored with an activity monitor ( Vitalog ) . RESULTS After 12 weeks of treadmill training  PAR scores increased by 48 metabolic equivalent hr/wk , the MOS physical functioning score by 24 percentage points , and the number of bouts of walking activity measured by the Vitalog by 4.5 bouts/hr ( all p < 0.05 ) . No changes were seen in WIQ scores . After 12 additional weeks of treadmill training improvements initially observed in the PAR , MOS , and Vitalog scores were maintained , and in addition the ability to walk distances ( WIQ ) improved by 31 percentage points , and the IC severity score had improved by 29 percentage points ( both p < 0.05 ) . After 12 weeks of strength training patients improved their WIQ walking speed , stair climbing scores , and MOS well-being scores with no other changes in functional status . Subjects in the control group did not improve functional status by any measure . Twelve weeks of treadmill training after the strength training program maintained WIQ walking speed scores , and activity level defined by Vitalog improved . Twelve weeks of combined treadmill and strength training after the control period had no effect on functional status . CONCLUSIONS A supervised treadmill training program improved functional status during daily activities , with 24 weeks more effective than 12 . In addition , treadmill training alone was more effective in improving functional status in patients with IC than strength training or combinations of the training modalities OBJECTIVE We used outdoor walking distance measured during 40 minutes as " real-life " outdoor walking capacity in 49 patients with intermittent claudication ( IC ) . The outdoor walking distance was measured by a global positioning system application for a smartphone . The relationships of self-reported maximum walking distance ( SR-MWD ) , the MWD on a grade d treadmill test , and the 6-minute maximum walk distance ( 6MWD ) vs outdoors walking capacity were investigated . Also studied were the associations of SR-MWD , MWD , and 6MWD with health-related quality of life assessed with the disease-specific instrument the  Vascular Quality of Life Question naire ( VascuQoL ) . METHODS In this prospect i ve observational cohort study , 49 IC patients underwent an  outdoor walking capacity test for 40 minutes , and MWD and 6MWD were measured . SR-MWD was recorded , and all subjects completed the VascuQoL question naire . Associations between the different walk estimates and outdoor walking capacity and health-related quality of life were investigated by correlation analysis ( Spearman ρ ) . RESULTS Outdoor walking distance during 40 minutes was a median 2495 m ( range , 1110 - 3300 m ) . SR-MWD correlated moderately and MWD correlated strongly to outdoor walking capacity ( r = 0.56 and r = 0.65 ; P < .001 , respectively ) . The 6MWD test showed the largest correlation to the outdoor walking capacity ( r = 0.78 ; P < .001 ) . The 6MWD was the only test that showed correlations with the VascuQoL sum score ( r = 0.53 ; P < .01 ) and all of the domain scores , whereas SR-MWD and MWD showed weak correlations to the VascuQoL. CONCLUSIONS The distance walked during the 6-minute walk test is closely correlated to outdoor walking capacity and health-related quality of life in IC patients . Our data support the use of 6MWD for routine clinical evaluation of walking capacity in IC patients OBJECTIVE 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 ) . METHODS 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 question naire response were prospect ively recruited . Participants were r and omly allocated to either a control PAD-IC group ( CPAD-IC )  ( n = 11 ) that received st and ard 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 grade d 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 ) . RESULTS 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 ) . CONCLUSION 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 Background — This prospect i ve , r and omized , controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent claudication after a home-based exercise program , a supervised exercise program , and usual-care control . Methods and Results — Of the 119 patients r and omized , 29 completed home-based exercise  , 33 completed  supervised exercise , and 30 completed usual-care control . Both exercise programs consisted of intermittent walking to nearly maximal claudication pain for 12 weeks . Patients wore a step activity monitor during each exercise session . Primary outcome measures included claudication onset time and peak walking time obtained from a treadmill exercise test ; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period . Adherence to home-based and supervised exercise was similar ( P=0.712 ) and exceeded 80 % . Both exercise programs increased claudication onset time ( P<0.001 ) and peak walking time ( P<0.01 ) , whereas only home-based exercise increased daily average cadence ( P<0.01 ) . No changes were seen in the control group ( P>0.05 ) . The changes in claudication onset time and peak walking time were similar between the 2 exercise groups ( P>0.05 ) , whereas the change in daily average cadence was greater with home-based exercise ( P<0.05 ) . Conclusions — A home-based exercise program , quantified with a step activity monitor , has high adherence and is efficacious in improving claudication measures similar to a st and ard supervised exercise program . Furthermore , home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise . Clinical Trial Registration — URL : http://www . Clinical Trials . Gov . Unique identifier : NCT00618670 PURPOSE This study was performed to test the efficacy of a supervised , hospital-based exercise program compared with a home-based exercise program involving minimal supervision , for both walking ability and quality of life measures in patients with exercise-limiting intermittent leg claudication . METHODS Twenty-one patients were assigned r and omly to 12 weeks of supervised exercise or to a home-based exercise group . After 12 weeks the participants in the supervised group transitioned to a home-based program . Both groups were then reevaluated at the end of 24 weeks . The initial claudication distance ( ICD ) and absolute claudication distance ( ACD ) on progressive treadmill exercise was measured at baseline , 12 weeks , and 24 weeks . Additionally , self-reported quality of life status was evaluated using the MOS SF-36 question naire . RESULTS Each group improved ( P < 0.01 ) ACD from baseline to 12 weeks , which was sustained at the 24-week follow-up . Both groups experienced similar long-term improvements ( P < 0.05 ) in ACD ( 521.5 + /- 253.4 meters to 741.9 + /- 365.6 meters for the supervised group , 532.2 + /- 263.5 meters to 715.0 + /- 394.4 meters in the home group , P not significant , between groups ) . The supervised group experienced a greater improvement ( P < 0.01 ) in the ICD after 12 weeks than the home group but not at 24 weeks . The on-site group also experienced significant improvements in ICD after 24 weeks ( P < 0.05 ) . Neither group manifested an improvement in self-reported physical function or mental health as assessed by the MOS SF-36 . CONCLUSION A structured exercise program was more effective in improving the ICD over a 24-week period than a less formal , home-based program . However , if patients are screened properly and receive adequate instruction , a home-based program can be a safe , low-cost alternative providing similar long-term ( 24 weeks ) exercise benefits in ACD Introduction A typical symptom of chronic lower-limb ischaemia is lower-limb pain , which occurs during walking forcing the patient to stop , intermittent claudication ( IC ) .  Exercise rehabilitation is the basic form of treatment for these patients . Aim The aim of this study was to compare the effectiveness of three types of physical training programmes conducted over a 12-week period in patients with chronic lower-limb arterial insufficiency . Material s and Methods Ninety-five people qualified for the 3-month supervised motor rehabilitation programme , conducted three times a week . The respondents were assigned to three types of rehabilitation programmes using a pseudo-r and omization method : Group I ( TW ) , subjects undertaking treadmill walking training ; Group II ( NW ) , subjects undertaking Nordic walking training ; Group III ( RES+NW ) , subjects undertaking resistance and Nordic walking training . Treadmill test , 6 Minute Walk Test ( 6MWT ) , and  isokinetic test  were repeated after 3 months of rehabilitation , which 80 people completed . Results Combined training ( RES+NW ) is more effective than Nordic walking alone and supervised treadmill training alone for improving ankle force-velocity parameters ( p<0.05 ) in patients with intermittent claudication . Each of the proposed exercise rehabilitation programmes increased walking distance of patients with intermittent claudication ( p<0.05 ) , especially in 6MWT ( p=0.001 ) . Significant relationships of force-velocity parameters are observed in the maximum distance obtained in 6MWT , both in Group III ( RES + NW ) and in Group II ( NW ) at the level of moderate and strong correlation strength , which indicates that if the lower limbs are stronger the walking distance achieved in 6MWT is longer . Conclusions Given both the force-velocity parameters and the covered distance , the training RES + NW gives the most beneficial changes compared to training TW alone and NW alone . All types of training increased walking distance , which is an important aspect of the everyday functioning of people with IC BACKGROUND In patients with intermittent claudication , a supervised walking exercise program increases peak exercise performance and community-based functional status .  Patients with peripheral arterial disease also have muscle weakness in the affected extremity that may contribute to the walking impairment . However , the potential benefits of training modalities other than walking exercise , such as strength training , have not been critically evaluated in this patient population . The present study tested the hypothesis that a strength training program would be as effective as treadmill walking exercise and that combinations of strengthening and walking exercise would be more effective than either alone in improving exercise performance . METHODS AND RESULTS Twenty-nine patients with disabling claudication were r and omized to 12 weeks of supervised walking exercise on a treadmill ( 3 h/wk at a work intensity sufficient to produce claudication ) , strength training ( 3 h/wk of resistive training of five muscle groups of each leg ) , or a nonexercising control group . Grade d treadmill testing was performed to maximally tolerated claudication pain to define changes in peak exercise performance . After 12 weeks , patients in the treadmill training program had a 74 + /- 58 % increase in peak walking time as well as improvements in peak oxygen consumption ( VO2 ) and the onset of claudication pain . Patients in the strength-trained group had a 36 + /- 48 % increase in peak walking time but no change in peak VO2 or claudication onset time . Control subjects had no changes in any of these measures over the 12-week period . After the first 12 weeks , patients in the initial walking exercise group continued for 12 more weeks of supervised treadmill training . This result ed in an additional 49 + /- 53 % increase in peak walking time ( total of 128 + /- 99 % increase over the 24 weeks ) . After the initial 12 weeks , patients in the strength-trained group began 12 weeks of supervised treadmill training , and patients in the control group participated in a 12-week combined program of strengthening and treadmill walking exercise . The combined strength and treadmill training program and treadmill training after 12 weeks of strength training result ed in increases in peak exercise performance similar to those observed with 12 weeks of treadmill training alone . CONCLUSIONS A supervised treadmill walking exercise program is an effective means to improve exercise performance in patients with intermittent claudication , with continued improvement over 24 weeks of training . In contrast , 12 weeks of strength training was less effective than 12 weeks of supervised treadmill walking exercise . Finally , strength training , whether sequential or concomitant , did not augment the response to a walking exercise program BACKGROUND Patients with intermittent claudication ( IC ) could benefit from low-cost , effective rehabilitative programs . This retrospective study evaluates compliance , impact on Quality of Life ( QoL ) and cost-effectiveness of a hospital prescribed , at-home performed ( Test-in/Train-out ) rehabilitative program for patients with IC . METHODS AND RESULTS Two-hundred and eighty-nine patients with IC ( 71 ± 10.1 years , M = 210 ) were enrolled for a 2-year period .  Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed , with serial check-ups at the hospital . Compliance with the program was assessed by assigning a score of 1 ( lowest compliance ) to 4 ( highest compliance ) . The SF-36 question naire and a constant-load treadmill test  were used to evaluate QoL and Initial/Absolute Claudication Distance , respectively . Both direct and indirect costs of the program were considered for cost-effectiveness analysis . Two-hundred and fifty patients ( 70.5 ± 9.2 years , M = 191 ) , at Fontaine 's II-B stage ( 86 % ) , were included in the study . No adverse events were reported . The average compliance score was 3.1 . At discharge , both SF-36 domains and walking performance significantly increased ( P < 0.0001 ) . A total of 1,839 in-hospital check-ups ( 7.36 /patient ) were performed . Direct and indirect costs represented 93 % and 7 % of the total costs , respectively . The average costs of a visit and of a therapy cycle were C68.93 and C507.20 , respectively . The cost to walk an additional meter before stopping was C9.22 . CONCLUSIONS A Test-in/Train-out program provided favourable patient compliance , QoL impact and cost-effectiveness in patients with IC Intermittent claudication impairs functional status and quality of life in many patients by limiting walking capacity . The aim of this study was to evaluate the effects of a 4-week treatment with prostagl and in E1 ( PGE1 ) , a drug inducing vasodilation and inhibiting platelet aggregation , on improving functional status and health-related quality of life in patients with disabling intermittent claudication . Forty-two untrained out patients ( 37 men and five women , mean age 64 ±8 years ) with intermittent claudication , and maximum walking distance ( MWD ) of at least 50 and no more than 200 m on treadmill test ( 5 % slope , 3 km/hr ) were r and omized to 4 weeks of double-blind treatment either with 60 mcg PGE1 daily given IV in 250 mL saline over a period of 2 hours ( 21 patients ) or placebo ( 250 mL saline , 21 patients ) . Treatment-free follow-up was completed 8 weeks after the final infusion . Pain free walking distance ( PFWD ) , MWD , and question naire evaluation were determined at baseline , after the 4-week treatment period , and at the end of the 8 weeks of the treatment-free follow-up period . After 4 weeks of treatment with PGE1 PFWD and MWD increased from 72 ±16 m to 135 ±33 m ( + 87 % , p<0.001 ) and from 140 ±30 m to 266 ±62 m ( + 90 % , p<0.001 ) , respectively . Analysis of the Walking Impairment Question naire responses in the PGE1 group at 4 weeks demonstrated significant improvements in the walking impairment score ( + 19 percentage points , p<0.001 ) , in the distance score ( + 25 percentage points , p<0.001 ) , in the speed score ( + 24 percentage points , p<0.001 ) , in the stair climbing score ( + 20 percentage points , p < 0.001 ) . The R AND survey responses showed improvements in physical function and bodily pain scores ( + 14 percentage points , p<0.001 , and + 15 percentage points , p<0.01 , respectively ) . After the treatment-free follow-up period of 8 weeks , increases in PFWD and MWD were maintained ( 113 ±26 m , + 57 % , p<0.001 , and 229 ±55 m , + 63 % , p<0.001 , respectively ) . Similarly , at the end of the treatment-free follow-up , the walking impairment score ( + 16 percentage points , p<0.001 ) , the distance score ( + 23 percentage points , p<0.001 ) , the speed score ( + 22 percentage points , p<0.001 ) , the stair climbing score ( + 18 percentage points , p<0.001 ) as well as the R AND physical function and bodily pain scores ( + 10 percentage points , p<0.001 , and + 13 percentage points , p<0.01 , respectively ) were still increased compared with baseline . No change from baseline was found in all the target parameters in the placebo group after 4 weeks of treatment and at the end of the treatment-free follow-up period . These data show that a 4-week treatment with PGE1 improves functional status and quality of life as well as treadmill performance in patients with disabling intermittent claudication as compared with placebo-treated patients . The improvements are also maintained for a period of 8 weeks beyond the end of the treatment . Additional studies are needed to determine the duration of functional benefits after the end of treatment IMPORTANCE Clinical practice guidelines state there is insufficient evidence to support advising patients with peripheral artery disease ( PAD ) to participate in a home-based walking exercise program . OBJECTIVE To determine whether a home-based walking exercise program that uses a group-mediated cognitive behavioral intervention , incorporating both group support and self-regulatory skills , can improve functional performance compared with a health education control group in patients with PAD with and without intermittent claudication . DESIGN , SETTING , AND PATIENTS R and omized controlled clinical trial of 194 patients with PAD , including 72.2 % without classic symptoms of intermittent claudication , performed in Chicago , Illinois between July 22 , 2008 , and December 14 , 2012 . INTERVENTIONS Participants were r and omized to 1 of 2 parallel groups : a home-based group-mediated cognitive behavioral walking intervention or an attention control condition . MAIN OUTCOMES AND MEASURES The primary outcome was 6-month change in 6-minute walk performance . Secondary outcomes included 6-month change in treadmill walking , physical activity , the Walking Impairment Question naire ( WIQ ) , and Physical and Mental Health Composite Scores from the 12-item Short-Form Health Survey . RESULTS Participants r and omized to the intervention group significantly increased their 6-minute walk distance ( [ reported in meters ] 357.4 to 399.8 vs 353.3 to 342.2 for those in the control group ; mean difference , 53.5 [ 95 % CI , 33.2 to 73.8 ] ; P < .001 ) , maximal treadmill walking time ( intervention , 7.91 to 9.44 minutes vs control , 7.56 to 8.09 ; mean difference , 1.01 minutes [ 95 % CI , 0.07 to 1.95 ] ; P = .04 ) , accelerometer-measured physical activity over 7 days ( intervention , 778.0 to 866.1 vs control , 671.6 to 645.0 ; mean difference , 114.7 activity units [ 95 % CI , 12.82 to 216.5 ] ; P = .03 ) , WIQ distance score ( intervention , 35.3 to 47.4 vs control , 33.3 to 34.4 ; mean difference , 11.1 [ 95 % CI , 3.9 to 18.1 ] ; P = .003 ) , and WIQ speed score ( intervention , 36.1 to 47.7 vs control , 35.3 - 36.6 ; mean difference , 10.4 [ 95 % CI , 3.4 to 17.4 ] ; P = .004 ) . CONCLUSION AND RELEVANCE A home-based walking exercise program significantly improved walking endurance , physical activity , and patient-perceived walking endurance and speed in PAD participants with and without classic claudication symptoms . These findings have implication s for the large number of patients with PAD who are unable or unwilling to participate in supervised exercise programs . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00693940 BACKGROUND The first-line intervention for intermittent claudication is usually supervised exercise therapy ( SET ) . The literature describes a range of exercise programs varying in setting , duration , and content . The purpose of the present study was to examine the exercise protocol s offered and to identify the impact of the intensity of the SET programs ( in terms of frequency , duration , and type of exercise ) on improvements in walking distance ( response ) in the first 3 months . The present study is part of the Exercise Therapy in Peripheral Arterial Disease ( EXITPAD ) study , a multicenter r and omized clinical trial comparing the effects of SET provided by regional physiotherapists , with or without daily feedback , on the level of activities with the effects of walking advice . METHODS The analysis included patients r and omized to receive SET with or without feedback . The physical therapists administering the SET were asked to fill out therapy evaluation sheets stating frequency , duration , and type of exercises . The relationship between training volume and the impact on walking distance was explored by dividing training volume data into tertiles and relating them to the median change in maximum walking distance at 3 and 12 months . RESULTS Data of 169 patients were included in the analysis . A SET program consisting of at least two training sessions per week each lasting over 30 minutes , during the first 3 months of a 1-year program tailored to individual patients ' needs led to better results in terms of walking distance after 3 and 12 months than the other variants . The results of our analysis dividing training volume into tertiles suggest that there is a relationship between training volume and improvement in walking distance and that at least 590 minutes of training should be offered in the first 3 months . No differences were found between program involving only walking and a combination of exercises , nor between individual and group training . CONCLUSION A SET programs consisting of at least two training sessions a week , each lasting over 30 minutes , should be offered during the first 3 months of the SET program to optimize improvement in terms of maximum walking distance The mechanisms by which exercise training improves intermittent claudication remain unclear . In this article , the effects of local and systemic physiological factors on improved exercise tolerance after a supervised exercise program in claudicants are investigated . A total of 60 patients were r and omized to 3 months of supervised exercise followed by 3 months of unsupervised exercise , or to exercise advice alone ( control ) . Supervised exercise increased both pain-free and maximal walking distances . Heart rate during submaximal exercise and resting mean arterial pressure were lower after supervised exercise at 6 months . Serum lactate at maximum claudication increased significantly after 3 months in the supervised exercise group but this change had resolved by 6 months . Symptomatic improvement was accompanied by modest reductions in mean arterial pressure and submaximal heart rate on exercise . Increased serum lactate at maximum claudication subsequently declined despite continued improvement in walking distance , suggesting local adaptations to improve efficiency of muscle oxygen delivery and /or utilization PURPOSE This study was performed to test the effectiveness of a formal supervised exercise program against a home-based exercise program for both walking ability and quality of life endpoints . METHODS Patients with arterial claudication were r and omized to either a 12-week supervised exercise program ( SUPEX ) with weekly lectures relating to peripheral vascular disease or to a home exercise group ( HOMEX ) who attended an identical lecture program and received weekly exercise instruction . The study population included 29 men and 26 women , with a mean age of 69.1 + /- 8.1 years . Forty-seven patients completed the 12-week program , 46 were available for testing at completion , and 38 for 6-month testing . Claudication pain time ( CPT ) and maximum walking time ( MWT ) on a progressive treadmill exercise test were assessed at baseline , program completion , and 6 months . The Medical Outcomes Study Short Form-36 ( SF-36 ) was administered at these intervals to assess effects on quality of life . RESULTS Each group improved ( p < 0.001 ) in both CPT and MWT at the completion of the 12-week program , which was sustained at the 6-month follow-up . Increase in HOMEX CPT from baseline ( 3.6 + /- 2.73 minutes ) to 6-month follow-up ( 6.6 + /- 3.17 minutes ) was less than for the SUPEX group ( 3.8 + /- 2.74 to 11.2 + /- 4.02 minutes , respectively ) ; similar results were obtained for MWT . At both completion and 6 months , there was a significant intergroup difference for CPT and MWT ( p < 0.004 ) favoring SUPEX . For both groups , measures of health perception based on the SF-36 demonstrated improvement ( p < 0.002 ) in Physical Function Subscale , Bodily Pain Subscale , and Physical Composite Score . There were no between-group differences on the subsets of the SF-36 at the three assessment intervals . CONCLUSIONS Supervised exercise programs provide superior increased walking ability in the noninterventional therapy of arterial claudication , and both supervised and home based exercise therapy result in improved SF-36 functional measures . The lack of intergroup differences in these measures may be a result of the high degree of interaction with healthcare providers in the HOMEX group . Although a supervised program results in optimal walking benefits , a highly structured home-based program provides similar functional improvement and may be a satisfactory alternative for patients with lesser walking requirements BACKGROUND Uncertainty exists on whether there is adjuvant benefit of percutaneous transluminal angioplasty ( PTA ) over supervised exercise and best medical therapy in the treatment of intermittent claudication . METHODS Patients with symptoms of stable mild to moderate intermittent claudication ( MIMIC ) were r and omised in two multi-centre trials , for femoropopliteal and aortoiliac arterial disease , to receive either PTA or no PTA against a background of supervised exercise and best medical therapy and followed up for 24 months . Initial claudication distance ( ICD ) and absolute walking distance ( AWD ) on treadmill were compared between r and omised groups adjusting for the corresponding measure at baseline . Secondary outcomes included ankle-brachial pressure index ( ABPI ) and quality of life . FINDINGS A total of 93 patients were r and omised into the femoropopliteal trial ( 48 into PTA ) and 34 into the aortoiliac trial ( 19 to PTA ) . The mean ( st and ard deviation , SD ) age was 66(9 ) years for the femoropopliteal trial ( 63 % male ) and 63(9 ) for the aortoiliac trial ( 65 % male ) . At 24 months , there were significant improvements in both AWD and ICD in the PTA groups for both trials . The adjusted AWD was 38 % greater in the PTA group for the femoropopliteal trial ( 95 % ; CI 1 - 90 ) ( p=0.04 ) and 78 % greater in the PTA group for the aortoiliac trial ( 95 % ; CI 0 - 216 ) ( p=0.05 ) . Further benefits were demonstrated for ABPI but not for quality of life . INTERPRETATION PTA confers adjuvant benefit over supervised exercise and best medical therapy in terms of walking distances and ABPI 24 months after PTA in patients with stable mild to moderate intermittent claudication The purpose of this study was to examine the effects of a 6-month exercise program on submaximal walking economy in individuals with peripheral arterial disease and intermittent claudication ( PAD-IC ) . Participants ( n = 16 ) were r and omly allocated to either a control PAD-IC group ( CPAD-IC , n = 6 ) which received st and ard medical therapy , or a treatment PAD-IC group ( TPAD-IC ;  n = 10 ) which took part in a supervised exercise program . During a grade d treadmill test , physiological responses , including oxygen consumption , were assessed to calculate walking economy during submaximal and maximal walking performance . Differences between groups at baseline and post-intervention were analyzed via Kruskal – Wallis tests . At baseline , CPAD-IC and TPAD-IC groups demonstrated similar walking performance and physiological responses . Postintervention , TPAD-IC patients demonstrated significantly lower oxygen consumption during the grade d exercise test , and greater maximal walking performance compared to CPAD-IC . These preliminary results indicate that 6 months of regular exercise improves both submaximal walking economy and maximal walking performance , without significant changes in maximal walking economy . Enhanced walking economy may contribute to physiological efficiency , which in turn may improve walking performance as demonstrated by PAD-IC patients following regular exercise programs OBJECTIVE The efficacy of polestriding exercise ( walking with modified ski poles with a movement pattern similar to cross-country skiing ) to increase exercise tolerance of persons with intermittent claudication pain caused by peripheral arterial disease was tested in this 24-week prospect i ve r and omized clinical trial . METHODS The study was conducted in a Department of Veterans Affairs Hospital with 52 individuals who gave written informed consent and were r and omized into either a polestriding exercise ( n = 27 ; age , 65.5 + /- 7.0 years ; ankle brachial index , 0.64 + /- 0.25 ) or nonexercise control ( n = 25 ; age , 68.6 + /- 8.9 years ; ankle brachial index , 0.69 + /- 0.14 ) group ( P > .05 for all comparisons ) . The polestriding exercise program consisted of supervised training three times per week for 4 weeks , two times per week for 8 weeks , one time per week for 4 weeks , biweekly for 4 weeks and unsupervised training for 4 weeks . Starting in week 5 , subjects took their poles home with instructions to repeat the most recent supervised training walk at an appropriate and convenient location near their residence . This was referred to as unsupervised but directed exercise . Subjects were provided with a personal log book for documenting unsupervised exercise sessions . With both supervised and unsupervised exercise , subjects were expected to complete a total of four 30-minute to 45-minute polestriding exercise sessions per week . The main outcome measures were exercise duration on symptom-limited incremental treadmill test , Walking Impairment Question naire , rating of perceived leg pain at baseline , 4 , 8 , 12 , 16 , and 24 weeks , and constant work-rate treadmill exercise tests at baseline and at 4 , 12 , and 24 weeks . RESULTS Polestriding significantly ( P < .001 ) improved exercise tolerance on the constant work-rate and incremental treadmill tests . Ratings of perceived claudication pain were significantly less after the polestriding training program .  Subject perceived distance and walking speed scores on the Walking Impairment Question naire improved in the polestriding trained group only ( P < .001 and .022 , respectively ) . CONCLUSION This r and omized clinical trial provides empirical evidence that 24 weeks of polestriding training significantly improves quantitative and qualitative measures of the exercise tolerance of persons limited by intermittent claudication pain OBJECTIVES In the current study , we hypothesized that beraprost would : 1 ) improve treadmill exercise performance and quality of life ; and 2 ) decrease rates of ischemic events in patients with intermittent claudication . BACKGROUND Previous trials with beraprost sodium , an orally active prostagl and in I(2 ) analogue , in the treatment of claudication in patients with peripheral arterial disease ( PAD ) have been inconsistent . METHODS Patients with intermittent claudication ( n = 897 ) were r and omized to receive either 40 microg three times a day of beraprost with meals ( n = 385 ) or placebo ( n = 377 ) in a double-blinded manner for one year . The primary efficacy parameter was treadmill-measured maximum walking distance , as assessed at three and six months after r and omization . Secondary efficacy parameters included treadmill-measured pain-free walking distance and change in quality of life . RESULTS There was no significant improvement in maximum walking distance in the beraprost group ( 16.7 % ) as compared with the placebo group ( 14.6 % , p = NS ) . Administration of beraprost did not improve the pain-free walking distance ( p = NS between treatment groups ) , and there was no improvement in the quality -of-life measures between the treatment groups . The incidence of critical cardiovascular events was 7.3 % in the beraprost group and 11.4 % in the placebo group ( p = NS ) . There was a significant reduction in the combination of cardiovascular death and myocardial infa rct ion in the beraprost group ( p = 0.01 ) . CONCLUSIONS Despite previous investigations suggesting efficacy , these results indicate that beraprost is not an effective treatment to improve symptoms of intermittent claudication in patients with PAD . The potential benefit of beraprost on critical cardiovascular events would require confirmation in a larger prospect i ve investigation Supervised walking exercise is an effective treatment to improve walking ability of patients with peripheral artery disease ( PAD ) , but few exercise programs in community setting s have been effective . The aim of this study was to determine the efficacy of a community-based walking exercise program with training , monitoring and coaching ( TMC ) components to improve exercise performance and patient-reported outcomes in PAD patients . This was a r and omized , controlled trial including PAD patients ( n=25 ) who previously received peripheral endovascular therapy or presented with stable claudication . Patients r and omized to the intervention group received a comprehensive community-based walking exercise program with elements of TMC over 14 weeks . Patients in the control group did not receive treatment beyond st and ard advice to walk . The primary outcome in the intent-to-treat ( ITT ) analyses was peak walking time ( PWT ) on a grade d treadmill . Secondary outcomes included claudication onset time ( COT ) and patient-reported outcomes assessed via the Walking Impairment Question naire ( WIQ ) . Intervention group patients ( n=10 ) did not significantly improve PWT when compared with the control group patients ( n=10 ) ( mean±st and ard error : + 2.1±0.7 versus 0.0±0.7 min , p=0.052 ) . Changes in COT and WIQ scores were greater for intervention patients compared with control patients ( COT : + 1.6±0.8 versus −0.6±0.7 min , p=0.045 ; WIQ : + 18.3±4.2 versus −4.6±4.2 % , p=0.001 ) . This pilot using a walking program with TMC and an ITT analysis did not improve the primary outcome in PAD patients . Other walking performance and patient self-reported outcomes were improved following exercise in community setting s. Further study is needed to determine whether this intervention improves outcomes in a trial employing a larger sample size OBJECTIVE Walking training ( WT ) is an established treatment for patients with intermittent claudication ( IC ) . Abnormalities specific to diabetes , such as a relative preponderance of distal lesions and the contribution of microcirculatory disease , might well influence the results of WT . We compared changes in walking distance during WT in diabetic patients with those in nondiabetic control subjects . RESEARCH DESIGN AND METHODS In consecutive patients with limiting IC and proven peripheral vascular disease , 33 patients with diabetes were compared with 136 control subjects during a  half-year supervised WT program .  Walking parameters were determined every 2 months , while vascular parameters were obtained at the start and end of the program . RESULTS Of the 33 diabetic patients , 25 ( 76 % ) completed the program , as did 87 of the 136 ( 64 % ) control subjects . Thereafter , the symptom-free walking distance and the maximum walking distance ( MWD ) were significantly increased in diabetic patients from 142 + /- 30 to 339 + /- 57 m and from 266 + /- 39 to 603 + /- 52 m , respectively , and in control subjects from 126 + /- 8 to 400 + /- 39 m and from 292 + /- 18 to 628 + /- 36 m , respectively . The relative gain in MWD was 88 % greater in those with diabetes . The vascular parameters were comparable for both groups before and after WT . CONCLUSIONS WT is an effective treatment for IC , with a greater relative gain in diabetic patients OBJECTIVES This study investigated the effects of walking training ( WT ) on cardiovascular function and autonomic regulation in patents with intermittent claudication ( IC ) . DESIGN R and omized controlled trial . METHODS Forty-two male patients with IC ( ≥50years ) were r and omly allocated into two groups : control ( CG , n=20 , 30min of stretching exercises ) and WT ( WTG , n=22 , 15 bouts of 2min of walking interpolated by 2min of upright rest-walking intensity was set at the heart rate of pain threshold ) . Both interventions were performed twice/week for 12 weeks . Walking capacity ( maximal treadmill test ) , blood pressure ( auscultatory ) , cardiac output ( CO2 rebreathing ) , heart rate ( ECG ) , stroke volume , systemic vascular resistance , forearm and calf vascular resistance ( plethysmography ) , and low ( LF ) and high frequency ( HF ) components of heart rate variability and spontaneous baroreflex sensitivity were measured at baseline and after 12 weeks of the study . RESULTS WT increased total walking distance ( + 302±85 m , p=0.001 ) and spontaneous baroreflex sensitivity ( + 2.13±1.07ms/mmHg , p=0.02 ) . Additionally , at rest , WT decreased systolic and mean blood pressures ( -10±3 and -5±2mmHg , p=0.001 and p=0.01 , respectively ) , cardiac output ( -0.37±0.24l/min , p=0.03 ) , heart rate ( -4±2bpm , p=0.001 ) , forearm vascular resistance ( -8.5±2.8U , p=0.02 ) and LF/HF ( -1.24±0.99 , p=0.001 ) . No change was observed in the CG . CONCLUSIONS In addition to increasing walking capacity , WT improved cardiovascular function and autonomic regulation in patients with IC Intermittent claudication is a common condition leading to significant functional impairment and enhanced risk of cardiovascular morbidity and mortality . However , despite the functional impairment caused by intermittent claudication , the natural history in the affected limb is fairly benign . Only about 25 % of patients show symptomatic deterioration and only 2 % eventually lose the affected limb.1 This epidemiological evidence has led most clinicians in both primary and hospital care to manage intermittent claudication conservatively , addressing cardiovascular risk factors2 and giving advice on exercise . This may well be appropriate but merely giving advice about exercise is unlikley to be the most effective treatment . Exercise as a treatment for intermittent claudication is not new , with improvements in walking described from as early as 1898 . A recent Cochrane review of 10 r and omised trials of exercise therapy estimated an overall improvement in walking distance of about 150%.3 The exercise component in all but one of these BACKGROUND In this r and omized trial we compared two treadmill trainings , based on exercises performed to moderate claudication pain vs pain-free training , with respect to their effects on walking ability and endothelial function . METHODS A total of sixty patients with stable intermittent claudication were r and omized to the pain-free treadmill training ( repetitive intervals to onset of claudication pain ) or moderate treadmill training ( repetitive intervals to moderate claudication pain ) . In both groups exercises were performed 3 times a week for 3 months . Changes in flow mediated dilatation ( FMD ) and treadmill walking performance as well as plasma levels of C-reactive protein ( hs-CRP ) and fibrinogen were assessed before and after the program . RESULTS Fifty-two patients completed the training program . Post-training maximal walking time was prolonged by 100 % ( p<0.001 ) vs 98 % ( p<0.001 ) , and pain-free walking time by 120 % ( p<0.001 ) vs 93 % ( p<0.001 ) in the moderate training group as compared to the pain-free training group , respectively . FMD increased by 56 % ( p<0.001 ) in the moderate training group and by 36 % ( p<0.01 ) in the pain-free training group . No significant changes in the levels of hs-CRP and fibrinogen were seen after treadmill program in either group . CONCLUSIONS Both pain-free treadmill training and the moderate treadmill training have similar efficacy on walking ability in patients with claudication . The improvement of post-training FMD indicates systemic effect of both treadmill programs on endothelial function . Both programs appear to be safe therapeutic modes , since none of them escalates the inflammation . Pain-free treadmill training seems useful and effective therapeutic option for patients with claudication BACKGROUND In this prospect i ve study we evaluated the effects of treadmill training on patients ' walking ability  , as well as endothelial function , high-sensitivity C-reactive protein ( hs-CRP ) , and fibrinogen concentration . METHODS A total of 67 patients with stable intermittent claudication were included in a 12-week supervised training program . An observational follow-up period then lasted a mean of 37 weeks . Forty patients completed follow-up . Changes in blood pressure , flow-mediated dilatation ( FMD ) , and treadmill walking performance expressed as maximal walking time ( MWT ) were assessed before and after the training program and during the follow-up period . Moreover , ankle/brachial index ( ABI ) , plasma levels of hs-CRP , fibrinogen , as well as a lipid profile were assessed before and after the training program . RESULTS Maximal walking time improved significantly after treadmill training by 90 % ( p<0.001 ) and after follow-up by 64 % ( p<0.001 ) in comparison to baseline . FMD values increased by 43 % ( p<0.001 ) after the training program , and by 29 % ( p=0.058 ) after follow-up , compared to baseline . We noticed a significant decrease in hs-CRP concentration ( p=0.025 ) and an increase in ABI values ( p=0.039 ) in response to the treadmill training program . No effect on lipid profile was observed . CONCLUSIONS The 12-week treadmill training program prolonged the asymptomatic walking distance . The improvement in FMD indicates a systemic effect of the treadmill program on endothelial function . The supervised treadmill training provides an effective and safe treatment option in patients with PAD . The effects of unsupervised exercise during follow-up period after treadmill programs remain tentative and underestimated OBJECTIVE Determine the efficacy of a home-based walking intervention to improve walking ability and quality of life in people with diabetes and peripheral arterial disease ( PAD ) . RESEARCH DESIGN AND METHODS We conducted a r and omized , controlled , single-blind trial within university-affiliated clinics in our local community . We r and omized 145 participants ( 45 women ) with diabetes and PAD to our intervention — a 6-month behavioral intervention targeting levels of readiness to engage in routine walking for exercise — versus attention control . Our primary outcome was 6-month change in maximal treadmill walking distance . Secondary outcomes included 3-month change in maximal walking distance , lower limb function ( i.e. , walking impairment scores ) , quality of life ( Medical Outcomes Short Form Survey ) , exercise behaviors , depressive symptoms , and self-efficacy at 3 and 6 months . RESULTS The mean age of participants was 66.5 ( SD 10.1 ) years . Intervention and control groups did not differ significantly in 6-month change in maximal treadmill walking distance ( average [ SE ] 24.5 [ 19.6 ] meters vs. 39.2 [ 19.6 ] meters ; P = 0.60 ) . Among secondary outcomes , for the intervention and control groups , respectively , average walking speed scores increased by 5.7 [ 2.2 ] units and decreased by 1.9 [ 2.8 ] units ( P = 0.03 ) ; the mental health quality of life subscale score increased by 3.2 [ 1.5 ] and decreased by 2.4 [ 1.5 ] units ( P = 0.01 ) . CONCLUSIONS A home-based walking intervention did not improve walking distance but did improve walking speed and quality of life in people with diabetes and PAD . Clinicians should consider recommending home-based walking therapy for such patients Indobufen — an inhibitor of platelets aggregation — has been used in 306 pa tients with intermittent claudication due to peripheral vascular disease . Patients were treated and followed up for one year . One patient of every 3 treated with indobufen was treated with ASA , and a control group of patients receiving no treatment was also followed up . The authors studied by means of a treadmill exercise test the  pain-free walking distance ( PFWD ) , the global walking distance ( GWD ) , and the recovery time after exercise . The treatment period was com pleted by 290 patients : 204 claudicants , 51 claudicants with diabetes , and 35 with a short PFWD and GWD ( > 150 m ) .  Indobufen was more effective than ASA in improving the PFWD and GWD in all groups . There were also fewer side effects with indobufen , and cardiac morbidity and mortality was also reduced . In conclusion indobufen showed its activity and safety in chronic treatment of patients with peripheral disease , and we suggest that it may be used for long periods without side effects Background This prospect i ve , r and omized , controlled clinical trial compared changes in primary outcome measures of claudication onset time ( COT ) and peak walking time ( PWT ) , and secondary outcomes of submaximal exercise performance , daily ambulatory activity , vascular function , inflammation , and calf muscle hemoglobin oxygen saturation ( StO2 ) in patients with symptomatic peripheral artery disease ( PAD ) following new exercise training using a step watch ( NEXT Step ) home‐exercise program , a supervised exercise program , and an attention‐control group . Methods and Results One hundred eighty patients were r and omized . The NEXT Step program and the supervised exercise program consisted of intermittent walking to mild‐to‐moderate claudication pain for 12 weeks , whereas the controls performed light resistance training . Change scores for COT ( P<0.001 ) , PWT ( P<0.001 ) , 6‐minute walk distance ( P=0.028 ) , daily average cadence ( P=0.011 ) , time to minimum calf muscle StO2 during exercise ( P=0.025 ) , large‐artery elasticity index ( LAEI ) ( P=0.012 ) , and high‐sensitivity C‐reactive protein ( hsCRP ) ( P=0.041 ) were significantly different among the 3 groups . Both the NEXT Step home program and the supervised exercise program demonstrated a significant increase from baseline in COT , PWT , 6‐minute walk distance , daily average cadence , and time to minimum calf StO2 . Only the NEXT Step home group had improvements from baseline in LAEI , and hsCRP ( P<0.05 ) . Conclusions NEXT Step home exercise utilizing minimal staff supervision has low attrition , high adherence , and is efficacious in improving COT and PWT , as well as secondary outcomes of submaximal exercise performance , daily ambulatory activity , vascular function , inflammation , and calf muscle StO2 in symptomatic patients with PAD . Clinical Trial Registration URL : Clinical Trials.gov . Unique Identifier : NCT00618670 IMPORTANCE Approximately one-third of patients with peripheral artery disease experience intermittent claudication , with consequent loss of quality of life . OBJECTIVE To determine the efficacy of ramipril for improving walking ability , patient-perceived walking performance , and quality of life in patients with claudication . DESIGN , SETTING , AND PATIENTS R and omized , double-blind , placebo-controlled trial conducted among 212 patients with peripheral artery disease ( mean age , 65.5 [ SD , 6.2 ] years ) , initiated in May 2008 and completed in August 2011 and conducted at 3 hospitals in Australia . INTERVENTION Patients were r and omized to receive 10 mg/d of ramipril ( n = 106 ) or matching placebo ( n = 106 ) for 24 weeks . MAIN OUTCOME MEASURES Maximum and pain-free walking times were recorded during a st and ard treadmill test . The Walking Impairment Question naire ( WIQ ) and Short-Form 36 Health Survey ( SF-36 ) were used to assess walking ability and quality of life , respectively . RESULTS At 6 months , relative to placebo , ramipril was associated with a 75-second ( 95 % CI , 60 - 89 seconds ) increase in mean pain-free walking time ( P < .001 ) and a 255-second ( 95 % CI , 215 - 295 seconds ) increase in maximum walking time ( P < .001 ) . Relative to placebo , ramipril improved the WIQ median distance score by 13.8 ( Hodges-Lehmann 95 % CI , 12.2 - 15.5 ) , speed score by 13.3 ( 95 % CI , 11.9 - 15.2 ) , and stair climbing score by 25.2 ( 95 % CI , 25.1 - 29.4 ) ( P < .001 for all ) . The overall SF-36 median Physical Component Summary score improved by 8.2 ( Hodges-Lehmann 95 % CI , 3.6 - 11.4 ; P = .02 ) in the ramipril group relative to placebo . Ramipril did not affect the overall SF-36 median Mental Component Summary score . CONCLUSIONS AND RELEVANCE Among patients with intermittent claudication , 24-week treatment with ramipril result ed in significant increases in pain-free and maximum treadmill walking times compared with placebo . This was associated with a significant increase in the physical functioning component of the SF-36 score . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00681226 Intermittent claudication ( IC ) is a mild stage of peripheral arterial disease that affects between 3 % and 7 % of the population and up to 1 in 5 patients over the age of 75 years . Risk factors such as hypertension , hyperlipidemia , diabetes , smoking , and genetics increase the incidence of peripheral arterial disease . Patients with IC have limitations in functional capacity and can benefit from regular exercise . Walking is the preferred mode of exercise and improves the symptoms of claudication in several ways . Vascular nurses can play an important role during exercise therapy . A personalized , home-based exercise program can be developed , and nurses can assist and motivate patients during follow-up periods . Helping patients to quit smoking and control other risk-factor modifications ( ie , high blood pressure and lipid levels ) also has high priority in daily practice of the vascular nurse . This prospect i ve study will illustrate the results of prescribed home-based exercise training by a vascular nurse on the maximum painless walking distance for patients with IC and will be applied to subgroups of vascular pathology PURPOSE The purpose of this r and omized trial was to compare the efficacy of a low-intensity exercise rehabilitation program vs a high-intensity program in changing physical function , peripheral circulation , and health-related quality of life in peripheral arterial disease ( PAD ) patients limited by intermittent claudication . METHODS Thirty-one patients r and omized to low-intensity exercise rehabilitation and 33 patients r and omized to high-intensity exercise rehabilitation completed the study . The 6-month exercise rehabilitation programs consisted of intermittent treadmill walking to near maximal claudication pain 3 days per week at either 40 % ( low-intensity group ) or 80 % ( high-intensity group ) of maximal exercise capacity . Total work performed in the two training regimens was similar by having the patients in the low-intensity group exercise for a longer duration than patients in the high-intensity group . Measurements of physical function , peripheral circulation , and health-related quality of life were obtained on each patient before and after the rehabilitation programs . RESULTS After the exercise rehabilitation programs , patients in the two groups had similar improvements in these measures . Initial claudication distance increased by 109 % in the low-intensity group ( P < .01 ) and by 109 % in the high-intensity group ( P < .01 ) , and absolute claudication distance increased by 61 % ( P < 0.01 ) and 63 % ( P < .01 ) in the low-intensity and high-intensity groups , respectively . Furthermore , both exercise programs elicited improvements ( P < .05 ) in peak oxygen uptake , ischemic window , and health-related quality of life . CONCLUSION The efficacy of low-intensity exercise rehabilitation is similar to high-intensity rehabilitation in improving markers of functional independence in PAD patients limited by intermittent claudication , provided that a few additional minutes of walking is accomplished to elicit a similar volume of exercise BACKGROUND Exercise training is recommended as the first-line therapy for intermittent claudication patients . However , the effects of exercise therapy on cardiovascular function of these patients have been poorly studied . The aim of this study is to compare the effects of walking and strength training on cardiovascular responses assessed at rest and during exercise in patients with intermittent claudication . PATIENTS AND METHODS Thirty-four patients with stable symptoms of intermittent claudication were r and omized into two groups : strength training ( ST ) consisting of eight exercises , three sets of 10 repetitions , intensity of 11 - 13 on 15- grade Borg scale , 2-min interval between sets ; and walking training ( WT ) consisting of walking on a treadmill , 15 bouts of 2-min , intensity of 11 - 13 on 15- grade Borg scale , with a 2-min interval between bouts . Before and after 12 weeks , blood pressure , heart rate and rate pressure product were measured at rest and during a progressive treadmill test until maximal claudication pain . RESULTS Fifteen patients in each group completed the training program . After the training programs , resting systolic blood pressure ( ST:-6 ± 13 mmHg and WT:-3 ± 18 mmHg , P = .04 ) , heart rate ( ST : -6 ± 10 bpm and WT:-2 ± 9 bpm , P = .03 ) , and rate pressure product ( ST:-1485 ± 1442 mmHg*bpm and WT:- 605 ± 2145 mmHg*bpm , P = .01 ) decreased significantly and similarly in both groups . Submaximal systolic blood pressure ( ST : -14 ± 23 mmHg and WT:-6 ± 23 mmHg , P = .02 ) , and rate pressure product ( ST:-1579 ± 3444 mmHg*bpm and WT : -1264 ± 3005 mmHg*bpm , P = .04 ) decreased significantly and similarly in both groups . There were no changes in submaximal heart rate after ST and WT . Maximal systolic blood pressure , heart rate , and rate pressure product did not change in either group , although maximal exercise time increased similarly in the ST and WT groups ( + 31 ± 19 % , and + 31 ± 32 % , respectively , P < .01 ) . CONCLUSIONS Strength and walking trainings promoted similar increases in walking capacity and decreases in resting and submaximal exercise cardiovascular load 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 r and omized , 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 question naires . 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 ( P = 0.025 ) group compared with placebo . A physical activity question naire demonstrated improvement in ambulatory ability for the 10- and 80-mg groups ( P = 0.011 ) , whereas 2 quality of life instruments , the Walking Impairment Question naire and Short Form 36 Question naire , 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 Objective : The aim of this study was to evaluate the effectiveness of a supervised exercise program ( SEP ) plus at home nonsupervised exercise therapy ( non-SET ) on functional status , quality of life ( QoL ) and hemodynamic response in post-lower-limb bypass surgery patients . Results : One hundred and seventeen patients were r and omized to an intervention ( n = 57 ) or a control group ( n = 60 ) . A new individual SEP was design ed for patients with peripheral arterial disease ( PAD ) and applied to the studied subjects of the intervention group who also continued non-SET at home , whereas those assigned to the control group received just usual SEP according to a common cardiovascular program . The participants of the study were assessed by a 6-min walking test ( 6 MWT ) , an ankle-brachial index ( ABI ) , and the Medical Outcomes Study Short Form-36 ( SF-36 ) of QoL at baseline , at 1 and 6 months after surgery . A significant improvement was observed in the walked distance in the intervention group after 6 months compared with the control group ( p < 0.001 ) . The intervention group had significantly higher QoL score in the physical and mental component of SF-36 ( p < 0.05 ) . Conclusions : A 6-month application of the new SEP and non-SET at home has yielded significantly better results in walking distance and QoL in the intervention group than in the controls Objective : To investigate the feasibility and effectiveness of six weeks of home-based treadmill training in people with mild Parkinson ’s disease . Design : Pilot r and omized controlled trial of a six-week intervention followed by a further six weeks follow-up . Setting : Home-based treadmill training with outcome measures taken at a hospital clinic . Participants : Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Two participants from the treadmill training group and one from the control group dropped out . Interventions : The treadmill training group undertook a semi-supervised home-based programme of treadmill walking for 20–40 minutes , four times a week for six weeks . The control group received usual care . Main outcome measures : The feasibility of the intervention was assessed by recording exercise adherence and acceptability , exercise intensity , fatigue , muscle soreness and adverse events . The primary outcome measure of efficacy was walking capacity ( 6-minute walk test distance ) . Results : Home-based treadmill training was feasible , acceptable and safe with participants completing 78 % ( SD 36 ) of the prescribed training sessions . The treadmill training group did not improve their walking capacity compared to the control group . The treadmill training group showed a greater improvement than the control group in fatigue at post test ( P = 0.04 ) and in quality of life at six weeks follow-up testing ( P = 0.02 ) . Conclusions : Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson ’s disease . Further investigation regarding the effectiveness of home-based treadmill training is warranted BACKGROUND Peripheral arterial occlusive disease ( PAOD ) at II stage results in a moderate to severe impairment in walking ability . Aim of this study , controlled and r and omized , was to evaluate the efficacy of an intensive 4 weeks exercise training in PAOD followed by a six-month period and to analyse the risk factors for atherosclerosis and the site of the lesion for possible predictors of result outcome . METHODS Patients with PAOD were included in the study ( ankle/arm ratio < or = 0.7 and < or = 0.5 after exercise ) with initial claudication distance ( ICD ) < or = 200 m and absolute claudication distance ( ACD ) < or = 500 m evaluated on a constant-load treadmill test ( 3 km/hr , 0 % slope ) . Forty patients were r and omized ( all with antiplatelet therapy ) : 20 to a supervised walking exercise ( mean ICD 121.8 m , ACD 289.7 m ) and 20 to a non exercising control group ( ICD 111.6 m , ACD 230.1 m ) . Both groups were tested at 4 weeks ( T1 ) and 6 months ( T2 ) . Training group was enrolled in a 4-week supervised training program . RESULTS In the training group 10 % of patients became asymptomatic ( > 1000 m ) . At T1 ICD increased 141 % ( p<0.001 ) and ACD was with low-pain-claudication > 1000 m in 50 % , at T2 ICD was 200 % ( p<0.05 ) with 70 % of asymptomatic for ICD and ACD . Control group has a no significant increase of ICD and ACD at T1 and T2 . Only arterial hypertension and intermittent claudication severity emerged as negative predictive factors for the results of training . CONCLUSIONS Vascular training produces a significant and lasting improvement in walking distance in PAOD Patients with atherosclerotic peripheral arterial disease ( PAD ) of the lower extremities have impaired walking ability due to exercise-induced muscle ischemia and the result ant pain of intermittent claudication . To evaluate the benefit of exercise training as a treatment for patients with PAD , as well as possible mechanisms associated with improvement , we r and omly assigned 19 men with disabling claudication to treated and control groups . Treatment consisted of supervised treadmill walking ( 1 hr/day , 3 days/wk , for 12 weeks ) with progressive increases in speed and grade as tolerated . Grade d treadmill testing was performed to maximal toleration of claudication pain on entry and after 12 weeks of training to define changes in peak exercise performance . After 12 weeks , treated subjects had increased their peak walking time 123 % , peak oxygen consumption 30 % , and pain-free walking time 165 % ( all p less than 0.05 ) . Control subjects had no change in peak oxygen consumption , but after 12 weeks , peak walking time increased 20 % ( p less than 0.05 ) . In treated subjects , maximal calf blood flow ( measured by a plethysmograph ) increased 38 + /- 45 % ( p less than 0.05 ) , but the change in flow was not correlated to the increase in peak walking time . Elevated plasma concentrations of acylcarnitines have been associated with the functional impairment of PAD and may reflect the metabolic state of ischemic skeletal muscle . In treated subjects , a 26 % decrease in resting plasma short-chain acylcarnitine concentration was correlated with improvement in peak walking time ( r = -0.78 , p less than 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND To explore the efficacy of cycle training in the treatment of intermittent claudication , the present study compared performance and physiologic effects of cycle training with more conventional treadmill walking training in a group of patients with claudication . METHOD Forty-two individuals with peripheral arterial disease and intermittent claudication ( 24 men , 18 women ) were stratified by gender and the presence or absence of type 2 diabetes mellitus and then r and omized to a treadmill ( n = 13 ) , cycle ( n = 15 ) , or control group ( n = 14 ) . Treadmill and cycle groups trained three times a week for 6 weeks , whereas the control group did not train during this period .  Maximal and pain-free exercise times were measured on grade d treadmill and cycle tests before and after training . RESULTS Treadmill training significantly improved maximal and pain-free treadmill walking times but did not improve cycle performance .  Cycle training significantly improved maximal cycle time but did not improve treadmill performance . However , there was evidence of a stronger cross-transfer effect between the training modes for patients who reported a common limiting symptom during cycling and walking at baseline . There was also considerable variation in the training response to cycling , and a subgroup of responsive patients in the cycle group improved their walking performance by more than the average response observed in the treadmill group . CONCLUSION These findings suggest that cycle exercise is not effective in improving walking performance in all claudication patients but might be an effective alternative to walking in those who exhibit similar limiting symptoms during both types of exercise OBJECTIVES To determine differences between PTA and conventional medical treatment in treadmill distance until onset of claudication , treadmill maximum walking distance , patient reported maximum walking distance , ankle brachial pressure index ( ABPI ) , quality of life ( Nottingham Health Profile , NHP ) and Duplex measured extent of occlusive disease . DESIGN R and omised controlled clinical trial . METHODS Six hundred claudicants were screened . Fifty-one men and 11 women with intermittent claudication due to short femoral stenoses or occlusions ( n = 47 ) and iliac stenoses ( n = 15 ) were r and omised to either PTA plus medical treatment ( PTA group , n = 30 ) or to medical treatment alone ( control group , n = 32 ) . Medical treatment consisted of daily low dose aspirin and advice on smoking and exercise . RESULTS At 6 month follow up : In the PTA group more patients reported no claudication ( p < or = 0.05 ) and were asymptomatic on the treadmill ( p < or = 0.01 ) compared to the control group . The ABPI was significantly higher in the PTA group . More of the PTA group reported lower NHP pain scores ( p < or = 0.05 ) . In the control group there were more occluded arteries ( p < or = 0.001 ) , and the stenosis velocity ratio of patient arteries was significantly higher ( p < or = 0.001 ) . CONCLUSIONS Only 10 % of claudicants had discrete lesions suitable for PTA . Treatment of these patients with PTA produces a greater short-term improvement in walking and quality of life than medical treatment alone and is associated with less progression of disease BACKGROUND : A key component in the management of chronic obstructive pulmonary disease ( COPD ) patients is pulmonary rehabilitation ( PR ) , the corner stone of which is exercise training . AIM : This study aims to evaluate the effect of a two-months , home-based PR program with outpatient supervision every two weeks , on exercise tolerance and health-related quality of life ( HRQL ) using Arabic-translated st and ardized generic and specific question naires in COPD patients recently recovered from acute exacerbation , DESIGN : R and omized clinical trial . SETTING AND SUBJECTS : A total of 39 COPD patients who recovered from acute exacerbation were r and omly allocated either a two-month home-based PR program in addition to st and ard medical therapy or st and ard medical therapy alone in the period between July 2008 and March 2009 . METHODS : Pulmonary function tests ( PFTs ) , six-minute walk distance ( 6-MWD ) test , Arabic-translated chronic respiratory disease question naire-self administered st and ardized format ( CRQ-SAS ) and quality of life scale Short Form ( SF-36 ) were compared between 25 patients with moderate to severe COPD who underwent a two-month PR program ( group 1 ) and 14 COPD patients who did not ( group 2 ) . RESULTS : Group 1 showed significant improvement in the 6-MWD , and HRQL scores at two months compared with the usual care patients in group 2 ( P less than 0.05 ) . Improvement in both CRQ-SAS and SF-36 scores were statistically significant and comparable in group 1 . CONCLUSION : The supervised , post discharge , two-month home-based PR program is an effective non pharmacological intervention in the management of stable patients with COPD . The 6-MWD is a simple , inexpensive and safe test to assess physical and functional capabilities among COPD patients . HRQL can be measured in patients with COPD either by disease-specific tools that have been specifically design ed for use in patients with respiratory system disorders or by generic HRQL tools that can be used across population s with a variety of medical conditions . The Arabic-translated CRQ-SAS is a new tool for assessment of Arabic-speaking patients with chronic respiratory diseases PURPOSE To determine whether a percutaneous vascular intervention ( PVI ) combined with supplemental supervised exercise therapy ( SET ) is more effective than a PVI alone in improving walking ability in patients with symptomatic peripheral arterial disease ( PAD ) . MATERIAL S AND METHODS In this prospect i ve r and omized trial , patients with PAD treated with a PVI were eligible . Exclusion criteria were major amputation or tissue loss , comorbidity preventing physical activity , insufficient knowledge of the Dutch language , no insurance for SET , and prior participation in a SET program . All patients received a PVI and subsequently were r and omly assigned to either the PVI alone group ( n = 35 ) or the PVI + SET group ( n = 35 ) . The primary outcome parameter was the absolute claudication distance ( ACD ) . This trial was registered at Clinical trials.gov , NCT00497445 . RESULTS The study included 70 patients , most of whom were treated for an aortoiliac lesion . The mean difference in ACD at 6 months of follow-up was 271.3 m ( 95 % confidence interval [ CI ] 64.0 - 478.6 , P = .011 ) in favor of additional SET . In the PVI alone group , 1 ( 3.7 % ) patient finished the complete treadmill test compared with 11 ( 32.4 % ) patients in the PVI + SET group ( P = .005 ) . Physical health-related quality -of-life score was 44.1 ± 7.8 in the PVI alone group compared with 41.9 ± 9.5 in the PVI + SET group , which was a nonsignificant difference ( P = .34 ) . CONCLUSIONS SET following a PVI is more effective in increasing walking distance compared with a PVI alone . These data indicate that SET is a useful adjunct to a PVI for the treatment of PAD We estimated minimal clinical ly important differences ( MCIDs ) for small , moderate , and large changes in measures obtained from a st and ardized treadmill test , a 6-minute walk test , and patient-based outcomes following supervised and home-based exercise programs in symptomatic patients with peripheral artery disease ( PAD ) . Patients were r and omized to either 12 weeks of a supervised exercise program ( n=60 ) , a home-based exercise program ( n=60 ) , or an attention-control group ( n=60 ) . Using the distribution-based method to determine MCIDs , the MCIDs for small , moderate , and large changes in peak walking time ( PWT ) in the supervised exercise group were 38 , 95 , and 152 seconds , respectively , and the changes in claudication onset time ( COT ) were 35 , 87 , and 138 seconds . Similar MCID scores were noted for the home-based exercise group . An anchor-based method to determine MCIDs yielded similar patterns of small , moderate , and large change scores in PWT and COT , but values were 1–2 minutes longer than the distribution approach . In conclusion , 3 months of supervised and home-based exercise programs for symptomatic patients with PAD results in distribution-based MCID small , moderate , and large changes ranging from 0.5 and 2.5 minutes for PWT and COT . An anchor-based approach yields higher MCID values , ranging from a minimum of 73 seconds for COT to a maximum of 4 minutes for PWT . The clinical implication is that a goal for eliciting MCIDs in symptomatic PAD patients through a walking exercise intervention is to increase PWT and COT by up to 4 minutes , which corresponds to two work stages during the st and ardized progressive treadmill test Functional impairment , functional decline , and mobility loss are major public health problems in people with lower extremity peripheral artery disease ( PAD ) . Few medical therapies significantly improve walking performance in PAD . We describe methods for the PROgenitor cell release Plus Exercise to improve functionaL performance in PAD ( PROPEL ) Study , a r and omized controlled clinical trial design ed to determine whether granulocyte-macrophage colony stimulating factor ( GM-CSF ) combined with supervised treadmill walking exercise improves six-minute walk distance more than GM-CSF alone , more than supervised treadmill exercise alone , and more than placebo plus attention control in participants with PAD , respectively . PROPEL Study participants are r and omized to one of four arms in a 2 by 2 factorial design . The four study arms are GM-CSF plus supervised treadmill exercise , GM-CSF plus attention control , placebo plus supervised exercise therapy , or placebo plus attention control . The primary outcome is change in six-minute walk distance at 12-week follow-up . Secondary outcomes include change in brachial artery flow-mediated dilation ( FMD ) , change in maximal treadmill walking time , and change in circulating CD34 + cells at 12-week follow-up . Outcomes are also measured at six-week and six-month follow-up . Results of the PROPEL Study will have important implication s for underst and ing mechanisms of improving walking performance and preventing mobility loss in the large and growing number of men and women with PAD Twenty-two patients with intermittent claudication were prospect ively enrolled in a 12-week program of supervised , grade d treadmill exercise therapy . Severity and distribution of arterial occlusive disease were ascertained by noninvasive determination of segmental lower extremity blood pressures and waveforms . No attempt was made to modify risk factors for atherosclerotic occlusive disease . The exercise-induced reduction of the ankle pressure and its recovery were recorded over time , and the area under this curve , the " ischemic window , " represents the severity of the ischemic deficit . Absolute systolic ankle pressure , ankle-brachial index , maximum walking time , claudication pain time , and the ischemic window were measured before and after exercise training in all subjects . Maximum walking time and claudication pain time increased 659 % and 846 % , respectively , among the 19 patients completing the 12-week program ( p = 0.001 ; p = 0.0002 ) . These patients underwent a mean reduction of 58.7 % in the ischemic window after a st and ardized workload ( p less than 0.05 ) , and this correlated with the degree of symptomatic improvement . Absolute ankle pressure and ankle-brachial index were unchanged after exercise training . This study confirms the utility of supervised exercise therapy in the treatment of intermittent claudication . The ischemic window is a useful method for quantifying the ischemic deficit produced by exercise and provides a reproducible means of documenting functional improvement in patients undergoing exercise training BACKGROUND Pulmonary hypertension ( PH ) restricts the ability to engage in physical activity and decreases longevity . We examined the impact of aerobic exercise training on function and quality of life in patients with World Health Organization group 1 PH . METHODS Patients were r and omized to a 10-week education only ( EDU ) or education/exercise combined ( EXE ) group . The exercise program consisted of 24 - 30 sessions of treadmill walking for 30 - 45 min per session at 70 % to 80 % of heart rate reserve . Outcome variables included changes in 6-min walk test ( 6MWT ) distance , time to exercise intolerance , peak work rate ( WR ) from a cardiopulmonary treadmill test , and quality -of-life measures , including the Short Form Health Survey , version 2 ( SF-36v2 ) and Cambridge Pulmonary Hypertension Outcome Review ( CAMPHOR ) . RESULTS Data are presented as mean SD . Twenty-three women ( age , 54 11 years ; BMI , 31 7 kg/m 2 ) were r and omized to the EDU ( n 5 13 ) or EXE ( n 5 10 ) groups . Following 10 weeks of intervention , patients in the EXE group demonstrated an improvement in 6MWT distance ( 56 45 m ; P 5 .002 ) , increased time to exercise intolerance ( 1.9 1.3 min ; P 5 .001 ) , and peak WR ( 26 23 W ; P 5 .004 ) . Additionally , the EXE group scored significantly ( P , .050 ) better on six of the eight scales on SF-36v2 , and fi ve of the six scales on CAMPHOR . In contrast , no significant improvement was observed for any of the outcome measures following EDU . No adverse events were noted in either group . CONCLUSION Ten weeks of brisk treadmill walking improved 6MWT distance , cardiorespiratory function , and patient-reported quality of life in female patients with group 1 PH PURPOSE Percutaneous transluminal angioplasty ( PTA ) is an increasingly popular invasive treatment for peripheral arterial disease , but there have been very few controlled trials to justify its use . This r and omized controlled clinical trial was performed to determine in patients with mild and moderate intermittent claudication differences in outcome between PTA and conventional medical treatment after 2 years . METHODS Six hundred patients with claudication were screened at the Peripheral Vascular Clinic , Royal Infirmary of Edinburgh . Sixty-two patients with short femoral artery stenoses or occlusions ( 47 patients ) and iliac stenoses ( 15 patients ) were r and omized to either PTA plus medical treatment ( PTA group , 30 patients ) or to medical treatment alone ( control group , 32 patients ) . Medical treatment consisted of daily low-dose aspirin and advice on smoking and exercise . Outcome measures studied were patient-reported maximum walking distance , exercise treadmill distance until onset of claudication , treadmill maximum walking distance , ankle-brachial pressure index ( ABPI ) , quality of life ( Nottingham Health Profile ) , and duplex ultrasound-measured extent of occlusive disease . RESULTS At 2 years of follow-up , the PTA group and control subjects did not differ significantly in patient-reported maximum walking , treadmill onset to claudication , treadmill maximum walking distances , or ABPI ( p > 0.05 ) . However , the PTA group had significantly fewer occluded arteries ( p = 0.003 ) and a lesser degree of stenosis ( expressed in terms of the velocity ratio ; p = 0.004 ) in patent arteries . Quality of life was not demonstrably different between the two groups ( p > 0.05 ) . CONCLUSIONS Two years after PTA , patients had less extensive disease than medically treated patients , but this did not translate into a significant advantage in terms of improved walking or quality of life . There are important implication s for patient management and future clinical research BACKGROUND This prospect i ve , r and omized controlled clinical trial determined whether an optimal exercise program length exists to efficaciously change claudication onset time ( COT ) and peak walking time ( PWT ) in patients with peripheral artery disease and claudication . METHODS The study r and omized 142 patients to supervised exercise ( n = 106 ) or a usual care control group ( n = 36 ) , with 80 completing the exercise program and 27 completing the control intervention .  The exercise program consisted of intermittent walking to nearly maximal claudication pain 3 days per week . COT and PWT were the primary outcomes obtained from a treadmill exercise test at baseline and bimonthly during the study . RESULTS After exercise , changes in COT ( P < .001 ) and PWT ( P < .001 ) were consistently greater than changes after the control intervention . In the exercise program , COT and PWT increased from baseline to month 2 ( P < .05 ) and from months 2 to 4 ( P < .05 ) but did not significantly change from months 4 to 6 ( P > .05 ) . When changes were expressed per mile walked during the first 2 months , middle 2 months , and final 2 months of exercise , COT and PWT only increased during the first 2 months ( P < .05 ) . CONCLUSIONS Exercise-mediated gains in COT and PWT occur rapidly within the first 2 months of exercise rehabilitation and are maintained with further training . The clinical significance is that a relatively short 2-month exercise program may be preferred to a longer program to treat claudication because adherence is higher , costs associated with personnel and use of facilities are lower per patient , and more patients can be trained for a given amount of personnel time and re source utilization PURPOSE The purpose of this investigation was to evaluate the efficacy of PoleStriding exercise ( a form of walking that uses muscles of the upper and lower body in a continuous movement similar to cross-country skiing ) and vitamin E ( alpha-tocopherol ) to improve walking ability and perceived quality of life ( QOL ) of patients with claudication pain secondary to peripheral arterial disease ( PAD ) . METHODS Fifty-two subjects were r and omized into four groups : PoleStriding with vitamin E ( N = 13 ) , PoleStriding with placebo ( N= 14 ) , vitamin E without exercise ( N= 13 ) , and placebo without exercise ( N = 12 ) . The dose of vitamin E was 400 IU daily . Only the PoleStriding with vitamin E and PoleStriding with placebo groups received PoleStriding instruction and training . Assignment to vitamin E or placebo was double blind . Subjects trained three times weekly for 30 - 45 min ( rest time excluded ) . Individuals in vitamin E and placebo groups came to the laboratory biweekly for ankle blood-pressure measurements . RESULTS Results of this r and omized clinical trial provide strong evidence that PoleStriding significantly ( P < 0.001 ) improved exercise tolerance on the constant work-rate and incremental treadmill tests . Ratings of perceived claudication pain were significantly less after the PoleStriding training program ( P= 0.02 ) . In contrast , vitamin E did not have a statistically significant effect on the subjects ' ratings of perceived leg pain ( P= 0.35 ) or treadmill walking duration ( P= 0.36 ) . Perceived distance and walking speed ( Walking Impairment Question naire ) and perceived physical function ( R and Short Form-36 ) improved in the PoleStriding trained group only ( P < 0.001 , 0.022 and 0.003 , respectively ) . CONCLUSION PoleStriding effectively improved the exercise tolerance and perceived QOL of patients with PAD . Little additional benefit to exercise capacity was realized from vitamin E supplementation Context Few therapies substantially reduce symptoms and improve exercise performance in patients with peripheral arterial disease ( PAD ) . Contribution In this double-blind trial , investigators r and omly assigned 40 older adults without diabetes and with symptomatic PAD to receive either ramipril or placebo , 10 mg once daily for 24 weeks . Compared with placebo , ramipril increased maximum and pain-free walking time and walking speed and distance . Caution s The trial was small and involved selected patients with limited mobility and exercise tolerance . Implication s Ramipril may improve symptoms in some patients with PAD . The Editors This article has been retracted . See Notice of Retraction . Peripheral arterial disease ( PAD ) is a common disorder , with 12 % of adults older than 50 years of age having an anklebrachial index ( ABI ) that is diagnostic of PAD ( < 0.9 ) ( 1 ) . Approximately one third of these patients experience intermittent claudication during walking , limiting normal activities . Medical treatments to improve walking distance are limited . The angiotensin-converting enzyme ( ACE ) inhibitor ramipril reduced cardiovascular morbidity and mortality compared with placebo in patients with established atherosclerotic disease , including PAD , in the Heart Outcomes Prevention Evaluation ( HOPE ) study ( 2 ) . This effect seemed to be independent of blood pressure reduction ( 3 ) and may relate to the known benefits of ACE inhibitors on both coronary and brachial endothelial function ( 4 ) . No previous controlled studies have investigated the effect of ACE inhibitors on symptoms of intermittent claudication . Given the positive effects of ramipril in the HOPE trial and its convenient once-daily dosing formulation , we hypothesized that therapy with ramipril would improve intermittent claudication symptoms . We aim ed to examine the effect of 6-month ramipril therapy on walking distance and claudication pain in a defined group of patients with claudication due to infrainguinal PAD by using a double-blind , r and omized , placebo-controlled design . Methods This article has been retracted . See Notice of Retraction . We screened 152 patients with PAD from general practice clinics in the Melbourne , Australia , metropolitan area ( Figure 1 ) . Of them , 40 patients ( mean age , 66 years [ SD , 4 ] ) were recruited and completed the trial . All patients gave written informed consent to participate in the study . The Ethics Committee of the Alfred Hospital , Melbourne , Australia , approved the study , and we performed the study in accordance with the Declaration of Helsinki 2000 . All participants had an ABI less than 0.9 at rest in at least 1 leg ; had a history of intermittent claudication ( unilateral or bilateral ) , which was stable for 6 months ; had evidence of superficial femoral artery stenosis or occlusion on duplex ultrasonography ; had blood pressure of 160/90 mm Hg or less ; had a stable medication regimen for at least 6 months ; and had not previously been treated with ACE inhibitors . We excluded patients with limiting coronary artery disease , renal failure , history of hypertension , or type 2 diabetes mellitus . Figure 1 . Flow of patients through the study . Computer-generated numbers specified the allocation sequence . A tamper-proof r and omization process generated by the hospital research center r and omly assigned participants into blocks of 10 to receive either ramipril ( Tritace , Aventis Pharma Pty . Ltd. , Macquarie Park , Australia , 10 mg once daily for 24 weeks ) or placebo ( 10 mg once daily for 24 weeks ) in a parallel-group , double-blind design . Both investigators and patients were blinded to drug assignment . Furthermore , investigators did not have access to baseline data when they performed follow-up measurements and patients were not asked which treatment they thought they were receiving . No patient assigned to placebo crossed over to ramipril during the trial or vice versa . We advised participants to maintain all aspects of their lifestyle throughout the trial and requested them to refrain from exercise , smoking , and caffeine for 24 hours before all testing . On the morning of testing , patients rested in a supine position for 15 minutes in a quiet room before the measurements . We assessed blood pressure , ABI , walking distance , duplex ultrasounds of leg arteries , and the Walking Impairment Question naire ( WIQ ) scores before and after both interventions . We advised patients about potential side effects and requested that they report any adverse event to the study coordinator . All patients performed a treadmill exercise test at a speed of 3.2 km/h and a grade of 12 % ( 5 ) , and we recorded pain-free walking time ( time to onset of claudication pain ) and maximum walking time . In our study , all patients reached a maximal level of claudication pain that limited exercise during the grade d treadmill test . The WIQ was developed and vali date d against treadmill walking and is used to evaluate limitations in community-based walking ability ( 6 ) . The WIQ assessed walking distance , speed , and stair-climbing ability , using a weighted st and ardized formula and returning a summary score between 0 % and 100 % ( 6 , 7 ) . Statistical Analyses All analysts were blinded to treatment assignment , and an independent investigator double-checked all measurement calculations and data base entries . The study was powered to detect a 180-second change in maximum walking time with ramipril , assuming a st and ard deviation of 250 seconds ( = 0.05 [ 2-sided ] ; power , 86 % ) . We compared 24-week changes from baseline in pain-free walking time , maximum walking time , and WIQ scores between treatments by using an analysis of covariance model with terms for treatment and baseline value as the analysis end points . We log-transformed the WIQ data to achieve a normal distribution before analysis . We conducted all statistical analyses by using Stata software , version 8.2 ( Stata Corp. , College Station , Texas ) . We expressed normally distributed data as means ( SDs ) or 95 % CIs and non-normally distributed data as medians ( ranges ) . A P value less 0.05 was deemed to be significant . No data were missing for any clinical variable measured in our study . Role of the Funding Sources This work was funded by the National Health and Medical Research Council of Australia . Aventis Pharma Pty . Ltd. provided ramipril ( Tritace ) and matching placebo capsules but provided no other funding for the study or to the investigators . The funding sources had no role in the design , conduct , or reporting of the study or in the decision to su bmi t the manuscript for publication . Results This article has been retracted . See Notice of Retraction . The ramipril and placebo groups were similar in age , other cardiovascular risk factors , medication use , and PAD severity , as evidence d by clinical symptoms ( walking times ) , WIQ scores , and resting ABI ( Table ) . No patient was taking cilostazol or pentoxifylline . On duplex ultrasonography , 6 of 40 patients had a superficial femoral artery occlusion ( 2 placebo patients and 4 ramipril patients ) , and the remaining patients had stenotic disease in the superficial femoral artery . Only 25 % of patients were taking antiplatelet or lipid-lowering therapy . No adverse events were reported . Table . Baseline Characteristics AnkleBrachial Index Ramipril  significantly increased ABI both at rest ( change with placebo , 0.05 mm Hg [ SD , 0.04 ] ; change with ramipril , 0.07 mm Hg [ SD , 0.08 ] ; P < 0.001 ) and after exercise ( change with placebo , 0.04 mm Hg [ SD , 0.05 ] ; change with ramipril , 0.08 mm Hg [ SD , 0.14 ] ; P < 0.001 ) . At rest , this increase was due to reduction in brachial systolic blood pressure with ramipril treatment ( 0.85 mm Hg [ SD , 1.57 ] vs. 5.05 mm Hg [ SD , 2.33 ] ; P < 0.001 ) rather than an increase in limiting leg pressure ( 0.75 mm Hg [ SD , 1.71 ] vs. 0.15 mm Hg [ SD , 1.27 ] ; P= 0.26 ) . After exercise , both a reduction in brachial pressure ( change with placebo , 0.30 mm Hg [ SD , 2.45 ] ; change with ramipril , 6.80 mm Hg [ SD , 6.07 ] ; P < 0.001 ) and an increase in limiting leg pressure ( change with placebo , 5.40 mm Hg [ SD , 7.56 ] ; change with ramipril , 7.10 mm Hg [ SD , 4.59 ] ; P < 0.001 ) contributed to the increase in ABI . Treadmill Test After adjustment for the baseline pain-free walking time , mean pain-free walking time after ramipril treatment was 227 seconds ( 95 % CI , 175 seconds to 278 seconds ; P < 0.001 ) longer than after placebo treatment ( Figure 2 ) . Similarly , maximum walking time significantly improved over the 24-week treatment period by 451 seconds ( CI , 367 seconds to 536 seconds ; P < 0.001 ) in the ramipril group after adjustment for baseline values ( Figure 2 ) . The lack of change observed over the 24-week treatment period in the placebo group ( change in mean walking time , 10 seconds [ SD , 9 ] [ CI , 14 seconds to 6 seconds ] ; P < 0.001 ) may reflect both the advanced age of participants and the fact that they all had limiting infrainguinal disease , which would probably give more reproducible treadmill data than aortoiliac disease . In addition , we asked patients to maintain all aspects of their lifestyle throughout the trial . Figure 2 . Effect of ramipril on maximum treadmill walking times . Walking Impairment Question naire Ramipril improved WIQ median distance score from 5 % ( range , 1 % to 39 % ) to 21 % ( range , 12 % to 58 % ) ( P < 0.001 ) , speed score from 3 % ( range , 3 % to 39 % ) to 18 % ( range , 8 % to 50 % ) ( P < 0.001 ) , and stair-climbing score from 17 % ( range , 4 % to 80 % ) to 67 % ( range , 38 % to 88 % ) ( P < 0.001 ) . Duplex Ultrasonography Volume flow was unaltered in the limiting leg at the stenotic site . However , ramipril significantly increased volume flow in the common femoral artery proximal to the site of stenosis in both the limiting leg ( change with placebo , 0.014 L/min [ SD , 0.022 ] ; change with ramipril , 0.017 L/min [ SD , 0.034 ] ; P= 0.008 ) and the nonlimiting leg ( change with placebo , 0.006 L/min [ SD , 0.041 ] ; change with ramipril , 0.019 L/min [ SD , 0.019 ] ; P= 0.035 ) . Discussion This article has been retracted . See Notice of Retraction . Our study shows that The efficacy , safety and cost of pentoxifylline ( PXF ) in severe intermittent claudication was studied comparing PXF and placebo in a 12-month study . A treadmill test and microcirculatory evaluation with laser Doppler flowmetry were performed at inclusion and at the end of 6 and 12 months . A physical training plan ( based on walking ) and reduction in risk factor levels plan was used in both groups . Of the 120 included patients , 101 completed the study : 56 in the  PXF group and 45 in the  placebo group . There were 19 dropouts ( due to low compliance ) . The two groups were comparable for age , sex distribution , walking distance , and the presence of risk factors and smoking . Intention-to-treat analysis indicated a 268 % increase in walking distance in the PXF group ( vs 198 % in the placebo group ; p<0.05 ) at 6 months and an increase of 404 % ( vs 280 % in the placebo group ; p<0.02 ) at 12 months . The absolute and percent increase in pain-free walking distance ( PFWD ) was greater in the PXF group ( p<0.05 ) . Treatment was well tolerated . No serious drug-related side effects were observed . Microcirculatory evaluation indicated an increase in flux ( p < 0.05 ) in the PXF group ( not significant in the placebo group ) ; the after-exercise flux ( AEF ) was increased ( p<0.05 ) in both groups at 6 months but the increase in AEF was greater in the PXF group at 12 month . In conclusion , between-group analysis favors PXF considering walking distance and microcirculatory parameters . Results indicate good efficacy and tolerability The purpose of this study was to evaluate the efficacy of a  pain-free treadmill walking program in intellectually disabled ( ID ) adults with arterial occlusive disease . Fourteen participants with mild ID participated in the walking program .  Six patients showed stable intermittent claudication . A control ( nontreadmill , n = 12 ) group consisted of 4 individuals with intermittent claudication . Noninvasive determinations of lower-limb hemodynamics included photoplethysmography and ankle-brachial pressure . Pain levels were measured according to a pain pathophysiology index . The treadmill program consisted of individually prescribed low-endurance walking at a 0 % incline done at a comfortable speed 3 times per week . All participants completed the 15-week walking program and showed significant improvements ( p < 0.05 ) in walking speed , distance , and duration . Pain levels were reduced in individuals suffering from intermittent claudication . Blood hemodynamic parameters also showed significant improvements . In conclusion , low-intensity treadmill walking significantly improved the functional capacities of adult individuals with mild ID with vascular occlusion and reduced pain levels Background The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis ( OA ) is limited . Objective The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion ( ROM ) , muscle strength , physical fitness , walking capacity , and pain during walking in people with hip OA . Design This was a secondary outcome analysis of a r and omized clinical trial . Setting The setting was a university hospital . Participants One hundred nine people with clinical ly and radiographically evident hip OA were r and omly allocated to receive both exercise therapy and patient education ( exercise group ) or patient education only ( control group ) . Intervention All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists . Two other physical therapists were responsible for providing the exercise therapy program , consisting of 2 or 3 weekly sessions of strengthening , functional , and stretching exercises over 12 weeks . Both interventions were conducted at a sports medicine clinic . Measurements Outcome measures included ROM , isokinetic muscle strength , predicted maximal oxygen consumption determined with the Astr and bicycle ergometer test , and distance and pain during the Six-Minute Walk Test ( 6MWT ) . Follow-up assessment s were conducted 4 , 10 , and 29 months after enrollment by 5 physical therapists who were unaware of group allocations . Results No significant group differences were found for ROM , muscle strength , predicted maximal oxygen consumption , or distance during the 6MWT over the follow-up period , but the exercise group had less pain during the 6MWT than the control group at 10 months ( mean difference=−8.5 mm ; 95 % confidence interval=−16.1 , −0.9 ) and 29 months ( mean difference=−9.3 mm ; 95 % confidence interval=−18.1 , −0.6 ) . Limitations Limitations of the study were reduced statistical power and 53 % rate of adherence to the exercise therapy program . Conclusions The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM , muscle strength , physical fitness , and walking capacity , but exercise in addition to patient education result ed in less pain during walking in the long term OBJECTIVES To determine if therapist supervision of an exercise program produced better functional outcomes in allogeneic stem cell transplant patients than a patient-directed exercise program . METHODS Sixty-one patients who were less than 6 months post allogeneic stem cell transplant were r and omly assigned to either a therapist supervised training group ( supervised ) or a patient-directed training group ( Self-directed ) . Training consisted of aerobic exercises ( treadmill , bicycle ergometer versus walking ) and resistance exercises ( free weights , weight machines versus resistive b and activities ) . Subjects completed physical performance tests ( 50-foot fast walk , 6-min walk , forward reach , repeated sit-to-st and , uniped stance ) and the Brief Fatigue Inventory ( BFI ) before and after 4 weeks of training . Pre- and post-training outcomes and group differences were analyzed by a Student t-test . RESULTS Patients in both groups were similarly deconditioned at baseline . Training increased the 6-min walk distance and 50-foot walk in the supervised group by 12 and 14 % , respectively , and increased the 6-min walk distance by 10 % in the Self-directed group ( p<0.05 ) . BFI score for worst level of fatigue declined in both groups but not significantly . CONCLUSIONS These results demonstrate that allogeneic transplant patients derive functional benefits from short-term exercise training regardless of how the training program is supervised . Determining ( 1 ) the reasons for the low participation rate ( 28 % ) , ( 2 ) the patient-preferred characteristics of each exercise supervision style and ( 3 ) how best to match patient preference to exercise supervision style remain significant issues in this area of patient delivery services OBJECTIVES To compare the effect of unsupervised exercise , supervised exercise and intermittent pneumatic foot and calf compression ( IPC ) on the claudication distance , lower limb arterial haemodynamics and quality of life of patients with intermittent claudication . METHODS Thirty-four eligible patients with stable intermittent claudication were r and omised to IPC ( n = 13 , 3h/d for 6 months ) , supervised exercise ( n = 12 , three hourly sessions/week for 6 months ) or unsupervised exercise ( n = 9 ) . In each patient , initial claudication distance ( ICD ) , absolute claudication distance ( ACD ) , resting ankle brachial pressure index ( ABPI ) , and resting hyperaemic calf arterial inflow were measured before , 6 weeks , 6 months and 1 year after r and omisation . Quality of life was assessed with the short form (SF)-36 , walking impairment ( WIQ ) and intermittent claudication question naires ( ICQ ) . RESULTS Compared with unsupervised exercise , both IPC and supervised exercise , increased ICD and ACD , up to 2.83 times . IPC  increased arterial inflow ( p < 0.05 at 6 weeks ) and ABPI .  Supervised exercise decreased arterial inflow and increased ABPI ( p < 0.05 at 6 months ) . Unsupervised exercise had no effect on arterial inflow or ABPI . IPC improved significantly the ICQ score and the speed score of the WIQ , while supervised exercise improved the WIQ claudication severity score . At 1 year clinical effectiveness of supervised exercise and IPC was largely preserved . CONCLUSIONS IPC , by augmenting leg perfusion , achieved improvement in walking distance comparable with supervised exercise . Long-term results in a larger number of patients will provide valuable information on the optimal treatment modality of intermittent claudication PURPOSE The effects of upper-limb ( arm cranking ) and lower-limb ( leg cranking ) exercise training on walking distances in patients with intermittent claudication was assessed . METHODS Sixty-seven patients ( 33 to 82 years old ) with moderate to severe intermittent claudication were recruited , and the maximum power generated during incremental upper- and lower-limb ergometry tests was determined , as were pain-free and maximum walking distances ( by using a shuttle walk test ) . Patients were r and omly assigned to an upper-limb training group ( n = 26 ) or a lower-limb training group ( n = 26 ) . An additional  untrained group ( n = 15 ) was recruited on an ad hoc basis in parallel with the main trial by using identical inclusion criteria . This group was subsequently shown to possess a similar demographic distribution to the two exercise groups . Supervised training sessions were held twice weekly for 6 weeks . RESULTS Both training programs significantly improved the maximum power generated during the incremental upper- and lower-limb ergometry tests ( P < . 001 ) , which may reflect an increase in central cardiovascular function that was independent of the training mode . More importantly , pain-free and maximum walking distances also improved in both training groups ( P < .001 ) . The improvements in the training groups were similar ; there were no changes in the untrained control group . These findings suggest that the symptomatic improvement after upper-limb exercise training may result , in part , from systemic cardiovascular effects rather than localized metabolic or hemodynamic changes . CONCLUSION Carefully prescribed upper-limb exercise training can evoke a rapid symptomatic improvement in patients with claudication , while avoiding the physical discomfort experienced when performing lower-limb weight-bearing exercise BACKGROUND Although there have been many studies showing that exercise training is beneficial for patients with peripheral vascular occlusive disease ( PVOD ) , there is little research comparing various modes of training . Previous studies showed that exercise tests performed on a StairMaster ( StairMaster Sports/Medical Products , Kirkl and , WA ) produce responses similar to those elicited by treadmill tests . The purpose of this study was to compare these modes of exercise in a training program for patients with PVOD . METHODS Of the 23 eligible individuals who began the exercise program  , 11 did not complete the regimen due to various complications . Thus , 12 patients were r and omly assigned to train for 12 weeks on either a StairMaster ( n = 6 ) or a treadmill ( n = 6 ) . Patients underwent progressive and single-stage exercise tests on both exercise modalities before and after training . RESULTS Mean exercise time before the onset of claudication pain for all tests rose significantly after training ( P < .01 ) , but greater improvements were seen on the specific training apparatus ( i.e. , treadmill training result ed in improvement in treadmill exercise performance with less improvement noted when tested on the StairMaster , and vice versa ) . Exercise time to maximal pain increased for the training apparatus only ( P < .01 ) . There were no changes in foot transcutaneous oxygen tension or the ankle-brachial blood pressure index . CONCLUSIONS Both StairMaster and treadmill training improve the exercise capacity of PVOD patients . The training effect is most apparent for the specific training apparatus , but there is some cross-over improvement to the other exercise modality . Thus , StairMaster training is appropriate and can be part of the exercise prescription for treatment of these patients BACKGROUND In this prospect i ve study we evaluated the relationship between thromboxane B2 ( TXB2 ) , prostacyclin ( PGI2 ) and lactate concentrations , and the improvement of walking abilities and endothelial function in patients with peripheral artery disease ( PAD ) undergoing a supervised treadmill training program ( STTP ) .  METHODS A total of fifty-nine patients with stable intermittent claudication were included into a 12-week long STTP .  Changes in blood pressure , biochemical parameters , ankle/brachial index ( ABI ) , flow-mediated dilatation ( FMD ) , maximal walking time ( MWT ) and pain-free walking time ( PFWT ) were assessed before and after STTP . Additional baseline and post-STTP measurements were taken for blood lactate , and TXB2 and PGI2 urinary derivatives before and after maximal exercise ( ME ) . RESULTS The MWT improved significantly after STTP by 91 % ( p<0.0001 ) and PFWT by 97 % ( p<0.0001 ) . Also , ABI values improved significantly after STTP in all patient groups and was more pronounced in those with longer MWT at baseline . FMD values increased by 45 % ( p<0.0001 ) after STTP . Urinary 11-dehydro-thromboxane B2 and 2,3-dinor-6-keto-PGF1α concentration tend to decrease after STTP and their ratio remained unchanged . Lactate levels did not change after the treadmill training program . Hs-CRP and fibrinogen concentration decreased significantly after STTP only in patients with longer MWT at baseline-fourth quartile . CONCLUSIONS STTP in patients with PAD showed significantly improved walking abilities and endothelial function . Lactate production , TXB2 release , and PGI2 release are not directly correlated with improvement of endothelial function and walking abilities . Patients with better-walking abilities at baseline derive greater clinical and metabolic benefits from STTP Background Patients with peripheral arterial disease ( PAD ) are limited by intermittent claudication in the distance they can walk . Allopurinol has been shown in coronary arterial disease to prolong exercise before angina occurs , likely by prevention of oxygen wastage in tissues and reduction of harmful oxidative stress . Methods In this study we evaluated whether allopurinol could prolong the time to development of leg pain in participants with PAD . In a double-blind , r and omized controlled clinical trial participants were r and omized to receive either allopurinol 300 mg twice daily or placebo for 6 months . The primary outcome was change in exercise capacity on treadmill testing at 6 months . Secondary outcomes were 6-minute walking distance , Walking Impairment Question naire , SF-36 question naire , flow-mediated dilatation , and oxidized low-density lipoprotein . Outcome measures were repeated mid study and at the end of study . The mean age of the 50 participants was 68.4 ± 1.2 years with 39 of 50 ( 78 % ) male . Results Five participants withdrew during the study ( 2 active , 3 placebo ) . There was a significant reduction in uric acid levels in those who received active treatment of 52.1 % ( P < 0.001 ) , but no significant change in either the pain-free or the maximum walking distance . Other measures of exercise capacity , blood vessel function , and the participants ' own assessment of their health and walking ability also did not change during the course of the study . Conclusions Although allopurinol has been shown to be of benefit in a number of other diseases , in this study there was no evidence of any improvement after treatment in patients with PAD The clinical significance of drugs improving red cell deformability is not confirmed . We established the effect of physical training alone and combined with flunarizine on intermittent claudication . Twelve patients aged 48 - 73 years were included in the study .  Pain-free walking distance on treadmill , ankle/arm pressure ratio and transcutaneous oxygen tension were measured . Walking distance increased significantly ( p less than 0.05 ) by 130 % from 75 m to 173 m during the first year when the patients were on programmed physical training .  Ankle/arm pressure ratio also increased significantly ( p less than 0.05 ) from 0.46 to 0.55 during this period . The increase in walking distance ceased when the programmed physical training was discontinued for 6 months . During the following double-blind , cross-over medication period the patients were given flunarizine 5 mg b.i.d . and placebos in r and omized order for 3 months each . They also continued the same programmed physical training as during the first year . Walking distance increased , albeit not significantly , with time to 392 m after the second medication period . There was no difference , however , between flunarizine and placebo .  Ankle/arm pressure ratio was of the same magnitude as at the beginning of the trial . Oxygen tension measurements did not give consistent results . We conclude that programmed physical training increased walking distance as a function of time . Flunarizine had no effect on the performance of patients with intermittent claudication PURPOSE To compare treadmill and shuttle walk tests for assessing functional capacity in patients with intermittent claudication , with respect to test-retest reliability , cardiovascular responses , and patient preferences . METHODS Patients with stable intermittent claudication ( N = 55 , ages 52 - 85 yr , median age 68 yr ) were recruited from the Sheffield Vascular Institute at the Northern General Hospital , Sheffield , UK . Each patient performed an incremental shuttle walk test , a constant-pace shuttle walk test , and a st and ardized treadmill test ( 3.2 km x h(-1 ) , 12 % gradient ) , each on three occasions . The incremental shuttle walk began at 3 km x h(-1 ) and increased by 0.5 km x h(-1 ) every minute , whereas the constant-pace shuttle walk was performed at the fixed pace of 4 km x h(-1 ) . Claudication distance ( CD ) , maximum walking distance ( MWD ) , heart rate ( HR ) , and blood pressure were assessed in each testing session . The patients also completed a test preference question naire . RESULTS CD and MWD for both shuttle walks were greater than the corresponding walking distances achieved in the treadmill test ( P < 0.001 ) . Average coefficients of variation for repeated incremental shuttle walk , constant-pace shuttle walk , and treadmill tests were 15.9 % , 21.1 % , and 18.7 % , respectively , for MWD , corresponding to average intraclass correlation coefficients of 0.87 , 0.82 , and 0.87 . Treadmill walking evoked greater increases in HR and blood pressure ( P < 0.001 ) , and fewer patients expressed a preference for it ( 24 vs 43 % for shuttle walking ) . CONCLUSION These findings indicated that shuttle walk testing exhibits similar test-retest reliability as treadmill testing , but that it evoked a lower level of cardiovascular stress and is preferred to treadmill testing by a large proportion of patients OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke Cilostazol , a novel oral phosphodiesterase inhibitor , has shown consistent improvement in exercise tolerance in patients with intermittent claudication ( IC ) . In addition to this effect , cilostazol has previously been shown to have beneficial effects on the dyslipidemia , i.e. , combination of high triglycerides with low high-density-lipoprotein cholesterol ( HDL-C ) levels . Interleukin-6 ( IL-6 ) suppresses the activity of lipoprotein lipase , which modulates the metabolism of triglycerides and HDL-C. To determine whether a reduction of IL-6 contributes to the improvement of lipid profiles , we prospect ively investigated the effect of cilostazol ( n=16 , 100 mg , twice daily ) on the changes of lipid profiles and on the association with the changes of IL-6 compared with those of pentoxifylline ( n=16 , 400 mg , bid ) in patients with IC . After eight weeks of administration of cilostazol to patients with IC , walking distances were increased , associated with a 29 % decrease in plasma triglycerides and a 13 % increase in HDL-C. No significant changes of lipid profiles in the pentoxifylline and placebo groups were observed although a similar improvement in walking distances was achieved in the pentoxifylline group . IL-6 levels were significantly reduced in patients receiving cilostazol as compared with those receiving placebo or pentoxifylline . The cilostazol-induced  changes in the IL-6 were positively related to those of triglycerides in the cilostazol group ( r=0.63 , P<0.05 ) and negatively related to those of HDL-C ( r=-0.55 , P<0.05 ) . These findings suggest that in addition to consistent improvement of exercise tolerance , cilostazol may improve lipid profiles by reducing IL-6 release . However , pentoxifylline did not affect lipid profiles although a similar improvement of maximal walking distance ( MWD ) was achieved BACKGROUND Locomotor training , including the use of body-weight support in treadmill stepping , is a physical therapy intervention used to improve recovery of the ability to walk after stroke . The effectiveness and appropriate timing of this intervention have not been established . METHODS We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment -- moderate ( able to walk 0.4 to < 0.8 m per second ) or severe ( able to walk < 0.4 m per second)-- and r and omly assigned them to one of three training groups . One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred ( early locomotor training ) , the second group received this training 6 months after the stroke had occurred ( late locomotor training ) , and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke ( home-exercise program ) . Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks . The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke . RESULTS At 1 year , 52.0 % of all participants had increased functional walking ability . No significant differences in improvement were found between early locomotor training and home exercise ( adjusted odds ratio for the primary outcome , 0.83 ; 95 % confidence interval [ CI ] , 0.50 to 1.39 ) or between late locomotor training and home exercise ( adjusted odds ratio , 1.19 ; 95 % CI , 0.72 to 1.99 ) . All groups had similar improvements in walking speed , motor recovery , balance , functional status , and quality of life . Neither the delay in initiating the late locomotor training  nor the severity of the initial impairment affected the outcome at 1 year . Ten related serious adverse events were reported ( occurring in 2.2 % of participants undergoing early locomotor training , 3.5 % of those undergoing late locomotor training , and 1.6 % of those engaging in home exercise ) . As compared with the home-exercise group , each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment ( P=0.008 ) . Among patients with severe walking impairment , multiple falls were more common in the group receiving early locomotor training than in the other two groups ( P=0.02 ) . CONCLUSIONS Locomotor training , including the use of body-weight support in stepping on a treadmill , was not shown to be superior to progressive exercise at home managed by a physical therapist . ( Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research ; LEAPS Clinical Trials.gov number , NCT00243919 . ) BACKGROUND The prothrombotic , hypofibrinolytic state that develops in patients with intermittent claudication ( IC ) upon walking due to ischemia-reperfusion injury ( IRI ) of the leg muscles may contribute to the high incidence of life- and limb-threatening thrombotic events observed in this patient group . Treatments , such as angioplasty , that obtund the IRI also ameliorate the procoagulant diathesis . The effect on this diathesis of supervised exercise and cilostazol , both of which provide symptomatic benefit in IC , but without significantly obtunding IRI , is unknown . METHODS Thirty-four patients ( 27 men and 7 women ; median age , 67 years ; range , 63 - 72 years ) were r and omized to receive best medical therapy ( BMT ) plus supervised exercise ( n = 9 ) , BMT plus cilostazol ( n = 9 ) , BMT plus supervised exercise plus cilostazol ( n = 7 ) , or BMT alone ( n = 9 ) in a 2 x 2 factorial design . Thrombin-antithrombin complex and prothrombin fragments 1 and 2 , both markers of thrombin generation ; plasminogen activator inhibitor antigen and tissue plasminogen activator antigen , both markers of fibrinolysis ; ankle-brachial pressure index ( ABPI ) ; and initial and absolute claudication distance ( ACD ) were measured at baseline and then 3 and 6 months after r and omization . RESULTS At 6 months , when compared with receiving BMT only , supervised exercise and cilostazol result ed in improvements in ABPI of 18 % and 13 % and in ACD of 40 % and 64 % , respectively . The effects on ABPI and ACD of combining supervised exercise and cilostazol were additive . Supervised exercise , cilostazol , and supervised exercise combined with cilostazol had no significant effect on any of the four hemostatic markers . CONCLUSIONS Treatment of IC by supervised exercise or cilostazol results in significant improvements in ABPI and ACD but has no demonstrable effect on the prothrombotic diathesis . This suggests that supervised exercise and cilostazol , unlike angioplasty , are unlikely to have a long-term beneficial effect on the thrombotic risks faced by these patients Patients with intermittent claudication due to peripheral arterial disease ( PAD ) experience muscle aching during walking secondary to ischemia . The purpose of this study was to examine the effects of low-intensity pain-free exercise ( LIPFE ) on functional capacity of individuals with PAD . A total of 12 participants with PAD underwent training on treadmill for 6 weeks , twice a week , for about 45 minutes . Outcome measures included walking distance ( WDI ) , walking duration ( WDU ) , mean walking rate ( WR ) , estimated oxygen consumption ( EVO2 ) , metabolic equivalent ( MET ) , estimated total energy expenditure ( ETEE ) , and estimated rate of energy expenditure ( EREE ) . Mean improvement of WDI , WDU , and MWR were 104 % ( an addition of 1.0 km ) , 55 % ( an addition of 13.3 minutes ) , and 41 % ( 0.9 km/h faster ) , respectively . Mean improvement of EVO2 , MET , ETEE , and EREE , were 20 % , 20 % , 80 % , and 20 % , respectively . In conclusion , it appears that LIPFE training is an effective intervention for individuals presenting with PAD Aim of the study is to evaluate the effects of Prostagl and in E-1 ( PGE-1 ) in patients with peripheral arterial disease ( PAD ) at the 2nd b stage Fontaine 's classification . The study , controlled , single blinded , enrolled 123 patients with intermittent claudication that were r and omised in two groups ; the first group received a treatment with PGE-1 while the second one received a pentoxifylline-buflomedil association by venous infusion . We evaluated : Pain Free Walking Distance ( PFWD ) , Maximum Walking Distance ( MWD ) , Rest Flow ( RF ) , Peak Flow ( PF ) , Basal ( BVR ) and Minimal Vascular Resistance ( MVR ) with a strain gauge plethysmograph , Resting Flow ( RF ) , Peak Flow ( PF ) , time to reach the Peak Flow ( tPF ) and time to recovery of the base values ( tRF ) with laser Doppler flowmeter . After a four weeks treatment , we observed an increase of 370 % about PFWD and of 260 % in the MWD in patients treated with PGE-1 ; the other group showed an increase of 110 % and 118 % respectively . Moreover , the patients of the first group showed a significant increase regarding the plethysmographic Peak Flow ( from 9.75+/-1.37 to 16.21+/-1.75 , p<0.001 ) , greater than the one observed in the second group ( from 9.53+/-1.41 to 13.47+/-1.53 , p<0.05 ) ; also the laser Doppler parameters showed a significant reduction , more evident in the first group ( tPF from 23.0+/-7.5 to 10.5+/-4.9 , p<0.001 ; tRF from 73.5+/-22.7 to 48.3+/-13.5 , p<0.001 ) than in the second one
The HBET group did not show improvement in MWD/T compared with the WA group ( SMD 0.30 , 95 % CI -0.45 to 1.05 ; P = 0.43 ; moderate- quality evidence ) .Compared with HBET , SET was more beneficial for PFWD/T but had no effect on quality of life parameters nor on self-reported functional impairment .
Compared with WA , SET was more beneficial for PFWD/T and self-reported functional impairment , as well as for some quality of life parameters ( e.g. , physical functioning , pain , and physical component summary after 12 months ) , and HBET had no effect .
Data show no obvious effects on mortality rates .
Evidence of moderate and high quality shows that SET provides an important benefit for treadmill-measured walking distance ( MWD and PFWD ) compared with HBET and WA , respectively .
Although its clinical relevance has not been definitively demonstrated , this benefit translates to increased MWD of 120 and 210 meters after three months in SET groups .
These increased walking distances are likely to have a positive impact on the lives of patients with IC .
Data provide no clear evidence of a difference between HBET and WA .
Trials show no clear differences in quality of life parameters nor in self-reported functional impairment between SET and HBET .
BACKGROUND Although supervised exercise therapy ( SET ) provides significant symptomatic benefit for patients with intermittent claudication ( IC ) , it remains an underutilized tool .
Widespread implementation of SET is restricted by lack of facilities and funding .
Structured home-based exercise therapy ( HBET ) with an observation component ( e.g. , exercise logbooks , pedometers ) and just walking advice ( WA ) are alternatives to SET .
This is the second up date of a review first published in 2006 .
OBJECTIVES The primary objective was to provide an accurate overview of studies evaluating effects of SET programs , HBET programs , and WA on maximal treadmill walking distance or time ( MWD/T ) for patients with IC .
Secondary objectives were to evaluate effects of SET , HBET , and WA on pain-free treadmill walking distance or time ( PFWD/T ) , quality of life , and self-reported functional impairment .