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a Department of Medicine, Division of Gerontology, Claude D. Pepper Older Americans Independence Center, University of Maryland, Baltimore, and Geriatric Research, Education and Clinical Center, Baltimore Veterans Affairs Medical Center, Maryland
b Department of Surgery, Division of Vascular Surgery, University of Maryland, Baltimore
Andrew W. Gardner, Baltimore Veterans Affairs Medical Center, Geriatrics/GRECC (18), 10 North Greene Street, Baltimore, MD 21201-1524 E-mail: gardner{at}grecc.umaryland.edu.
Decison Editor: William B. Ershler, MD
Background. The purposes of this study were to identify predictors of increased claudication distances following exercise rehabilitation in peripheral arterial occlusive disease (PAOD) patients with intermittent claudication and determine whether improved claudication distances translated into increased free-living daily physical activity in the community setting.
Methods. Sixty-three patients were recruited (age, 68 ± 1 years, mean ± standard error). Patients were characterized on treadmill claudication distances, walking economy, peripheral circulation, cardiopulmonary function, self-perceived ambulatory function, body composition, baseline comorbidities, and free-living daily physical activity before and after a 6-month treadmill exercise program.
Results. Exercise rehabilitation increased distance to onset of claudication pain by 115% (178 ± 22 m to 383 ± 34 m; p < .001) and distance to maximal claudication pain by 65% (389 ± 29 m to 641 ± 34 m; p < .001). The increased distance to onset of pain was independently related to a 27% increase in calf blood flow (r = .42, p < .001) and to baseline age (r = -.26, p < .05), and the increased distance to maximal pain was predicted by a 10% increase in peak oxygen uptake (r = .41, p < .001) and by a 10% improvement in walking economy (r = -.34, p < .05). Free-living daily physical activity increased 31% (337 ± 29 kcal/day to 443 ± 37 kcal/day; p < .001) and was related to the increases in treadmill distances to onset (r = .24, p < .05) and to maximal pain (r = .45, p < .001).
Conclusions. Increased claudication distances following exercise rehabilitation are mediated through improvements in peripheral circulation, walking economy, and cardiopulmonary function, with younger patients having the greatest absolute ambulatory gains. Furthermore, improved symptomatology translated into enhanced community-based ambulation.
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