Exercise rehabilitation improves functional outcomes and peripheral circulation in patients with intermittent claudication: A randomized controlled trial

OBJECTIVE: To determine the effects of a 6-month exercise program on ambula tory function, free-living daily physical activity, peripheral circulation, and health-related quality of life (QOL) in disabled older patients with i ntermittent claudication. DESIGN: Prospective, randomized controlled trial. SETTING: University Medical Center and Veterans Affairs Medical Center, Bal timore, Maryland. PARTICIPANTS: Thirty-one of 61 patients with Fontaine stage II peripheral a rterial occlusive disease (PAOD) were randomized to exercise rehabilitation and 30 to usual-care control. Three patients from the exercise group and s ix 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 max imal claudication, ambulatory function, peripheral circulation, perceived Q OL, and daily physical activity. RESULTS: Compliance With the exercise program was 73% of the possible sessi ons. Exercise rehabilitation increased treadmill distance walked to onset o f 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 w alked to maximal pain correlated with changes in walking economy (r = -.50, P =.013) and changes in maxi mal calf blood flow (r = .38, P = .047). Exer cise rehabilitation increased accelerometer-derived daily physical activity by 38% (P < .001); this change correlated with the change in distance walk ed to maximal pain (r = .45, P = .020). These improvements were significant ly 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 circulat ion and walking economy. Improvement in treadmill claudication distances in these patients translated into increased accelerometer-derived physical ac tivity in the community, which enabled the patients to become more function ally independent.