Efficacy of arm-ergometry versus treadmill exercise training to improve walking distance in patients with claudication

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 randomized 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.

Keywords

claudication exercise therapy intermittent claudication peripheral arterial disease

References

1 Ostchega Y Paulose-Ram R Dillon CF Gu Q Hughes JP . Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999–2004. J Am Geriatr Soc 2007; 55: 583–589.

2 Allison MA Ho E Denenberg JO . Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med 2007; 32: 328–333.

3 Criqui MH Fronek A Barrett-Connor E Klauber MR Gabriel S Goodman D . The prevalence of peripheral arterial disease in a defined population. Circulation 1985; 71: 510–515.

4 Criqui MH Langer RD Fronek A . Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326: 381–386.

5 Khaira HS Hanger R Shearman CP . Quality of life in patients with intermittent claudication. Eur J Vasc Endovasc Surg 1996; 11: 65–69.

6 Pell JP . Impact of intermittent claudication on quality of life. The Scottish Vascular Audit Group. Eur J Vasc Endovasc Surg 1995; 9: 469–472.

7 Hiatt WR . Exercise physiology in cardiovascular diseases. Curr Opin Cardiol 1991; 6: 745–749.

8 Hiatt WR Regensteiner JG Hargarten ME Wolfel EE Brass EP . Benefit of exercise conditioning for patients with peripheral arterial disease. Circulation 1990; 81: 602–609.

9 Regensteiner JG Steiner JF Hiatt WR . Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg 1996; 23: 104–115.

10.

10 Regensteiner JG . Exercise in the treatment of claudication: assessment and treatment of functional impairment. Vasc Med 1997; 2: 238–242.

11.

11 Stewart KJ Hiatt WR Regensteiner JG Hirsch AT . Exercise training for claudication. N Engl J Med 2002; 347: 1941–1951.

12.

12 Hiatt WR Wolfel EE Meier RH Regensteiner JG . Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response. Circulation 1994; 90: 1866–1874.

13.

13 Gardner AW Katzel LI Sorkin JD Goldberg AP . Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease: a randomized controlled trial. J Cardiopulm Rehabil 2002; 22: 192–198.

14.

14 Leng GC Fowler B Ernst E . Exercise for intermittent claudication. Cochrane Database Syst Rev 2000; 2: CD000990.

15.

15 Hiatt WR Nawaz D Brass EP . Carnitine metabolism during exercise in patients with peripheral vascular disease. J Appl Physiol 1987; 62: 2383–2387.

16.

16 Walker RD Nawaz S Wilkinson CH Saxton JM Pockley AG Wood RF . Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication. J Vasc Surg 2000; 31: 662–669.

17.

17 Zwierska I Walker RD Choksy SA Male JS Pockley AG Saxton JM . Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial. J Vasc Surg 2005; 42: 1122–1130.

18.

18 American College of Sports Medicine . Guidelines for exercise testing and prescription. Philadelphia: Lea and Febiger, 1986.

19.

19 Criqui MH Denenberg JO Bird CE Fronek A Klauber MR Langer RD . The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing. Vasc Med 1996; 1: 65–71.

20.

20 Gardner AW Poehlman ET . Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. JAMA 1995; 274: 975–980.

21.

21 Bulmer AC Coombes JS . Optimising exercise training in peripheral arterial disease. Sports Med 2004; 34: 983–1003.

22.

22 Loftin M Boileau RA Massey BH Lohman TG . Effect of arm training on central and peripheral circulatory function. Med Sci Sports Exerc 1988; 20: 136–141.

23.

23 Lewis S Thompson P Areskog NH . Transfer effects of endurance training to exercise with untrained limbs. Eur J Appl Physiol 1980; 44: 25–34.

24.

24 Rosler K Hoppeler H Conley KE Claassen H Gehr P Howald H . Transfer effects in endurance exercise. Adaptations in trained and untrained muscles. Eur J Appl Physiol 1985; 54: 355–362.

25.

25 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.

26.

26 Tsai JC Chan P Wang CH . The effects of exercise training on walking function and perception of health status in elderly patients with peripheral arterial occlusive disease. J Intern Med 2002; 252: 448–455.

27.

27 Holm J Dahllöf AG Björntorp P Scherstén T . Enzyme studies in muscles of patients with intermittent claudication. Effect of training. Scand J Clin Lab Invest Suppl 1973; 128: 201–205.