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Overcoming claudication: effects of a home-based walking program at maximal asymptomatic speed.



Background: Peripheral vascular disease (PVD) is responsible for ambulatory disfunction, sedentary lifestyle and lower health-related quality of life (HRQL). A benefit of exercise training in patients with claudication has been demonstrated 1. This study evaluates the effectiveness of an original 120 days home-based program guided by the Pain Threshold Speed (PTS) 2 on outcome measures and HRQL.\ud Methods: We studied 29 patients (19 men), aged 66±12, with PVD and stable claudication. Systolic (SP) and diastolic (DP) brachial pressure, and ankle pressure (AP) were measured and ankle-brachial index (ABI) calculated. Pain Threshold Speed (PTS) was determined on treadmill and maximal asymptomatic speed (MAS) obtained. HRQL was assessed with MOS SF-36. A home-based walking program at MAS was prescribed. After 120 days, before the final evaluation, training schedules were evaluated and patients divided into three groups according to the compliance: Trained (T, n=14): exercise at MAS, Free-Walkers (FW, n=7): walking speed markedly below MAS, Untrained (U, n=8): incomplete program compliance.\ud Results: All patients showed significant DP decrease (77.1±9.172.4± 8.0, p=0.008), concomitant slight SP reduction and AP increase with favourable ABI variation (0.65±0.130.71±0.18, p=0.01). PTS rose from 3.2±1.1 to 4.2±1.5 km/h (p=0.0001). All SF-36 domains improved, significantly for Physical Activity (PA,p=0.0031) Bodily Pain (BP,p=0.0001), General Health (GH,p=0.0002), Vitality (VT,p=0.0008), Mental Health (MH,p=0.0017).\ud T group showed ABI change (0.72±0.090.82± 0.16,p<0.02) correlated to AP increase (r=0.879). PTS rose (3.6±1.15.4±0.8 km/h, p<0.02) with symptoms reduction up to pain disappearance. Significant variations were found in SF-36 domains for PA and BP (p<0.0001), VT, GH, MH (p<0.005). FW showed improvement of functional parameters, and increase for PA and VT domains (p<0.005) while in U group a better walking efficiency was found without significant HRQL variations.\ud Conclusion: A low-cost home-based program driven by PTS is effective to reduce the disability from PVD. Adherence to the prescribed program allowed dramatic improvements of functional and HRQL parameters, presumably in relation to the increased peripheral blood flow

Publisher: IFAPA - International Federation for Adapted Physical Activity
Year: 2005
OAI identifier: oai:iris.unife.it:11392/1194389
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