Factors predicting walking intolerance in patients with peripheral arterial disease(PAD) and intermittent claudication

Objective. To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). Design. The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. Setting. Patients were recruited from the Department of Vascular Surgery, Groote Schuur Hospital, Cape Town. Subjects. Thirty-one patients diagnosed with PAD were included in the study. Outcome measures. During a GTT, peak oxygen consumption (VO2peak), peak minute ventilation (VEpeak), peak heart rate and peak venous lactate concentrations were measured and compared with those from a comparison group. Anklebrachial index (ABI) was measured at rest and after exercise. During the GTT, maximum walking distance (MWD) and pain-free walking distance (PFWD) were measured to determine walking tolerance. Results. Peak venous lactate concentrations did not correlate significantly with either PFWD (r=–0.08; p=0.3) or MWD (r=–0.03; p=0.4). Resting ABI did not correlate with either MWD (r=0.09; p=0.64) or PFWD (r=–0.19; p=0.29). Subjects terminated exercise at significantly (

Factors predicting walking intolerance in patients with peripheral arterial disease and intermittent claudication

Objective. To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). Design. The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. Setting. Patients were recruited from the Department of Vascular Surgery, Groote Schuur Hospital, Cape Town. Subjects. Thirty-one patients diagnosed with PAD were included in the study. Outcome measures. During a GTT, peak oxygen consumption (VO2peak), peak minute ventilation (VEpeak), peak heart rate and peak venous lactate concentrations were measured and compared with those from a comparison group. Anklebrachial index (ABI) was measured at rest and after exercise. During the GTT, maximum walking distance (MWD) and pain-free walking distance (PFWD) were measured to determine walking tolerance. Results. Peak venous lactate concentrations did not correlate significantly with either PFWD (r=–0.08; p=0.3) or MWD (r=–0.03; p=0.4). Resting ABI did not correlate with either MWD (r=0.09; p=0.64) or PFWD (r=–0.19; p=0.29). Subjects terminated exercise at significantly (p<0.05) lower levels of cardiorespiratory effort and venous lactate concentrations than did a sedentary but otherwise healthy comparison group: peak heart rate 156±11 v. 114±22 beats per minute (BPM); p=0.001; and peak venous lactate concentration 9.7±2.7 mmol/l v. 3.28±1.39 mmol/l; p=0.001. Conclusion. Perceived discomfort in these patients is not caused by elevated blood lactate concentrations, a low ABI or limiting cardiorespiratory effort but by other factors not measured in this study

Experiences of psychosocial and programme-related barriers to recovery in lifestyle interventions for noncommunicable diseases

Background: The majority of global deaths are due to noncommunicable diseases, largely preventable and treatable utilising behavioural interventions.Objectives: The study investigated patients’ experiences of a lifestyle intervention programme for noncommunicable diseases (NCDs), and the influence that psychosocial and programme-related barriers had on patients’ ability to improve their well-being.Methods: Fourteen patients with NCDs were interviewed before and on completion of a 12-week lifestyle intervention programme at a sports and exercise medicine clinic. Thematic analysis techniques were used to analyse interview data.Results: Patients described their experiences of NCDs diagnosis as traumatic, and their own relationship with their bodies and with the disorder(s) to be vulnerable and significantly challenging. Professional incompetence and unethical treatment were included as barriers to recovery. Barriers specifically relating to the programme included scheduling, as well as the online assessment component. Those reporting more premorbid psychosocial barriers were more likely to experience current complications, whether disease- or treatment-related, often emphasising the negative influence of programme and professional-related problems.Conclusion: Qualitative methodologies enabled the study to yield clinically relevant insights with respect to patients with NCDs. Accounting for the trauma and vulnerability experienced by this cohort may assist in the development of more patient-centred interventions and sustainable secondary prevention of NCDs.Keywords: chronic diseases of lifestyle; intervention evaluation; psychological risk factors; social support; professional conduc

Persistent pain following ankle sprain: Bilateral accessory soleus muscles

Persistent pain following ankle sprain remains a difficult diagnostic and management dilemma. We report a 22 year old rugby player who presented with a persistent painful left ankle following a minor ankle sprain. After examination and imaging investigations, a symptomatic accessory soleus muscle was diagnosed on the left ankle, and an asymptomatic accessory soleus muscle on the right

Sacroiliac tuberculosis masquerading as mechanical lower back pain in a collegiate basketball athlete: a case presentation

Background: Sacroiliac tuberculosis is a rare condition for which early diagnosis and effective management frequently proves challenging. This report describes a case that was initially overlooked due to its presentation and unreported constitutional symptoms.Aim: To alert clinicians about skeletal tuberculosis, an often neglected diagnostic differential, which requires a high index of clinical suspicion, especially for patients from endemic areas.Findings: This patient’s presentation (sports injury) and unreported constitutional symptoms resulted in a delay in the diagnosis and initial institution of treatment.Implications: This report illustrates the importance of specifically asking about constitutional symptoms, even in sports injury settings and being mindful of infectious diseases or other chronic medical conditions, which may masquerade as common sports injuries.Keywords: skeletal tuberculosis, sacroiliitis, hip pai

Healthy lifestyle interventions in general practice: Part 15: Lifestyle and lower back pain

Lower back pain (LBP) is one of the most common medical problems in the adult population. LBP can be defined as pain, muscle tension or stiffness that is localised below the costal margin (inferior rib cage) and above the inferior gluteal folds and that can present either with or without leg pain (sciatica), and it can be classified as “specific” or “non-specific”. LBP has a high lifetime prevalence and is associated with a substantial direct and indirect cost to the individual and society. In this review, the focus is on the identification of lifestyle risk factors and interventions that are associated with mainly non-specific chronic LBP. In addition to pharmacotherapy, the best treatment approach is exercise therapy (including physical reconditioning), psychosocial and behavioural intervention and therapeutic education. Other lifestyle changes include nutritional intervention and smoking cessation

Electroweak Radiative Corrections To Polarized M{\o}ller Scattering Asymmetries

One loop electroweak radiative corrections to left-right parity violating M{\o}ller scattering ($e^-e^-\to e^-e^-$) asymmetries are presented. They reduce the standard model (tree level) prediction by 40$\pm 3$ \% where the main shift and uncertainty stem from hadronic vacuum polarization loops. A similar reduction also occurs for the electron-electron atomic parity violating interaction. That effect can be attributed to an increase of $\sin^2\theta_W(q^2)$ by $3\%$ in running from $q^2=m_Z^2$ to 0. The sensitivity of the asymmetry to ``new physics'' is also discussed.Comment: 14 pages, Revtex, postscript file including figures is available at ftp://ttpux2.physik.uni-karlsruhe.de/ttp95-14/ttp95-14.ps or via WWW at http://ttpux2.physik.uni-karlsruhe.de/cgi-bin/preprints/ (129.13.102.139

Healthy lifestyle interventions in general practice: Part16: Lifestyle and fibromyalgia

Fibromyalgia is a chronic disorder, characterised by chronic widespread musculoskeletal pain, and the presence of multiple tender points as well as a host of associated symptomatology. Optimal management of patients with fibromyalgia requires a multidisciplinary approach, with a combination of pharmacological and non-pharmacological interventions that are tailored to the patient's pain, dysfunction and associated features, including depression, sleep disorder and fatigue. Non-pharmacological lifestyle-based interventions to treat this disorder include exercise therapy, dietary modification, and psychosocial interventions. This review outlines these three forms of lifestyle intervention in patients with fibromyalgia

Healthy lifestyle interventions in general practice. Part 2: Lifestyle and cardiovascular disease

This article forms the second part of the series on the role of lifestyle modification in general practice with specific reference to chronic cardiovascular disease. Whilst the major risk factors which constitute an unhealthy lifestyle were discussed in part 1 of this series, the focus of part 2 will give specific practical guidelines which the general practitioner may incorporate into their practice when counselling patients with chronic cardiovascular disease