American Association of Cardiovascular and Pulmonary Rehabilitation Annual Meeting and Scientific Abstracts: Scientific Poster Presentations, Friday, September 19, Saturday, September 20
The purpose of this study was to compare the effects of a 24-week walking with poles rehabilitation program with a traditional 24-week walking program on physical function in patients with peripheral arterial disease (PAD).Patients with PAD (n = 103, age = 69.7 ± 8.9 years, ankle-brachial index < 0.90 or evidence of calcified vessels) were randomized into a rehabilitation program of traditional walking (n = 52) or walking with poles (n = 51). Patients exercised 3 times per week for 24 weeks. Exercise endurance was measured by time walked on a constant work rate treadmill test at 6, 12, and 24 weeks. Perceived physical function was measured by the Medical Outcomes Study Short Form-36 and Walking Impairment Questionnaire. Tissue oxygenation was measured using near-infrared spectroscopy.Patients assigned to the traditional walking group walked longer at 24 weeks than those assigned to the pole walking group (21.10 ± 17.07 minutes and 15.02 ± 12.32 minutes, respectively, P = .037). There were no differences between the groups in tissue oxygenation. However, there was a significant lengthening of time for which it took to reach minimum tissue oxygenation values (P < .001) within the groups on the constant work rate test. There were no differences between the groups in perceived physical function as measured by the Physical Function subscale on the Medical Outcomes Study Short Form-36 or perceived walking distance as measured by the Walking Distance subscale on the Walking Impairment Scale.Traditional walking was superior to walking with poles in increasing walking endurance on a constant work rate treadmill test for patients with PAD.
Patients with peripheral arterial disease (PAD) have decreased blood flow to the legs that may cause claudication pain and limit the amount of physical activity that an individual engages in. Walking exercise in persons with PAD should address chronic ischemic myopathy by reconditioning the muscle to more effectively use the available blood flow. PURPOSE: To determine whether tissue de-oxygenation in the gastrocnemius muscle will decline at a slower rate in patients with peripheral arterial disease who completed a 12 week walking program compared to a 12 week walking with poles program. METHODS: Subjects were randomized into a thrice weekly, six month walking (n=22) or walking with poles (n=25) training program. Data reported reflect preliminary 3 month data. Subjects with documented PAD completed a progressive treadmill test with metabolic measures (MedGraphics CPX-D) and tissue de-oxygenation (InSpectra™, Hutchinson Technology) measures at baseline and three months. The tissue spectrometer was placed at the point of widest circumference on the most severely affected calf (gastrocnemius muscle) during the duration of the exercise tests. The spectrometer continuously measured oxygenation levels throughout the test. Resting, time (sec) it took to record the lowest oxygenation value, and recovery time were computed before and after training. RESULTS: Forty-seven older (age = 70±8 yr) and overweight (BMI = 28.5±4.6) subjects with documented PAD (ABI = 0.64±0.20) participated in the study. No differences in ankle-brachial index and oxygen uptake were identified between the walking and the pole walking groups. After three month of training, the walking group walked longer on the treadmill test (4.0±5.8 min) before reaching the lowest tissue oxygenation value than the walking with poles group (0.85±3.2 min, p = 0.03). No differences in baseline or recovery tissue oxygenation were identified. CONCLUSION: Walking may be more beneficial than walking with poles in increasing tissue oxygenation to the gastrocnemius muscle in subjects with PAD.
Background: Smoking is a leading risk factor for peripheral arterial disease (PAD), yet little is known about the interrelationships among smoking status, walking endurance, calf muscle tissue oxygenation, and quality of life in patients with PAD. Objective: The aim of this study was to explore the differences in factors associated with walking endurance including walk distance, perceived walking ability, measures of skeletal muscle tissue oxygenation (StO2), claudication pain, peak oxygen consumption per unit time, and quality of life in smokers versus nonsmokers. Methods: A total of 105 patients with PAD performed progressive, symptom-limited treadmill test. Ankle-brachial index was measured at baseline. Calf muscle tissue oxygenation measures were obtained during testing. The RAND Short Form-36 and Walking Impairment Questionnaire were used to measure health-related quality of life (HR-QoL). Results: In the total sample (36 current smokers, 69 nonsmokers), smokers had steeper declines in StO2 from baseline to 2 minutes (42.3% vs 33%, P = .05) and shorter distance walked to onset of claudication pain (142.6 vs 247.7 m) than did nonsmokers (P < .0125), despite having no differences in ankle-brachial index, peak oxygen consumption per unit time, or any momentary measure of StO2 during walking. Smokers reported significantly lower HR-QoL on the Short Form-36 in several domains but no differences in the Walking Impairment Questionnaire measures. The smokers were younger than the nonsmokers; however, when age was entered as a covariate in the analyses, the results remained unchanged. Conclusions: These findings suggest that smokers have lower HR-QoL than do nonsmokers with PAD and that smoking confers risks for disrupted tissue oxygenation above those seen in patients who do not smoke.
This randomized trial proposed to determine if there were differences in calf muscle StO(2) parameters in patients before and after 12 weeks of a traditional walking or walking-with-poles exercise program. Data were collected on 85 patients who were randomized to a traditional walking program (n = 40) or walking-with-poles program (n = 45) of exercise training. Patients walked for 3 times weekly for 12 weeks. Seventy-one patients completed both the baseline and the 12-week follow-up progressive treadmill tests (n = 36 traditional walking and n = 35 walking-with-poles). Using the near-infrared spectroscopy measures, StO(2) was measured prior to, during, and after exercise. At baseline, calf muscle oxygenation decreased from 56 ± 17% prior to the treadmill test to 16 ± 18% at peak exercise. The time elapsed prior to reaching nadir StO(2) values increased more in the traditional walking group when compared to the walking-with-poles group. Likewise, absolute walking time increased more in the traditional walking group than in the walking-with-poles group. Tissue oxygenation decline during treadmill testing was less for patients assigned to a 12-week traditional walking program when compared to those assigned to a 12-week walking-with-poles program. In conclusion, the 12-week traditional walking program was superior to walking-with-poles in improving tissue deoxygenation in patients with PAD.
