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Exercise Rehabilitation for Intermittent Claudication

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Peripheral Arterial Disease

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Intermittent claudication (IC), secondary to peripheral arterial disease (PAD), is an important cause of a reduced functional exercise capacity. In this population, peak exercise capacity is typically 50% of that measured in age-matched control subjects (1–4). This severe reduction in functional capacity is significant and equivalent to those patients with the categorization of New York Heart Association class III heart failure. Owing to their limited ability to ambulate, this exercise disability affects all aspects of patients’ lives including work and leisure time activities. Consequently, the reduction in walking capacity is associated with an impairment in measures of quality of life (5,6). Therefore, the primary goal of exercise therapy is focused toward improving quality of life through relieving the symptoms of claudication and improving functional capacity. In addition, the modification of cardiovascular risk factors is an important secondary and long-term goal of PAD exercise rehabilitation.

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References

  1. Bauer TA, Regensteiner JG, Brass EP, Hiatt WR. Oxygen uptake kinetics during exercise are slowed in patients with peripheral arterial disease. J Appl Physiol 1999; 87: 809–816.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  4. Eldridge J.E, Hossack K.F. Patterns of oxygen consumption during exercise testing in peripheral vascular disease. Cardiology 1987; 74: 236–240.

    Article  PubMed  CAS  Google Scholar 

  5. McDermott M.M, Liu K, Guralnik J.M, Martin G.J, Criqui M.H, Greenland P. Measurement of walking endurance and walking velocity with questionnaire: validation of the walking impairment questionnaire in men and women with peripheral arterial disease. J Vasc Surg 1998; 28: 1072–1081.

    Article  Google Scholar 

  6. McDermott M.M, Fried L, Simonsick E. Ling S,Guralnik J.M. Aymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: The Women’s Health and Aging Study. Circulation 2001; 101: 1007–1012.

    Google Scholar 

  7. Foley WT. Treatment of gangrene of the feet and legs by walking. Circulation 1957; 15: 689–700.

    Article  PubMed  CAS  Google Scholar 

  8. Gardner A.W, Poehlman E.T. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA 1995; 274: 975–980.

    Article  PubMed  CAS  Google Scholar 

  9. Leng G.C, Fowler B, Ernst E. Exercise for intermittent claudication (Cochrane Review). In: The Cochrane Library. Oxford: Update Software, 1999.

    Google Scholar 

  10. Brandsma.JW, Robeer B.G, van den H.S, Smit B, Wittens C.H, Oostendorp R.A. The effect of exercises on walking distance of patients with intermittent claudication: a study of randomized clinical trials [published erratum appears in Phys Ther 1998 May;78:547]. Phys Ther 1998; 78: 278–286.

    PubMed  CAS  Google Scholar 

  11. Girolami B, Bernardi E, Prins M.H, et al. Treatment of intermittent claudication with physical training, smoking cessation, pentoxifylline, or nafronyl: a meta-analysis. Arch Intern Med 1999; 159: 337–345.

    Article  PubMed  CAS  Google Scholar 

  12. Nehler M.R, Hiatt W.R. Exercise therapy for claudication. Ann Vasc Surg 1999; 13: 109–114.

    Article  PubMed  CAS  Google Scholar 

  13. DahllofA, Holm J, Schersten T, Sivertsson R. Peripheral arterial insufficiency: effect of physical training on walking tolerance, calf blood flow, and blood flow resistance. Scand J Rehab Med 1976; 8: 19–26.

    Google Scholar 

  14. Tan K.H, Cotterrell D, Sykes K, Sissons G.R, de Cossart L, Edwards PR. Exercise training for claudicants: changes in blood flow, cardiorespiratory status, metabolic functions, blood rheology and lipid profile. Eur J Vasc Endovasc Surg 2000; 20: 72–78.

    Article  PubMed  CAS  Google Scholar 

  15. Regensteiner JG, Steiner JF, Panzer RJ, Hiatt WR. Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease. J Vasc Med Biol 1990; 2: 142–152.

    Google Scholar 

  16. Tarlov A.R, Ware J.E, Jr., Greenfield S, Nelson E.C, Perrin E, Zubkoff M. The Medical Outcomes Study: an application of methods for monitoring the results of medical care. JAMA 1989; 262: 925–930.

    Article  PubMed  CAS  Google Scholar 

  17. Sallis J.F, Haskell W.L, Wood P.D, et al. Physical activity assessment methodology in the five-city project. Am J Epidemiol 1985; 121: 91–106.

    PubMed  CAS  Google Scholar 

  18. Regensteiner J.G, Steiner J.F, Hiatt W.R. Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg 1996; 23: 104–115.

    Article  PubMed  CAS  Google Scholar 

  19. Izquierdo-Porrera A.M, Gardner A.W, Powell C.C, Katzel LI. Effects of exercise rehabilitation on cardiovascular risk factors in older patients with peripheral arterial occlusive disease. J Vasc Surg 2000; 31: 670–677.

    Article  PubMed  CAS  Google Scholar 

  20. Lavie C.J, Milani R.V. Effects of cardiac rehabilitation and exercise training in obese patients with coronary artery disease. Chest 1996; 109: 52–56.

    Article  PubMed  CAS  Google Scholar 

  21. Lavie C.J, Milani RV. Effects of cardiac rehabilitation and exercise training programs in patients > or = 75 years of age. Am J Cardiol 1996; 78: 675–677.

    Article  PubMed  CAS  Google Scholar 

  22. Brubaker P.H, Warner J.G, Jr, Rejeski W.J, et al. Comparison of standard-and extended-length participation in cardiac rehabilitation on body composition, functional capacity, and blood lipids. Am J Cardiol 1996; 78: 769–773.

    Article  PubMed  CAS  Google Scholar 

  23. Warner J.G, Jr, Brubaker P.H, Zhu Y, et al. Long-term (5-year) changes in HDL cholesterol in cardiac rehabilitation patients: do sex differences exist? Circulation 1995; 92: 773–777.

    Article  PubMed  Google Scholar 

  24. Gardner A.W, Skinner J.S, Vaughan N.R, Bryant C.X, Smith L.K. Comparison of three progressive exercise protocols in peripheral vascular occlusive disease. Angiology 1992; 43: 661–671.

    Article  PubMed  CAS  Google Scholar 

  25. Valentine R, Grayburn P.A, Eichhorn E.J, Myers S, Clagett G.E Coronary artery disease is highly prevalent among patients with premature peripheral vascular disease. J Vasc Surg 1994; 19: 688–674.

    Article  Google Scholar 

  26. American College of Sports Medicine. Guidelines for Exercise Testing and Prescription, 6 edit. Philadelphia: Lippincott Williams & Wilkins, 2000.

    Google Scholar 

  27. Katzel L.I, Sorkin J, Bradham D, Gardner AW. Comorbidities and the entry of patients with peripheral arterial disease into an exercise rehabilitation program. J Cardiopulm Rehabil 2001; 20: 165–171.

    Article  Google Scholar 

  28. Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med 2001; 345: 892–902.

    Article  PubMed  CAS  Google Scholar 

  29. Regensteiner J.G, Meyer T.J, Krupski W.C, Cranford L.S, Hiatt W.R. Hospital vs home-based exercise rehabilitation for patients with peripheral arterial occlusive disease. Angiology 1997; 48: 291–300.

    Article  PubMed  CAS  Google Scholar 

  30. Jonason T, Ringqvist I, Oman-Rydberg A. Home-training of patients with intermittent claudication. Scand J Rehab Med 1981; 13: 137–141.

    CAS  Google Scholar 

  31. Larsen O.A, Lassen NA. Effect of daily muscular exercise in patients with intermittent claudication. Lancet 1966; 2: 1093–1096.

    Article  PubMed  CAS  Google Scholar 

  32. Kasiske B.L. Risk factors for accelerated atherosclerosis in renal transplant recipients. Am J Med 1988; 84: 985–992.

    Article  PubMed  CAS  Google Scholar 

  33. Clifford P.C, Davies P.W, Hayne J.A, Baird R.N. Intermittent claudication: is a supervised exercise class worth while? Br Med J 1980; 280: 1503–1505.

    Article  PubMed  CAS  Google Scholar 

  34. Patterson R.B, Pinto B, Marcus B, Colucci A, Braun T, Roberts M. Value of a supervised exercise program for the therapy of arterial claudication. J Vasc Surg 1997; 25: 312–318.

    Article  PubMed  CAS  Google Scholar 

  35. Alpert J.S, Larsen O.A, Lassen N.A. Exercise and intermittent claudication.: blood flow in the calf muscle during walking studied by the xenon-133 clearance method. Circulation 1969; 39: 353–359.

    Article  PubMed  CAS  Google Scholar 

  36. American Medical Association. Current Procedural Terminology (CPT). Chicago. 2001. Ref Type: Catalog

    Google Scholar 

  37. Remijnse-Tamerius H.C.M, de Buyzere M, Oeseburg B, Clement DL. Why is training effective in the treatment of patients with intermittent claudication? Internat Angio 2001; 18: 103–112.

    Google Scholar 

  38. Tan K.H, Cossart L, Edwards P.R. Exercise training and peripheral vascular disease. Br J Surg 2000; 87: 553–562.

    Article  PubMed  CAS  Google Scholar 

  39. Hiatt W.R, Regensteiner J.G. Exercise rehabilitation in the treatment of patients with peripheral arterial disease. J Vasc Med Biol 1990; 2: 163–170.

    Google Scholar 

  40. Ericsson B, Haeger K, Lindell SE. Effect of physical training on intermittent claudication. Angiology 1970; 21: 188–192.

    Article  PubMed  CAS  Google Scholar 

  41. FitzGerald D.E, Keates J.S, MacMillan D. Angiographie and plethysmographic assessment of graduated physical exercise in the treatment of chronic occlusive arterial disease of the leg. Angiology 1971; 22: 99–106.

    Article  PubMed  CAS  Google Scholar 

  42. Lundgren F, Dahllof A, Lundholm K, Schersten T, Volkmann R Intermittent claudication–surgical reconstruction or physical training? A prospective randomized trial of treatment efficiency. Ann Surg 1989; 209: 346–355.

    Article  PubMed  CAS  Google Scholar 

  43. Sorlie D, Myhre K. Effects of physical training in intermittent claudication. Scand J Clin Lab Invest 1978; 38: 217–222.

    Article  PubMed  CAS  Google Scholar 

  44. Zetterquist S. The effect of active training on the nutritive blood flow in exercising ischemic legs. Scand J Clin Lab Invest 1970; 25: 101–111.

    Article  PubMed  CAS  Google Scholar 

  45. Hiatt W.R, Regensteiner J.G, Wolfel E.E, Carry M.R, Brass E.P. Effect of exercise training on skeletal muscle histology and metabolism in peripheral arterial disease. J Appl Physiol 1996; 81: 780–788.

    PubMed  CAS  Google Scholar 

  46. Lundgren F, Dahllof A.G, Schersten T, Bylund-Fellenius A.C. Muscle enzyme adaptation in patients with peripheral arterial insufficiency: spontaneous adaptation. Clin Sci 1989; 77: 485–493.

    PubMed  CAS  Google Scholar 

  47. Holm J, Dahllof A, Bjorntorp P, Schersten T. Enzyme studies in muscles of patients with intermittent claudication: effect of training. Scand J Clin Lab Invest 1973;(Suppl 128)31:201–205.

    Google Scholar 

  48. Hiatt W.R, Regensteiner J.G, Wolfel E.E, Ruff L, Brass E.P. Carnitine and acylcarnitine metabolism during exercise in humans• dependence on skeletal muscle metabolic state. J Clin Invest 1989; 84: 1167–1173.

    Article  PubMed  CAS  Google Scholar 

  49. Hiatt W.R, Wolfel E.E, Regensteiner J.G, Brass E.R Skeletal muscle carnitine metabolism in patients with unilateral peripheral arterial disease. J Appl Physiol 1992; 73: 346–353.

    PubMed  CAS  Google Scholar 

  50. Tisi P.V, Shearman C. E The evidence for exercise-induced inflammation in intermittent claudication: should we encourage patients to stop walking? Eur J Vasc Endovasc Surg 1998; 15: 7–17.

    CAS  Google Scholar 

  51. Ernst E.E, Matrai A. Intermittent claudication, exercise, and blood rheology. Circulation 1987; 76: 1110–1114.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Timothy A. Bauer MS
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  2. William R. Hiatt MD
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Editor information

Editors and Affiliations

  1. Department of Medicine, Boston University Medical Center, Boston, MA, USA

    Jay D. Coffman MD  & Robert T. Eberhardt MD  & 

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Bauer, T.A., Hiatt, W.R. (2003). Exercise Rehabilitation for Intermittent Claudication. In: Coffman, J.D., Eberhardt, R.T. (eds) Peripheral Arterial Disease. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-331-6_8

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  • DOI: https://doi.org/10.1007/978-1-59259-331-6_8

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-326-8

  • Online ISBN: 978-1-59259-331-6

  • eBook Packages: Springer Book Archive

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