SLR - October 2010 - Stephanie Ouhadi
Reference: McDermott, Mary M, Ades, Phillip, Guralnik, Jack M. (2009). Treadmill Exercise and Resistance Training in Patients with Peripheral Arterial Disease With and Without Intermittent Claudication: A Randomized Controlled Trial. JAMA, 301(2); 165-174.
Scientific Literature Reviews
Reviewed by: Stephanie Ouhadi, DPM/PGY-1
Residency Program: UH Richmond Heights/OCPM
Podiatric Relevance:
Many podiatric patients have a diagnosis of PAD, and many have symptoms of intermittent claudication. This study will be helpful in outlining an appropriate treatment plan for podiatric patients with PAD with and without intermitten claudication.
Methods:
This randomized controlled trial included 156 patients with peripheral arterial disease (PAD) who were randomly assigned to one of three groups: treadmill group, lower extremity strength training group or control group. Patients in the treadmill group walked on a treadmill three times per week for 24 weeks under the supervision of a pysiologist. The lower extremity strength training group performed lower extremity resistance training three times per week for 24 weeks with a certified trainer. The control group attended multiple one hour information sessions about health, proper diet, and discussion of medical supplements. The groups were tested with multiple tests to determine improvement with treadmill or resistance training of their PAD and related symptoms (when present).
Patients completed a six minute walk and a short physical performance battery including repeated chair rises, standing balance tests and a test for walking velocity. Brachial artery flow-medicated dilation was also tested. Patients were also given a quality of life questionare. Leg extension and flexion strength was also measured. Each subject's BMI was calculated.
Results:
The supervised treadmill exercise group increased their walking distance, had improved brachial artery flow-mediation dilation, and had increased treadmill walking time before becoming symptomatic as compared to the control group. The lower extremity resistance exercise group had increases in treadmill walking time, walking impairment scores and stair climbing as compared to the control group.
Conclusions:
Patients will PAD with and without symptoms should be placed into a supervised treadmill walking program to improve quality of life and lower extremity blood flow.