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Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent ClaudicationA Randomized Controlled Trial
Mary M. McDermott, MD;
Philip Ades, MD;
Jack M. Guralnik, MD, PhD;
Alan Dyer, PhD;
Luigi Ferrucci, MD, PhD;
Kiang Liu, PhD;
Miriam Nelson, PhD;
Donald Lloyd-Jones, MD, MPH;
Linda Van Horn, PhD;
Daniel Garside, BS;
Melina Kibbe, MD;
Kathryn Domanchuk, BS;
James H. Stein, MD;
Yihua Liao, MS;
Huimin Tao, MS;
David Green, MD, PhD;
William H. Pearce, MD;
Joseph R. Schneider, MD, PhD;
David McPherson, MD;
Susan T. Laing, MD, MS;
Walter J. McCarthy, MD, MS;
Adhir Shroff, MD;
Michael H. Criqui, MD, MPH
JAMA. 2009;301(2):165-174.
Context Neither supervised treadmill exercise nor strength training for patients with peripheral arterial disease (PAD) without intermittent claudication have been established as beneficial.
Objective To determine whether supervised treadmill exercise or lower extremity resistance training improve functional performance of patients with PAD with or without claudication.
Design, Setting, and Participants Randomized controlled clinical trial performed at an urban academic medical center between April 1, 2004, and August 8, 2008, involving 156 patients with PAD who were randomly assigned to supervised treadmill exercise, to lower extremity resistance training, or to a control group.
Main Outcome Measures Six-minute walk performance and the short physical performance battery. Secondary outcomes were brachial artery flow-mediated dilation, treadmill walking performance, the Walking Impairment Questionnaire, and the 36-Item Short Form Health Survey physical functioning (SF-36 PF) score.
Results For the 6-minute walk, those in the supervised treadmill exercise group increased their distance walked by 35.9 m (95% confidence interval [CI], 15.3-56.5 m; P < .001) compared with the control group, whereas those in the resistance training group increased their distance walked by 12.4 m (95% CI, –8.42 to 33.3 m; P = .24) compared with the control group. Neither exercise group improved its short physical performance battery scores. For brachial artery flow-mediated dilation, those in the treadmill group had a mean improvement of 1.53% (95% CI, 0.35%-2.70%; P = .02) compared with the control group. The treadmill group had greater increases in maximal treadmill walking time (3.44 minutes; 95% CI, 2.05-4.84 minutes; P < .001); walking impairment distance score (10.7; 95% CI, 1.56-19.9; P = .02); and SF-36 PF score (7.5; 95% CI, 0.00-15.0; P = .02) than the control group. The resistance training group had greater increases in maximal treadmill walking time (1.90 minutes; 95% CI, 0.49-3.31 minutes; P = .009); walking impairment scores for distance (6.92; 95% CI, 1.07-12.8; P = .02) and stair climbing (10.4; 95% CI, 0.00-20.8; P = .03); and SF-36 PF score (7.5; 95% CI, 0.0-15.0; P = .04) than the control group.
Conclusions Supervised treadmill training improved 6-minute walk performance, treadmill walking performance, brachial artery flow-mediated dilation, and quality of life but did not improve the short physical performance battery scores of PAD participants with and without intermittent claudication. Lower extremity resistance training improved functional performance measured by treadmill walking, quality of life, and stair climbing ability.
Trial Registration clinicaltrials.gov Identifier: NCT00106327
Author Affiliations: Departments of Medicine (Drs McDermott, Lloyd-Jones, and Green and Ms Domanchuk), Preventive Medicine (Drs Dyer, Liu, Lloyd Jones, and Van Horn, Mr Garside, and Mss Liao and Tao), surgery (Drs Kibbe and Pearce), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine, University of Vermont, Burlington (Dr Ades); Laboratory of Epidemiology, Demography, and Biometry, Bethesda (Dr Guralnik) and Clinical Epidemiology, Baltimore (Dr Ferrucci), National Institute on Aging, Maryland; Tufts University, Medford, Massachusetts (Dr Nelson); Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Stein); Department of Surgery, Central DuPage Hospital, Winfield, Illinois (Dr Schneider); Department of Medicine, University of Texas Health Sciences Center at Houston, Houston (Drs McPherson and Laing); Department of Surgery, Rush School of Medicine, Chicago, Illinois (Dr McCarthy); Department of Medicine, University of Illinois, Chicago (Dr Shroff); and Department of Family and Preventive Medicine, University of California at San Diego, San Diego (Dr Criqui).
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