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To the Editor: Dr McDermott and colleagues¹ reported the results of a randomized trial of treadmill exercise or resistance training in patients with peripheral arterial disease (PAD), a prevalent condition. I am interested in knowing what medications the participants were using. Drugs such as aspirin, cilostazol, pentoxifylline, and clopidogrel that are used for PAD could have altered the outcome of the study. There may be improved walking distances with both cilostazol and pentoxifylline in comparison with placebos.^2-4

Also, the baseline performance characteristics of the treadmill exercise group were better than both the control group and the lower extremity resistance training group despite randomization. Although these differences did not reach statistical significance, in aggregate they could have affected the study outcomes.

Financial Disclosures: None reported.

Saakshi Khattri, MD
drsaakshi@gmail.com
Department of Internal Medicine
Staten Island University Hospital
Staten Island, New York

1. McDermott MM, Ades P, Guralnik JM; et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication. JAMA. 2009;301(2):165-174. FREE FULL TEXT 2. Regensteiner JG, Ware JE Jr, McCarthy WJ; et al. Effect of cilostazol on treadmill walking, community-based walking ability, and health-related quality of life in patients with intermittent claudication due to peripheral arterial disease: meta-analysis of six randomized controlled trials. J Am Geriatr Soc. 2002;50(12):1939-1946. FULL TEXT | WEB OF SCIENCE | PUBMED 3. Money SR, Herd JA, Isaacsohn JL; et al. Effect of cilostazol on walking distances in patients with intermittent claudication caused by peripheral vascular disease. J Vasc Surg. 1998;27(2):267-274. FULL TEXT | WEB OF SCIENCE | PUBMED 4. Creager MA. Medical management of peripheral arterial disease. Cardiol Rev. 2001;9(4):238-245. FULL TEXT | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(19):1986.

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RELATED ARTICLE

Treadmill Exercise and Resistance Training in Patients With Peripheral Arterial Disease With and Without Intermittent Claudication: A Randomized Controlled Trial
Mary M. McDermott, Philip Ades, Jack M. Guralnik, Alan Dyer, Luigi Ferrucci, Kiang Liu, Miriam Nelson, Donald Lloyd-Jones, Linda Van Horn, Daniel Garside, Melina Kibbe, Kathryn Domanchuk, James H. Stein, Yihua Liao, Huimin Tao, David Green, William H. Pearce, Joseph R. Schneider, David McPherson, Susan T. Laing, Walter J. McCarthy, Adhir Shroff, and Michael H. Criqui
JAMA. 2009;301(2):165-174.
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Treadmill Exercise or Resistance Training in Patients With Peripheral Arterial Disease—Reply
Mary M. McDermott and Alan Dyer
JAMA. 2009;301(19):1986-1987.
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