The influence of a long term exercise program on lower limb movement variability and walking performance in patients with peripheral arterial disease. Initial Results of a 12-week, Institution-based, Supervised Exercise Rehabilitation Program for the Management of Peripheral Arterial Disease Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease. One-year effect of a supervised exercise programme on functional capacity and quality of life in peripheral arterial disease Benefit of exercise conditioning for patients with peripheral arterial disease. Effects of a 12-Week mHealth Program on FunctionalCapacity and Physical Activity in Patients With PeripheralArtery Disease. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. Acute effects of walking and combined exercise on oxidative stress and vascular function in peripheral artery disease Improvement of the walking ability in intermittent claudication due to superficial femoral artery occlusion with supervised exercise and pneumatic foot and calf compression: a randomised controlled trial. Effects of a 6-month exercise program pilot study on walking economy, peak physiological characteristics, and walking performance in patients with peripheral arterial disease Randomized controlled trial of supervised exercise to evaluate changes in cardiac function in patients with peripheral atherosclerotic disease Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. Cardiovascular Training Effect Associated With Polestriding Exercise in Patients With Peripheral Arterial Disease The Group Oriented Arterial Leg Study (GOALS) to improve walking performance in patients with peripheral arterial disease. The effect of exercise intensity on the response to exercise rehabilitation in patients with intermittent claudication. Recruitment to clinical trials of exercise: challenges in the peripheral arterial disease population. Unsupervised Exercise and Mobility Loss in Peripheral Artery Disease: A Randomized Controlled Trial
The purpose of this study was to examine the effects of a 12month exercise program on lower limb movement variability in patients with peripheral arterial disease ( PAD ) . Participants ( n=21 ) with an appropriate history of PAD and intermittent claudication ( IC ) volunteered for this study and were r and omly allocated to either a control group ( CPAD-IC ) ( n=11 ) , which received normal medical therapy and a treatment group ( TPAD-IC ) ( n=10 ) , which received normal medical therapy treatment and a 12month supervised exercise program . All participants underwent 2D joint angular kinematic analysis during normal walking to assess lower limb movement variability and walking speed . Between-group differences were analyzed via mixed measures ANOVA . The 12month supervised exercise program made no significant impact on the lower limb movement variability or walking speed of the TPAD-IC group as determined by either intralimb joint coordination or single joint analysis techniques . Long term supervised exercise programs do not appear to influence the lower limb movement variability of PAD-IC patients This study assessed the effectiveness of a 12-week , institution-based , supervised exercise rehabilitation program with atherogenic risk factor modification in improving cardiovascular profile , ambulatory function , and quality of life of patients with peripheral arterial disease ( PAD ) by comparing pre- and postprogram measurements . Participants were prospect ively enrolled .  Cardiovascular profile variables , ambulatory function tests , and quality of life question naires were evaluated . Of 101 institution-based program participants , 69 completed the 12-session minimum and 47 completed a postprogram evaluation . Mean postprogram results were significantly different from preprogram results , corresponding to improvement , for the following variables : triglyceride levels ( p = .036 ) , both function tests ( p < .001 for both ) , four of five Walking Impairment Question naire measurements , and Intermittent Claudication Question naire score ( p = .001 ) . This supervised exercise program improved the cardiovascular profiles , ambulatory function , and quality of life of PAD patients completing the program and is a viable adjunct to drug therapy and surgical intervention OBJECTIVE The purpose of the study was to examine the effects of a 12-month exercise program on lower limb mobility ( temporal-spatial gait parameters and gait kinematics ) , walking performance , peak physiological responses , and physical activity levels in individuals with symptoms of intermittent claudication due to peripheral arterial disease ( PAD-IC ) . METHODS Participants ( n = 21 ) with an appropriate history of PAD-IC , ankle-brachial pressure index ( ABI ) < 0.9 in at least one leg and a positive Edinburgh claudication question naire response were prospect ively recruited . Participants were r and omly allocated to either a control PAD-IC group ( CPAD-IC )  ( n = 11 ) that received st and ard medical therapy and a treatment PAD-IC group ( TPAD-IC ) ( n = 10 ) , which also took part in a 12-month supervised exercise program . A further group of participants ( n = 11 ) free of PAD ( ABI > 0.9 ) and who were non-regular exercisers were recruited from the community to act as age and mass matched controls ( CON ) . Lower limb mobility was determined via two-dimensional video motion analysis . A grade d treadmill test was used to assess walking performance and peak physiological responses to exercise . Physical activity levels were measured via a 7-day pedometer recording . Differences between groups were analyzed via repeated measures analysis of variance ( ANOVA ) . RESULTS The 12-month supervised exercise program had no significant effect on lower limb mobility , peak physiological responses , or physical activity levels in TPAD-IC compared with CPAD-IC participants . However , the TPAD-IC participants demonstrated significantly greater walking performance ( 171 % improvement in pain free walking time and 120 % improvement in maximal walking time compared with baseline ) . CONCLUSION The results of this study confirm that a 12-month supervised exercise program will result in improved walking performance , but does not have an impact on lower limb mobility , peak physiological responses , or physical activity levels of PAD-IC patients Purpose : Peripheral arterial disease ( PAD ) is a chronic , progressive disease with a significant cardiovascular and cerebrovascular risk burden and a considerable impact on functional capacity and quality of life ( QoL ) . Exercise programmes result in significant improvements in walking distances but long-term effects are uncertain . The aim of this study was to assess the one-year effects of participation in a 12-week supervised exercise programme on functional capacity and QoL for PAD patients . Methods : Patients were r and omly allocated to a control ( n = 16 ) or an exercise ( n = 28 ) group . Data regarding functional capacity ( Walking Impairment Question naire WIQ ) , disease-specific QoL ( Intermittent Claudication Question naire ICQ ) and generic QoL ( SF-36 ) were collected at baseline , 12 weeks and 1 year . Results : At 12 weeks , there was a trend towards improved QoL in both groups , with a tendency for greater improvement in the exercise group ( p = 0.066 ) and a trend towards improved functional capacity ( WIQ Stair-climbing p = 0.093 ) in the exercise group . At 1 year , ICQ scores in the exercise group were considerably better than those in the control group ( p = 0.058 ) , reflecting improved QoL and maintenance of benefits . Conclusions : Participation in a supervised exercise programme results in improvements in functional capacity and QoL at 1 year post-participation . Implication s for Rehabilitation Peripheral arterial disease has a considerable impact on functional capacity and quality of life Functional capacity and quality of life are improved in patients with peripheral arterial disease up to 1 year post-participation in supervised exercise Improvements at 1 year are reduced from those noted immediately following an exercise Patients with atherosclerotic peripheral arterial disease ( PAD ) of the lower extremities have impaired walking ability due to exercise-induced muscle ischemia and the result ant pain of intermittent claudication . To evaluate the benefit of exercise training as a treatment for patients with PAD , as well as possible mechanisms associated with improvement , we r and omly assigned 19 men with disabling claudication to treated and control groups . Treatment consisted of supervised treadmill walking ( 1 hr/day , 3 days/wk , for 12 weeks ) with progressive increases in speed and grade as tolerated . Grade d treadmill testing was performed to maximal toleration of claudication pain on entry and after 12 weeks of training to define changes in peak exercise performance . After 12 weeks , treated subjects had increased their peak walking time 123 % , peak oxygen consumption 30 % , and pain-free walking time 165 % ( all p less than 0.05 ) . Control subjects had no change in peak oxygen consumption , but after 12 weeks , peak walking time increased 20 % ( p less than 0.05 ) . In treated subjects , maximal calf blood flow ( measured by a plethysmograph ) increased 38 + /- 45 % ( p less than 0.05 ) , but the change in flow was not correlated to the increase in peak walking time . Elevated plasma concentrations of acylcarnitines have been associated with the functional impairment of PAD and may reflect the metabolic state of ischemic skeletal muscle . In treated subjects , a 26 % decrease in resting plasma short-chain acylcarnitine concentration was correlated with improvement in peak walking time ( r = -0.78 , p less than 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS Supervised exercise is beneficial for peripheral artery disease ( PAD ) patients limited by intermittent claudication ( IC ) . However , supervised exercise for PAD remains widely underutilized . Mobile health ( mHealth ) provides an intermediate solution between supervised and independent home-based exercise . The purpose of this study was to determine the effects on functional capacity and physical activity patterns of a 12-week mHealth program in PAD patients with IC . Twenty patients were r and omized into  usual care or a 12-week mHealth intervention consisting of patient education , smartphones , and physical activity trackers . Patient education was disseminated through smartphone and a daily exercise prescription was given based on steps per day . Primary outcomes were 12-week changes in peak VO2 and claudication onset time ; and changes in physical activity measured by steps per/day and minutes of exercise per/week . mHealth patients significantly increased peak VO2 from 15.2 ± 4.3 to 18.0 ± 4.8 ml/kg/min ( 20.3 ± 26.4 % ; p ≤0.05 ) , while usual care did not change from 14.3 ± 5.4 to 14.5 ± 5.7 ml/kg/min ( 1.0 ± 6.9 % ; NS ) . Comparison of these changes result ed in a significant difference between groups ( p ≤0.05 ) for peak VO2 . Claudication onset time significantly increased in mHealth ( 320 ± 226 to 525 ± 252 seconds ; ≤ 0.05 ) , while usual care demonstrated a worsening ( 252 ± 256 to 231 ± 196 seconds ; NS ) . The comparison of these group changes result ed in a significant difference ( p ≤0.05 ) . Neither steps per day or minutes of activity reached significant differences between groups . In conclusion , a 12-week mHealth program in PAD patients with IC  can improve peak VO2 and claudication onset time ; and mHealth interventions represent a promising alternative therapy for those patients who can not participate in supervised exercise 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 R and omized 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 r and omly 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 Question naire , 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 clinical trials.gov Identifier : NCT00106327 The aim of this study was to compare the effects of a single session of walking and combined exercise on oxidative stress and vascular function in peripheral arterial disease patients . Thirteen patients with peripheral arterial disease underwent two experimental sessions in r and om order : walking ( ten sets of 2‐min walking at the speed corresponding to the onset of claudication pain with 2‐min interval between sets ) and combined exercise ( 1 × 10 reps in eight resistance exercises plus five‐two‐minute sets of walking ) . Before and after the exercise , vascular function ( blood flow , leg vascular resistance and blood‐flow postreactive hyperaemia ) and oxidative stress ( malondialdehyde and plasma nitrite levels ) were obtained . Blood flow increased similarly after both sessions , whilst leg vascular resistance decreased similarly after both sessions . Plasma nitrite increased only after the combined exercise . Malondialdehyde decreased after both sessions , and the decrease was greater after combined exercise . As a conclusion , a single session of combined exercise improves blood flow and leg vascular resistance similarly to walking session ; however , combined exercise promoted better effects on oxidative stress OBJECTIVES To compare the effect of unsupervised exercise , supervised exercise and intermittent pneumatic foot and calf compression ( IPC ) on the claudication distance , lower limb arterial haemodynamics and quality of life of patients with intermittent claudication . METHODS Thirty-four eligible patients with stable intermittent claudication were r and omised to IPC ( n = 13 , 3h/d for 6 months ) , supervised exercise ( n = 12 , three hourly sessions/week for 6 months ) or unsupervised exercise ( n = 9 ) . In each patient , initial claudication distance ( ICD ) , absolute claudication distance ( ACD ) , resting ankle brachial pressure index ( ABPI ) , and resting hyperaemic calf arterial inflow were measured before , 6 weeks , 6 months and 1 year after r and omisation . Quality of life was assessed with the short form (SF)-36 , walking impairment ( WIQ ) and intermittent claudication question naires ( ICQ ) . RESULTS Compared with unsupervised exercise , both IPC and supervised exercise , increased ICD and ACD , up to 2.83 times . IPC  increased arterial inflow ( p < 0.05 at 6 weeks ) and ABPI .  Supervised exercise decreased arterial inflow and increased ABPI ( p < 0.05 at 6 months ) . Unsupervised exercise had no effect on arterial inflow or ABPI . IPC improved significantly the ICQ score and the speed score of the WIQ , while supervised exercise improved the WIQ claudication severity score . At 1 year clinical effectiveness of supervised exercise and IPC was largely preserved . CONCLUSIONS IPC , by augmenting leg perfusion , achieved improvement in walking distance comparable with supervised exercise . Long-term results in a larger number of patients will provide valuable information on the optimal treatment modality of intermittent claudication The purpose of this study was to examine the effects of a 6-month exercise program on submaximal walking economy in individuals with peripheral arterial disease and intermittent claudication ( PAD-IC ) . Participants ( n = 16 ) were r and omly allocated to either a control PAD-IC group ( CPAD-IC , n = 6 ) which received st and ard medical therapy , or a treatment PAD-IC group ( TPAD-IC ;  n = 10 ) which took part in a supervised exercise program . During a grade d treadmill test , physiological responses , including oxygen consumption , were assessed to calculate walking economy during submaximal and maximal walking performance . Differences between groups at baseline and post-intervention were analyzed via Kruskal – Wallis tests . At baseline , CPAD-IC and TPAD-IC groups demonstrated similar walking performance and physiological responses . Postintervention , TPAD-IC patients demonstrated significantly lower oxygen consumption during the grade d exercise test , and greater maximal walking performance compared to CPAD-IC . These preliminary results indicate that 6 months of regular exercise improves both submaximal walking economy and maximal walking performance , without significant changes in maximal walking economy . Enhanced walking economy may contribute to physiological efficiency , which in turn may improve walking performance as demonstrated by PAD-IC patients following regular exercise programs Introduction : Peripheral atherosclerotic disease ( PAD ) is a condition characterized by low functional capacity which is associated with impaired free living , ambulation and low exercise tolerance . The purpose of this r and omized controlled study was to evaluate whether changes in maximal walking time are associated with adaptations in cardiovascular function following supervised exercise BACKGROUND Treatment for claudication that is due to aortoiliac peripheral artery disease ( PAD ) often relies on stent revascularization ( ST ) . However , supervised exercise ( SE ) is known to provide comparable short-term ( 6-month ) improvements in functional status and quality of life . Longer-term outcomes are not known . OBJECTIVES The goal of this study was to report the longer-term ( 18-month ) efficacy of SE compared with ST and optimal medical care ( OMC ) . METHODS Of 111 patients with aortoiliac PAD r and omly assigned to receive OMC , OMC plus SE , or OMC plus ST , 79 completed the 18-month clinical and treadmill follow-up assessment . SE consisted of 6 months of SE and an additional year of telephone-based exercise counseling . Primary clinical outcomes included objective treadmill-based walking performance and subjective quality of life . RESULTS Peak walking time improved from baseline to 18 months for both SE ( 5.0 ± 5.4 min ) and ST ( 3.2 ± 4.7 min ) significantly more than for OMC ( 0.2 ± 2.1 min ; p < 0.001 and p = 0.04 , respectively ) . The difference between SE and ST was not significant ( p = 0.16 ) . Improvement in claudication onset time was greater for SE compared with OMC , but not for ST compared with OMC . Many disease-specific quality -of-life scales demonstrated durable improvements that were greater for ST compared with SE or OMC . CONCLUSIONS Both SE and ST had better 18-month outcomes than OMC . SE and ST provided comparable durable improvement in functional status and in quality of life up to 18 months . The durability of claudication exercise interventions merits its consideration as a primary PAD claudication treatment Because individuals with claudication pain secondary to peripheral arterial disease ( PAD ) are limited in both walking speed and duration , the benefits of walking exercise may be insufficient to yield a cardiovascular training effect . The objectives of this analysis were to determine whether polestriding exercise training , performed by persons with PAD , would improve exercise endurance , elicit a cardiovascular training benefit , and improve quality of life ( QoL ) .  Persons ( n = 49 ) whose claudication pain limited their exercise capacity were r and omized into a 24-week polestriding training program ( n = 25 , 65.8 ± 7.1 years of age ) or a nonexercise attention control group ( n = 24 , 68.0 ± 8.6 years of age ) . Those assigned to the polestriding group trained 3 times weekly . Control group subjects came to the laboratory biweekly for ankle blood pressure measurements . A symptom-limited ramp treadmill test , ratings of perceived leg pain , and QoL data ( using the Short Form-36 ) were obtained at baseline and upon completion of training . After 24 weeks of polestriding training , subjects increased their exercise endurance from 10.3 ± 4.1 minute to 15.1 ± 4.5 minute . This was significantly greater than control group subjects whose exercise endurance declined ( from 11.2 ± 4.7 to 10.3 ± 4.7 minute ; P < .001 ) . Relationships between systolic blood pressure ( P < .001 ) , heart rate ( P = .04 ) , rate pressure product ( P = .05 ) , oxygen uptake ( P = .016 ) , and perceived leg pain ( P = .02 ) and exercise time improved from the baseline symptom-limited treadmill test to the 6-month symptom-limited treadmill test in the polestriding group compared to the control group . The improvement in the physical component summary score of the Short Form-36 was also greater in the polestriding group ( P = .031 ) . Polestriding training significantly improved the clinical indicators of cardiovascular fitness and QoL , and decreased symptoms of claudication pain during exertion People with lower extremity peripheral artery disease ( PAD ) have greater functional impairment and faster functional decline than those without PAD . We describe methods for the Group Oriented Arterial Leg Study ( GOALS ) , an ongoing r and omized controlled clinical trial design ed to determine whether a Group-Mediated Cognitive Behavioral ( GMCB ) intervention improves functional performance in PAD participants , compared to a health education control condition . In GOALS , PAD participants were r and omized to either an intervention or a health education control condition in a parallel design . Both conditions consist of weekly group sessions with other PAD participants . In the intervention , cognitive behavioral techniques are used to assist participants in setting and adhering to home-based walking exercise goals . Participants are encouraged to walk for exercise at home at least 5 days/week . In the control condition , participants receive lectures on health-related topics . After 6 months of on-site weekly sessions , participants are transitioned to telephone follow-up for another 6 months . Participants in the intervention are asked to continue home walking exercise .  The primary outcome is change in six-minute walk performance between baseline and six-month follow-up . Secondary outcomes include change in six-minute walk performance at 12-month follow-up , and change in treadmill walking performance , the Walking Impairment Question naire , quality of life , and physical activity at six and 12-month follow-up . In conclusion , if our group-mediated cognitive behavioral intervention is associated with improved walking performance in individuals with PAD , results will have major public health implication s for the large and growing number of people with PAD PURPOSE The purpose of this r and omized trial was to compare the efficacy of a low-intensity exercise rehabilitation program vs a high-intensity program in changing physical function , peripheral circulation , and health-related quality of life in peripheral arterial disease ( PAD ) patients limited by intermittent claudication . METHODS Thirty-one patients r and omized to low-intensity exercise rehabilitation and 33 patients r and omized to high-intensity exercise rehabilitation completed the study . The 6-month exercise rehabilitation programs consisted of intermittent treadmill walking to near maximal claudication pain 3 days per week at either 40 % ( low-intensity group ) or 80 % ( high-intensity group ) of maximal exercise capacity . Total work performed in the two training regimens was similar by having the patients in the low-intensity group exercise for a longer duration than patients in the high-intensity group . Measurements of physical function , peripheral circulation , and health-related quality of life were obtained on each patient before and after the rehabilitation programs . RESULTS After the exercise rehabilitation programs , patients in the two groups had similar improvements in these measures . Initial claudication distance increased by 109 % in the low-intensity group ( P < .01 ) and by 109 % in the high-intensity group ( P < .01 ) , and absolute claudication distance increased by 61 % ( P < 0.01 ) and 63 % ( P < .01 ) in the low-intensity and high-intensity groups , respectively . Furthermore , both exercise programs elicited improvements ( P < .05 ) in peak oxygen uptake , ischemic window , and health-related quality of life . CONCLUSION The efficacy of low-intensity exercise rehabilitation is similar to high-intensity rehabilitation in improving markers of functional independence in PAD patients limited by intermittent claudication , provided that a few additional minutes of walking is accomplished to elicit a similar volume of exercise OBJECTIVES To describe recruitment to a r and omised controlled trial of a 12-week ( twice-weekly ) supervised exercise programme for patients with peripheral arterial disease ( PAD ) . PAD is a chronic , progressive disease with a significant cardiovascular and cerebrovascular risk burden , and exercise is an effective primary management approach . METHOD Potential patients were identified from the Non-Invasive Vascular Laboratory records and invited to participate in the study . On successful completion of an incremental treadmill exercise test , patients were allocated at r and om to a control ( usual care ) or an exercise group . RESULTS Between November 2006 and June 2009 , 548 patients were identified . Of the 156 patients who met the inclusion criteria , 40 ( 26 % ) declined to participate . Of the 71 patients who underwent exercise testing  , 23 ( 32 % ) did not complete the test . The final enrolment number was 44 ( 44/156 ; 28 % ) . Eleven patients ( 11/28 ; 39 % ) subsequently withdrew from the exercise programme . CONCLUSION Recruitment to clinical trials of exercise presents significant challenges in the PAD population due to the presence of co-existing cardiovascular and cerebrovascular disease , a reluctance to exercise due to leg pain , and an acceptance of reduced mobility as part of ageing . Early identification in primary care before the onset of significant comorbidity may ameliorate some of these issues Background Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease ( PAD ) . Among people with PAD , we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control . Methods and Results One hundred ninety-four PAD participants were r and omized . During months 1 to 6 , the intervention group met weekly with other PAD participants and a facilitator . Group support and self-regulatory skills were used to help participants adhere to walking exercise . Ninety-percent of exercise was conducted at or near home . The control group attended weekly lectures . During months 6 to 12 , each group received telephone contact only . Primary outcomes have been reported . Here we compare changes in exploratory outcomes of mobility loss ( the inability to climb a flight of stairs or walk one-quarter mile without assistance ) , walking velocity , and the Short Physical Performance Battery . Compared to controls , fewer participants r and omized to the intervention experienced mobility loss at 6-month follow-up : 6.3 % versus 26.5 % , P=0.002 , odds ratio=0.19 ( 95 % CI=0.06 to 0.58 ) and at 12-month follow-up : 5.2 % versus 18.5 % , P=0.029 , odds ratio=0.24 ( 95 % CI=0.06 to 0.97 ) . The intervention improved fast-paced 4-m walking velocity at 6-month follow-up ( P=0.005 ) and the Short Physical Performance Battery at 12-month follow-up ( P=0.027 ) , compared to controls . Conclusions In exploratory analyses , a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients . Clinical Trial Registration URL : http:// clinical trials.gov . Unique identifier : NCT00693940
Conclusions : Currently , there is insufficient evidence about the effects of combined aerobic and resistance exercise compared to isolated aerobic exercise or usual care on walking performance .
However , despite the low quality of evidence , the combined aerobic and resistance exercise seems to be an effective strategy to improve walking performance in patients with intermittent claudication .
These combined exercise modes or isolated aerobic exercise produce positive and significant results on walking performance .
The usual care approach has a trend to deteriorate the walking performance .
Background : The short-term benefits of aerobic and resistance exercise in subjects affected by Peripheral Arterial Disease ( PAD ) are scarcely examined in interaction .
This study aim ed to identify the effects of combined aerobic and resistance exercise programs on walking performance compared with isolated aerobic exercise or with the usual care in patients with intermittent claudication .