Circulation, Vol 90, 1866-1874, Copyright © 1994 by American Heart Association
WR Hiatt, EE Wolfel, RH Meier and JG Regensteiner
BACKGROUND: In patients with intermittent claudication, a supervised
walking exercise program increases peak exercise performance and
community-based functional status. Patients with peripheral arterial
disease also have muscle weakness in the affected extremity that may
contribute to the walking impairment. However, the potential benefits of
training modalities other than walking exercise, such as strength training,
have not been critically evaluated in this patient population. The present
study tested the hypothesis that a strength training program would be as
effective as treadmill walking exercise and that combinations of
strengthening and walking exercise would be more effective than either
alone in improving exercise performance. METHODS AND RESULTS: Twenty-nine
patients with disabling claudication were randomized to 12 weeks of
supervised walking exercise on a treadmill (3 h/wk at a work intensity
sufficient to produce claudication), strength training (3 h/wk of resistive
training of five muscle groups of each leg), or a nonexercising control
group. Graded treadmill testing was performed to maximally tolerated
claudication pain to define changes in peak exercise performance. After 12
weeks, patients in the treadmill training program had a 74 +/- 58% increase
in peak walking time as well as improvements in peak oxygen consumption
(VO2) and the onset of claudication pain. Patients in the strength- trained
group had a 36 +/- 48% increase in peak walking time but no change in peak
VO2 or claudication onset time. Control subjects had no changes in any of
these measures over the 12-week period. After the first 12 weeks, patients
in the initial walking exercise group continued for 12 more weeks of
supervised treadmill training. This resulted in an additional 49 +/- 53%
increase in peak walking time (total of 128 +/- 99% increase over the 24
weeks). After the initial 12 weeks, patients in the strength-trained group
began 12 weeks of supervised treadmill training, and patients in the
control group participated in a 12-week combined program of strengthening
and treadmill walking exercise. The combined strength and treadmill
training program and treadmill training after 12 weeks of strength training
resulted in increases in peak exercise performance similar to those
observed with 12 weeks of treadmill training alone. CONCLUSIONS: A
supervised treadmill walking exercise program is an effective means to
improve exercise performance in patients with intermittent claudication,
with continued improvement over 24 weeks of training. In contrast, 12 weeks
of strength training was less effective than 12 weeks of supervised
treadmill walking exercise. Finally, strength training, whether sequential
or concomitant, did not augment the response to a walking exercise program.
ARTICLES
Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Implications for the mechanism of the training response
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262.
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