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 & 3 others Walter J. McCarthy, Adhir Shroff, Michael H. Criqui

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Pages (from-to)165-174
Number of pages10
JournalJournal of the American Medical Association
Volume301
Issue number2
DOIs
StatePublished - Jan 14 2009
Externally publishedYes

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Intermittent Claudication
Resistance Training
Peripheral Arterial Disease
Randomized Controlled Trials
Walking
Confidence Intervals
Exercise
Control Groups
Brachial Artery
Dilatation
Lower Extremity
Quality of Life
Health Surveys
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

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Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication : A randomized controlled trial. / McDermott, Mary M.; Ades, Philip; Guralnik, Jack M.; Dyer, Alan; Ferrucci, Luigi; Liu, Kiang; Nelson, Miriam; Lloyd-Jones, Donald; Van Horn, Linda; Garside, Daniel; Kibbe, Melina; Domanchuk, Kathryn; Stein, James H.; Liao, Yihua; Tao, Huimin; Green, David; Pearce, William H.; Schneider, Joseph R.; McPherson, David; Laing, Susan T.; McCarthy, Walter J.; Shroff, Adhir; Criqui, Michael H.

In: Journal of the American Medical Association, Vol. 301, No. 2, 14.01.2009, p. 165-174.

Research output: Contribution to journalArticle

McDermott, MM, Ades, P, Guralnik, JM, Dyer, A, Ferrucci, L, Liu, K, Nelson, M, Lloyd-Jones, D, Van Horn, L, Garside, D, Kibbe, M, Domanchuk, K, Stein, JH, Liao, Y, Tao, H, Green, D, Pearce, WH, Schneider, JR, McPherson, D, Laing, ST, McCarthy, WJ, Shroff, A & Criqui, MH 2009, 'Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: A randomized controlled trial', Journal of the American Medical Association, vol. 301, no. 2, pp. 165-174. https://doi.org/10.1001/jama.2008.962
McDermott, Mary M. ; Ades, Philip ; Guralnik, Jack M. ; Dyer, Alan ; Ferrucci, Luigi ; Liu, Kiang ; Nelson, Miriam ; Lloyd-Jones, Donald ; Van Horn, Linda ; Garside, Daniel ; Kibbe, Melina ; Domanchuk, Kathryn ; Stein, James H. ; Liao, Yihua ; Tao, Huimin ; Green, David ; Pearce, William H. ; Schneider, Joseph R. ; McPherson, David ; Laing, Susan T. ; McCarthy, Walter J. ; Shroff, Adhir ; Criqui, Michael H. / Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication : A randomized controlled trial. In: Journal of the American Medical Association. 2009 ; Vol. 301, No. 2. pp. 165-174.
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abstract = "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 = "McDermott, {Mary M.} and Philip Ades and Guralnik, {Jack M.} and Alan Dyer and Luigi Ferrucci and Kiang Liu and Miriam Nelson and Donald Lloyd-Jones and {Van Horn}, Linda and Daniel Garside and Melina Kibbe and Kathryn Domanchuk and Stein, {James H.} and Yihua Liao and Huimin Tao and David Green and Pearce, {William H.} and Schneider, {Joseph R.} and David McPherson and Laing, {Susan T.} and McCarthy, {Walter J.} and Adhir Shroff and Criqui, {Michael H.}",
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TY - JOUR

T1 - Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication

T2 - A randomized controlled trial

AU - McDermott, Mary M.

AU - Ades, Philip

AU - Guralnik, Jack M.

AU - Dyer, Alan

AU - Ferrucci, Luigi

AU - Liu, Kiang

AU - Nelson, Miriam

AU - Lloyd-Jones, Donald

AU - Van Horn, Linda

AU - Garside, Daniel

AU - Kibbe, Melina

AU - Domanchuk, Kathryn

AU - Stein, James H.

AU - Liao, Yihua

AU - Tao, Huimin

AU - Green, David

AU - Pearce, William H.

AU - Schneider, Joseph R.

AU - McPherson, David

AU - Laing, Susan T.

AU - McCarthy, Walter J.

AU - Shroff, Adhir

AU - Criqui, Michael H.

PY - 2009/1/14

Y1 - 2009/1/14

N2 - 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

AB - 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

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