Document Detail

Effectiveness and costs of a short-course supervised training program in claudicants: proposal for a shared protocol with aerobic working load.
MedLine Citation:
PMID:  18974703     Owner:  NLM     Status:  MEDLINE    
AIM: The purpose of this study was to assess the costs and effectiveness of a short-course physical training program, consisting of an aerobic protocol with clearly defined working loads in each single training session, in patients with intermittent claudication (IC). METHODS: Initial (ICD), absolute (ACD) claudication distance, and recovery time (RT) have been measured by maximal treadmill exercise in 74 claudicants. Ankle brachial index (ABI) has been measured too. Measurements have been repeated after 18 days of supervised physical training consisting of a daily walk reaching either a distance goal of 1-2 km or a time goal of at least 30 min. The working load of each single training session has been tailored at 60-70% of the ACD measured by a non-maximal treadmill exercise. RESULTS: ICD increased from 56.2 (+/- standard deviation/+/- standard error: 35.3/4.1) to 123.9 (66.5/7.7); ACD increased from 104.8 (49.8/5.8) to 195.1 (81.7/9.5) and RT reduced from 201.2 (98.3/11.4) to 85.8 (43.6/5.1), with P<0.0001 for all parameters. We analyzed separately patients with moderate (M-CL) and severe (S-CL) claudication, and found significant improvements in both groups. The Ds (post-training value minus pretraining value) were: ICD 89.6 (59.9/10.9) in M-CL and 50.2 (29.9/4.6) in S-CL; ACD 102.8 (66.8/11.6) in M-CL and 80.1 (41.5/6.4) in S-CL; RT -98.7 (86.9/15.1) in M-CL and -128.5 (88.1/13.7) in S-CL, with P<0.0001 for all parameters. The differences between M-CL and S-CL were significant only for ICD (P=0.0003) and ACD (P<0.05). ABI showed an increasing trend, which was statistically significant (P<0.001), but clinically irrelevant. The protocol cost was 4179 Euro (average cost 46.30 Euro to walk one additional meter). CONCLUSION: Supervised physical training is confirmed to be an effective tool for the treatment of IC, and the proposed short-course protocol gave the same improvements as the longer ones while reducing the costs. The proposed procedure for tailoring the working load of a single session identifies clearly the working load, near maximal pain but avoiding the risk of inflammatory activation.
G M Andreozzi; A Leone; R Martini; R Laudani; G Salimistraro; G Deinite
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  International angiology : a journal of the International Union of Angiology     Volume:  27     ISSN:  0392-9590     ISO Abbreviation:  Int Angiol     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-31     Completed Date:  2009-02-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8402693     Medline TA:  Int Angiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  401-7     Citation Subset:  IM    
Angiology Care Unit, University Hospital of Padua, Padua, Italy.
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MeSH Terms
Aged, 80 and over
Clinical Protocols
Cost-Benefit Analysis
Exercise Tolerance
Intermittent Claudication / rehabilitation*
Middle Aged
Physical Exertion
Physical Therapy Modalities / economics*
Program Evaluation
Treatment Outcome

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