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Effects of treadmill training on walking distance and lower limb blood flow in patients with intermittent claudication

100%

Mika P., Cencora A.

Medical Rehabilitation

2005

vol. 9(1)

3-9

Cel: U pacjentów z chromaniem przestankowym regularnie prowadzony trening marszowy na bieżni prowadzi do wzrostu dystansu marszu. Mechanizm tej poprawy jest wieloczynnikowy a jedną z prawdopodobnych przyczyn może być wzrost przepływu tętniczego w kończynach dolnych. Przedmiotem badań była ocena zmian dystansu marszu oraz przepływu tętniczego w kończynach dolnych podczas treningu marszowego na bieżni u pacjentów z chromaniem przestankowym. Metoda: 80 pacjentów z miażdżycą zarostową kończyn dolnych (II stopień według Fontaine) było randomizowanych do programu treningowego lub do grupy kontrolnej. Pacjenci z grupy badawczej przez okres 3 miesięcy uczestniczyli 3 razy tygodniowo w treningu marszowym. Sesje składały się z wysiłków marszowych powtarzanych 3-krotnie, każdy o dystansie marszu wynoszącym 85% indywidualnie określonego dystansu chromania. Przed rozpoczęciem programu i po jego zakończeniu w obu grupach oceniano dystans pojawienia się chromania oraz zmiany w prędkości przepływu tętniczego w kończynach dolnych (pomiar indeksu pulsacji metodą dopplerowską). Wyniki: Po 12 tygodniach programu w grupie badawczej zaobserwowano wzrost indeksu pulsacji mierzony na tętnicy podkolanowej (43%), piszczelowej tylnej (59%) i grzbietowej stopy (78,8%). W grupie kontrolnej niewielki wzrost (11,4%) odnotowano na tętnicy podkolanowej. Towarzyszyła temu poprawa dystansu pojawienia się chromania – 119,6% w grupie badawczej i 16,9% w grupie kontrolnej. Zmiany były istotne statystycznie (p< 0,05). Wnioski: Wyniki badań wskazują, że trening marszowy prowadzony u pacjentów z chromaniem przestankowym prowadzi do korzystnych zmian przepływu tętniczego w kończynach dolnych w zakresie poprawy jego prędkości oraz znacznej poprawy dystansu marszu pokonywanego bez bólu.

Background: In patients with intermittent claudication treadmill training improves their walking ability. While the benefits of an exercise rehabilitation programme are recognized, the mechanisms involved are not completely appreciated. The improvement in lower limb blood flow may by one of the mechanisms leading to the increase in walking distance. In the present study arterial blood flow in lower limb as well as walking distance were assessed before and after supervised pain-free treadmill training. Methods: Eighty patients with peripheral arterial occlusive disease (stage II according to Fontaine) were randomised into the treadmill program or to the control group. Patients in the exercising group participated for 3 months 3 times a week in supervised treadmill trainings. Each session consisted of 3 cycles, each amounting to 85% of the pain-free walking distance. Changes in arterial blood flow and the onset of claudication pain were assessed in both groups.Results: After 12 weeks of the treadmill training lower limb blood flow in exercising group significantly improved (p<0.05). Painfree walking distance was prolonged by 119,6% in the exercising group and only 16.9% in the control group. Those changes were statistically significant in both groups (p<0.05).Conclusion: The results indicate that exercise training program using intermittent walking to 85% of the onset of claudication pain leads to a significant improvement in lower limb blood velocity and increase in pain-free walking distance.

Results of Serum Lipid Concentration Measurements Associated with the Level of Arteriosclerosis in Patients with Advanced Lower Extremity Ischaemia

81%

Cencora A., Górkiewicz M., Kostka A., Pająk A.

Polish Journal of Surgery

2007

vol. 79

issue 8

526-532

The aim of the study was to evaluate whether serum lipid concentrations [total cholesterol (TC), HDL cholesterol (HDL), LDL cholesterol (LDL), triglycerides (TG)] vary between patients with lower extremity claudication depending on the location of pathologic arterial changes above and below the inguinal ligament.Material and methods. Our investigation included 24 patients with changes in the aorto-iliac and 15 in the femoro-popliteal segment, in whom advanced ischaemia reached IIb and III according to Fontaine's scale. The results obtained from our patients were compared to non-claudicant controls, who were matched to the claudification patients with respect to age, body mass index, smoking and concomitant illnesses.Results. Every fourth patient with claudication demonstrated correct results of the four mentioned lipidogram components. The percentage of incorrect results was higher in patients with changes in the aorto-iliac segment relative to patients with changes in the femoro-popliteal segment and amounted to 63% vs 20% for HDL, and 63% vs 13% for TG, respectively. TG concentration and TC/HDL and LDL/HDL ratios vary between the two groups of patients. TC/HDL and LDL/HDL ratios are significantly higher in patients with aorto-iliac segment changes as compared to the control group, but do not vary when compared to arteries below the inguinal ligament. The level of TC, HDL and LDL is higher in the control group as compared to the median results for all examined patients.Conclusions. Patients with lower limb claudication following pathology of the aorto-iliac and femoropopliteal segments do not constitute a homologous group; therefore, further extensive research is necessary to explain this phenomenon.

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Effects of treadmill training on walking distance and lower limb blood flow in patients with intermittent claudication

Results of Serum Lipid Concentration Measurements Associated with the Level of Arteriosclerosis in Patients with Advanced Lower Extremity Ischaemia