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Purpose: This study aimed to investigate the acute effect of intermittent walking exercise (WE) on blood pressure (BP) responses in patients with intermittent claudication (IC). Secondly, this study aimed to gain improved insight into the physiological mechanisms controlling BP regulation after intermittent WE in this patient group., Methods: Twenty patients with IC participated in two experimental sessions in a random order, as follows: WE (15 × 2-min bouts of WE interpolated with 2-min rest intervals) and control (standing rest on a treadmill for 60 min). BP, cardiac output (CO: CO2 rebreathing), and cardiovascular autonomic modulation (spectral analysis of HR variability) were assessed before and after both experimental sessions during supine rest, and stroke volume (SV) and systemic vascular resistance (SVR) were calculated. Data were analyzed using two-way ANOVA., Results: WE decreased systolic, diastolic, and mean BP, with net effects of -13 ± 2, -5 ± 2, and -7 ± 2 mm Hg versus control, respectively (all P < 0.05). WE also decreased SV (-5.62 ± 1.97 mL, P < 0.05) and CO (-0.05 ± 0.13 L·min(-1), P < 0.05) versus preintervention and prevented the observed increase in SVR in the control condition (+4.2 ± 1.4 U, P < 0.05). HR showed a decrease (P < 0.05), consistent with evidence of increased vagal modulation, in the control condition. BP measurements over the subsequent 24 h were similar between experimental conditions., Conclusions: In patients with IC, WE induced a postexercise hypotension response that had a significant magnitude versus control but was not maintained over the next 24 h of daily activities. The acute postexercise hypotension response was mediated by a decrease in CO and SV, which was not compensated by an augmentation of SVR, as observed in the control arm of the study.

Background: Comorbid conditions are known to increase cardiovascular risk in patients with peripheral artery disease (PAD). However, whether comorbid conditions affect walking capacity remains controversial. Previous studies have analyzed comorbidities separately, but they are known to occur in a clustered fashion in PAD patients. Therefore, the aim of this study was to analyze the influence of clustered comorbid conditions on walking capacity in PAD patients., Methods: This cross-sectional study included 415 PAD patients (155 women and 260 men with an average age of 63 years). Claudication distance and total walking distance were assessed with the graded maximal treadmill test. Medical histories of hypertension, diabetes, cerebrovascular disease (CVD), coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD) were obtained. Binary logistic regression was carried out to analyze whether clustered comorbid conditions were associated with walking capacity., Results: CVD was associated with lower total walking distance (odds ratio [OR] = 2.45; 95% confidence interval [CI]: 1.11-5.39). The cluster hypertension, diabetes, CVD, CAD, and COPD were associated with a lower claudication distance (OR = 7.63; 95% CI: 1.42-40.96). In addition, the clusters of CVD and hypertension (OR = 3.16; 95% CI: 1.38-7.23), CVD and CAD (OR = 3.46; 95% CI: 1.25-9.57), CVD, hypertension, and diabetes (OR = 11.38; 95% CI: 2.27-57.00) were associated with a lower total walking distance., Conclusions: CVD was associated with walking impairment of IC patients and in particular when CVD is clustered with other comorbid conditions., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To analyze if there is any relation between functional capacity assessed by subjective and objective methods regarding the current state and after clinical treatment in patients with intermittent claudication., Methods: A total of 500 patients with intermittent claudication were enrolled. All patients underwent clinical examination and a functional evaluation by subjective (clinical visit) and objective method (treadmill test). Additionally, 50 patients were selected to evaluate the effect of clinical treatment by subjective and objective methods in relation to functional capacity., Results: Out of 500 patients, only 60 (12.0%) had similar results in both methods. The remaining, that is 440 patients (88.0%) had subject values in disagreement with stress test findings. Regarding the clinical effect of the treatment on the functional outcomes, results were similar in both methods (χ²=1.7; p=0.427)., Conclusion: Although the subjective method overestimates the functional capacity when compared to the objective method, no significant differences were observed between both methods when analyzing the effect of clinical treatment. Thus, the subjective method provides similar information as compared with objective method, in monitoring the clinical treatment of patients with intermittent claudication.

Objective: To assess the acute metabolic and cardiovascular responses to walking exercise at an intensity corresponding to the heart rate of claudication pain onset and to investigate the effects of a 12-week walking training program at this intensity on walking capacity., Methods: Twenty-nine patients with intermittent claudication were randomly allocated to the walking training (n=17) or control (CO, n=12) group. The walking training group performed an acute exercise session comprising 15×2-min bouts of walking at the heart rate of claudication pain onset, with 2-min interpolated rest intervals. The claudication symptoms and cardiovascular and metabolic responses were evaluated. Walking training was then performed at the same intensity twice each week for 12 weeks, while the control group engaged in twice weekly stretching classes. The claudication onset distance and total walking distance were evaluated before and after the interventions. Brazilian Registry Clinical Trials: RBR-7M3D8W., Results: During the acute exercise session, the heart rate was maintained within tight limits. The exercise intensity was above the anaerobic threshold and >80% of the heart rate peak and VO2peak. After the exercise training period, the walking exercise group (n=13) showed increased claudication onset distance (309±153 vs. 413±201m) and total walking distance (784±182 vs. 1,100±236m) compared to the control group (n=12) (p<0.05)., Conclusion: Walking exercise prescribed at the heart rate of claudication pain onset enables patients with intermittent claudication to exercise with tolerable levels of pain and improves walking performance.

Objective: To estimate walking capacity in intermittent claudication patients through a prediction model based on clinical characteristics and the walking impairment questionnaire., Methods: The sample included 133 intermittent claudication patients of both genders aged between 30 and 80 years. Data regarding clinical characteristics, the walking impairment questionnaire and treadmill walking test performance were obtained. Multiple regression modeling was conducted to predict claudication onset distance and total walking distance using clinical characteristics (age, height, mass, body mass index, ankle brachial index lower, gender, history of smoking and co-morbid conditions) and walking impairment questionnaire responses. Comparisons of claudication onset distance and total walking distance measured during treadmill tests and estimated by a regression equation were performed using paired t-tests., Results: Co-morbid conditions (diabetes and coronary artery disease) and questions related to difficulty in walking short distances (walking indoors - such as around your house and walking 5 blocks) and at low speed (walking 1 block at average speed - usual pace) resulted in the development of new prediction models high significant for claudication onset distance and total walking distance (p<0.001). In addition, non-significant differences from the results obtained by the treadmill test and estimated by the current model (p>0.05) were observed., Conclusion: The current study demonstrated that walking capacity can be adequately estimated based on co-morbid conditions and responses to the walking impairment questionnaire.

Objective: To analyze, in people with intermittent claudication, the frequency of individuals who are in each of stages of health behavior change to practice physical activity, and analyze the association of these stages with the walking capacity., Methods: We recruited 150 patients with intermittent claudication treated at a tertiary center, being included those > 30-year-old-individuals and who had ankle-arm index < 0.90. We obtained socio-demographic information, presence of comorbidities and cardiovascular risk factors and stages of health behavior change to practice physical activity through a questionnaire, they being pre-contemplation, contemplation, preparation, action and maintenance. Moreover, the walking capacity was measured in a treadmill test (Gardner protocol)., Results: Most individuals were in the maintenance stage (42.7%), however, when the stages of health behavior change were categorized into active (action and maintenance) and inactive (pre-contemplation, contemplation and preparation), 51.3% of the individuals were classified as inactive behavior. There was no association between stages of health behavior change, sociodemographic factors and cardiovascular risk factors. However, patients with intermittent claudication who had lower total walking distance were three times more likely to have inactive behavior., Conclusion: Most patients with intermittent claudication showed an inactive behavior and, in this population, lower walking capacity was associated with this behavior.