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Med Sci Sports Exerc 2001 Oct;33(10):1629-34 Related Articles, Books, LinkOut A primary care walking exercise program for patients with intermittent claudication. Wullink M, Stoffers HE, Kuipers H. Department of Movement Sciences and Department of General Practice, Maastricht University, Maastricht, The Netherlands. PURPOSE: In a pilot study, the hypothesis was tested that a home-based walking exercise program with structured coaching would improve walking performance and adherence in patients with intermittent claudication (IC). METHODS: Thirty-one IC patients with a rest ankle-brachial pressure index < 0.90 started a 24-wk walking program in the home environment. They were coached according to the Health Counseling Model (HCM). Patients were instructed to walk at least 9 bouts.wk-1 and to walk through the pain. The main effect measures were pain-free (initial claudication distance (ICD)) and maximum walking distance (absolute claudication distance (ACD)) measured with a graded treadmill test, a corridor exercise test, a walking-diary, and the score on the Walking Impairment Questionnaire (WIQ). RESULTS: Twenty-four participants completed the program. The reported walking frequency was 7.4 times.wk-1. The average ICD improved from 289 m (95% CI, 209-369) to 347 m (95% CI, 244-449) (P < 0.05) and from 241 m (95% CI, 171-310) to 373 m (95% CI, 273-472) on the treadmill and the corridor test, respectively. The average ACD improved from 490 m (95% CI, 397-583) to 544 m (95% CI, 438-650) and from 564 m (95% CI, 412-717) to 726 m (95% CI, 546-906) (P < 0.01) on the treadmill and the corridor test, respectively. The average maximum distance reported in the walking-diary improved from 957 m (95% CI, 291-1623) to 1294 m (95% CI, 646-1941). The score of the walking distance on the WIQ improved from 57% (95% CI, 42-71%) to 60% (95% CI, 46-74%). CONCLUSION: IC patients improved their average ICD and ACD. The walking exercise program in the home environment with coaching according to the HCM seems a promising intervention to be tested in a randomized controlled trial.

Atrial fibrillation (AF) is a heart disease characterised by an irregular heart rhythm and that can present asymptomatically. AF can lead to complications, mainly stroke and heart failure. If patients with (silent) AF receive a timely diagnosis and are started on oral anticoagulants, this may prevent strokes. This thesis describes the results of the Diagnosing and Detecting Atrial Fibrillation (D2AF) trial, a multicenter cluster randomised controlled trial set in primary care. It investigated whether opportunistic screening increases detection of AF as compared to usual care. The intervention consisted of inviting patients visiting the general practitioner (GP) for testing using pulse palpation and measurements with two devices with an AF-detection algorithm – an electronic blood pressure monitor and a single lead electrocardiogram. The main finding was that opportunistic screening for AF did not improve the detection rate of AF (adjusted odds ratio 1.06 (95% confidence interval: 0.84–1.35)). In 0.7% of the screened patients, the protocol detected AF. All methods were suitable for screening purposes, however using pulse palpation would lead to more false positive tests. GPs and nurses using the methods, found all three methods easy to use and suitable for implementation in general practices. The thesis contains a systematic review demonstrating that there was no clear relation between a higher AF burden are at higher risk of stroke. In conclusion, detection of AF during usual care by GPs in the Netherlands is as effective as screening. Future studies should focus on selecting high risk patients and using prolonged monitoring.