Full text of DOI:10.1177/000331970105200603

381
of
and
Short-Term
Improvement
Peripheral
Cardiopulmonary
Exercise
PerformanceAfter
a
withAdditive
E1
Prostaglandin
Program
Milan
BadBevensen and
MD*and Waltraud
Cachovan,
MD,†
Rogatti,
Cologne, Germany
In
with intermittent
the
distance can be
both
increased,
claudication,
patients
means of several months
walking
by
E1(PGE
IV
of
administration
of intensive
and
training
prostaglandin
4
The
the
of
for
weeks.
aim of this
and
to
whether
combination
was, therefore,
during pedalergometry
after 2 weeks. Ten
study
investigate
can increase
and
intensive
infusions
training
PGE
peripheral
with intermittent claudication
cardiopulmonary performance
received
patients
2
a
intravenous infusion of 60
over hours
PGE
once-daily
a
μg
during pedalergometry.
as well as
In
was carried out
and
addition,
afternoons,
physical training program
mornings
and
12%)
treadmill
distance
(3
km/h,
and end of the 2-week treatment. Results were
progressive
mance were determined at the
training. Walking
cardiopulmonary perfor-
beginning
historical control
with those of
The initial
a
received a similar
training
compared
without
group
having
program
distance increased from 71 to 166
m
At the same
100%.
capacity by
(134%).
PGE
walking
work load increased
work
and the
time,
108%,
peak
by
physical
all the
in
function
was reflected
of
Cardiopulmonary
VOpeak /peak
control
group,
distance
parameters investigated (peak
improvement
work load
with the historical
RER).
ratio;
slope
&
D
D
e
e
l
l
t
t
a
a
;
;
V
t
O
;
Compared
the difference between the two
with
to the increase in
groups
regard
walking
in
was
favor of the combined
with
PGE
significant
training program
The combination of short-term intensive
and
infusions
PGE
during pedal
training
as
both the
well as the restricted functional
ergometry significantly improves
peripheral
highly
in
with intermittent claudication.
capacity
patients
Introduction
There is
treatment of
al arterial occlusive disease
Fontaine’s
that the
general
agreement
primary
intermittent
claudication
(peripher-
II
to
stage
according
52:381-391, 2001
*Division of
Angiology
the
should be
conserva-
have shown
train-
classification)
Herz-Kreislauf-Klinik
Medical
From
Angiology,
Numerous clinical
studies
t
i
-
ve
5
.
Bad
Bevensen,
Bevensen,
Cologne,
Germany;
Consulting,
Germany
was
that in these
a
patients supervised physical
the Schwarz Pharma
This
by
GmbH,
supported
study
ing program improves walking
c2a,pa5c-it1y4.
Monheim,
Germany
in the
of differences
Because
parameters—in—
Milan
Cachovan, MD,
30,
Correspondence:
Hans-T6njes-Ring
duration—of
and
such
exer-
frequency,
tensity,
cise
21337
Germany
Luneburg,
wide
in the increase in
distance has been noted.
Moreover,
variability
programs,
708 Glen
Westminster
NY
Cove
@2001
Glen
Publications, Inc.,
11545,
Avenue,
USA
Head,
walking
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382
there is evidence that the
in these
of
Methods
compliance
patients
is
limited, 15
programs
par-
participating
when at least
6
months are needed to
ticularly
Population
Study
effect.
weeks
4
can
achieve an
of treatment
result in an
Alternatively
optimal
with
Teninpatients
57
our
men, 3 women;
(7
E1 (PGE1)
age,
in
average
prostaglandin
improvement
in
our
of the initial
14
years)
hospital
participated
average
all
criteria:
met the inclusion
as various
distance ofabout 100%
demonstrated.l6-22
stud-
pilot study.
They
walking
stable intermittent claudication of at least
2
have
Even
ies
in
months
the treadmill
absolute
distance on
dis-
standing,
walking
between50 and 200
12%)
improvements
walking
a
greater
tance-up
seen with
combina-
and IV
to 263%-are
(3
km/h,
m. Stenoses or occlusions of the
or
tion of weeks ofintensive
4
PGE1
upper thigh
training
lower
were confirmed
These better-
infusions
leg
or
by Duplex ultrasonog-
during pedalergometry.23
The ankle-brachial index
us to
out a
results
raphy
(ABI)
at
angiography.
carry
than-average
prompted
with the aim of
<
of the affected
to be
had
0.85
at the
on the treadmill
similar
whether
extremity
establishing
investigation
and
the absolute arterial
minute of
a
relevant
in intermittent
rest,
pressure
improvement
with shorter
1
ankle after
of
train-
claudication is
treatment.
a
walking
possible
period
had to decrease
more than
Since it is known that
a
(3
12%)
km/h,
by
major
with
10%. Patients
cardiac
diseases
severe
mechanism is the
in
(eg, decompensated
ing
improvement
oxygen
heart dis-
coronary
but
is known
mismatch,
insufficiency,
supply-demand
nothing
severe ventilation
for whomthe
about the effect of
treatment on this
para-
disorders)
ease,
treadmill test
PGE1
also examined
were
involve an addition
our
risk,
meter,
might
study
cardiopul-
pilot
from
Also
were
excluded
the
excluded
function
The
2
of
study.
pa-
well as
dis-
using spiroergometry.
monary
with
and
tients
rest
as
choice ofthe relative short treatment
necroses,
pain
period
those with other conditions
weeks was
both
the
of
limiting walking
by
length
stay
prompted
with
and
vascular
to initiation of
in our
but also
the wish to
tance,
disorders. Within
patients
inflammatory
hospital,
by
improve
the
weeks
4
motivation and
prior
the
treatment
compliance by achieving
patient
the
and also
and interventional
visible results more
while at the same
effect bylowering
during
pilot study,
pe-
addi-
other
vasoactive
rapidly,
time
costs
a
socioeconomic
measures,
riod,
surgical
realizing
tional
treatment times.
and/or
permitted.
walking training,
byshortening
the results of our
not
All
the
medications were
To
a
patients
pilot study,
sim-
served as
compare
their written informed consent to
with 23
a
gave
participate
receiving
patients
previous study’
in the
The
conforms with the
without
a
ilar
PGE1
investigation
study.
training
program
in the
outlined
Declaration ofHelsinki.
historical control
principles
group.
CPX
ankle-brachial
1.
ABI
exercise
test;
3
Figure
systolic
Studydesign.
cardiopulmonary
constant
CL-test
12%grade.
blood
load
and
km/h
test at
index;
pressure
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383
I.
SELT-treadmill
for
arterial occlusive disease.
Table
testing protocol
peripheral
for inclusion in the
standardized treadmill
was carried out under
Protocol
study
Testing
and
ergometric loading,
were mea-
the
and
of the
height
sured.
weight
patients
Exercise Test andABI
Constant-Load
A
maximumincremental exercise test was
the
ofthe
for in-
At
clusion
the SELT
admission,
(Table I)
protoco125
suitability
patient
performed using
in the
wastested onthe basis ofthe
and the Trackmaster
treadmill
TM-310
(JAS
study
this
inclusion andexclusion criteria. For
as
a
test device.
the
Fitness
FL)
Pensacola,
purpose,
exercise ECG
System,
air was
a
and an
ECG
were obtained.
(75
initially,
resting
Expired
sampled continuously using
a
of fa-
the
and metabolic
watts)
period
Following
breath-by-breath technique,
gas
miliarization ofthe
with the
(ACD)
measurements were
treadmill,
patient
exchange
performed
and absolute
3
initial
at
distance
exercise
(ICD)
12% and
walking
system
The
(MedGraphic cardiopulmonary
were
Medical
St.
km/h
(constant-load test)
MN).
CPX/D;
system
Paul,
Graphic Corp,
determined. Preference was
to this
then
treadmill
tients
the
was calibrated before each test. The ECG
and blood
given
recent
in
200
since in
a
was
monitored
protocol
study
pa-
m)
continuously,
measured before and after the exercise test. The
were instructed to the
pressure
<
with
severe claudication
(ACD
to the
constant-load test
touch
to maintain bal-
superior
proved
patients
handrail of the treadmill
lightly
test with
The ankle-brachial
to the coefficient
regard
graded-exercise
only
variation.24
index was de-
minute ofexer-
of
and to walkuntil
the claudication-related
could no
bear
ance,
they
pain.
longer
1
both at rest
on the treadmill. In the absence of
after
termined
cise
and
For online data
PC-work station
Predicted
pro-
a
and
(SCS
Normals,
following para-
angio-
cessing
reporting,
software
DTD
and/or
CPX-D,
packages
Duplexultrasonographic findings,
graphic
such
if
were older than 6
or
was used. The
months,
to document
findings
Integration)
examinations were
these
the
meters were documented in accordance with the
repeated
stenoses or occlusions.
SELT
time
work load
(sec),
protocol: walking
work
in
%
load
(work
(W),
capacity
physical
x
load
mL/min
achieved/work
100),
predicted
oxygen
Exercise Test
Cardiopulmonary
in
and
(V02)
V02/mL/kg/min,
uptake
Protocol)
(SELT
carbon dioxide
in
(VC02)
VC02/V02
minute,
mL/min,
output
ratio
in beats
per
respi-
the
Atbaseline
ergometric
heart
(see
investigation
1),
(RER),
spiro-
studydesign, Figure
of the
ratory
exchange
suitable
rate
linear
(HR)
patients
regression
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384
of
coefficient &dquo;b&dquo;
increase
time),
to increase
Historical Control
(ratio
in V02
and ratio
in treadmill exercise
workload
peak
Aprevious
multicenter
with intermittent claudication served as
with 23
inpatients
his-
study’
as
a
coefficient
(mL/min/W)
V02/peak
a
of
demand.
oxygen
To determine
torical
control. Inclusion and exclusion
criteria,
physical
study.
blood lactate con-
were taken from the
capillary
samples
as well as the intensive
standardized
blood
centrations,
were
with our
identical
training program,
ear lobe at rest and 30 sec after
hyperemized
The
difference
the
23
was the fact that
only
pa-
infusions
the test. Measurements were made
the
followed
using
tients did not receive additional
PGE1
was carried out
the initial and
absolute
was
This
portable system.26
Accusport
and that the
training program
a
measurementofthe
arteri-
by repeated
systolic
for
weeks.
4
Weekly,
al
at ankle at rest and after
as
exercise,
pressure
claudication distances were measured.
There-
2
We com-
after an
of
determina-
distance
also,
rest,
adequate period
a
of the
obtained
data after
fore,
comparison
in our
tion of the initial and absolute
walking
weeks
pared
was
(as
study)
of
possible.
as described
test)
(constant-load
previously.
the mean
the two
ICD andACDbetween
change
t
the Student’s
test for in-
groups using
Treatment Schedule
the next the 2-week
dependent
samples.
oftreatment
On
was
day,
period
everymorning,
intravenous infusion of 60
Statistical
Analysis
the
which,
begun, during
pa-
ptg
tient received an
Statistical
tistical software
Microsoft WindowsO
were
the sta-
analyses
performed using
of
Schwarz
hours
SAS@ 6.12 under the
(Prostavasin@
E1
prostaglandin
package
administered over
2
at the
Pharma,
during
Germany)
operating system
intermittent
was
exercise.
pedalergometric
a
Pedalergometry
performed
by
using
pedaler-
manufactured
HWK,
gometer
Germany
the
fre-
load of 2.5
(Profitrainer
Modell),
Tfbinger
target
at
a
60-90
quency being
cycles/min
As soon as claudication
the
was
kg.
pain
experi-
and con-
enced,
patient stopped exercising
tinued
on
of
the 30-
again immediately
disappearance
the
after the
infusion,
pain. Directly
minute standardized
was initiated under
physical training program
The
supervision.
and
program
exercis-
comprised loosening up
stretching
at
knee
es,
walking
speeds,
tiptoeing,
varying
bends and
exercises. This was followed
balancing
onthe
with
treadmill
to 66%ofthe absolute walk-
bytraining
weekly adapta-
tion
ing
of
performance
distance. The
two sessions
training comprised
of exercise
a
10-minute
The
separated by
pause.
and the treadmill
30-minute exercise
were
program,
afternoon.
This
training
repeated every
combined treatment schema
in-
PGE1
involving
fusions and
was carried out
5
times
a
training
week
2
the
re-
for weeks. On
weekends,
patients
ceived
infusions.
PGE1
day
only
One
after the end of the treatment
peri-
determina-
the
od,
examination,
spiroergometric
index and the constant-
tion ofthe ankle-brachial
load exercise test were
Thereafter fol-
repeated.
test
lowed
a
without
2.
Treadmill exercise test
test at
load
3-months
Figure
follow-up period,
At
end of this
3
and
12%
km/h
medication and
the
(constant
time,
un-
training.
the
derwentthe
returned to our
spiroergometric
and
Initial claudication distance
grade).
and
(ICD)
(ACD)
patient
hospital
again
and de-
claudication distance
absolute
examination
index.
before and after
termination ofthe ankle-brachial
therapy.
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385
83 to
to
m
after
1
of IFNS
In
m
facilities
92
109
to 102
after
2
GmbH,
week,
weeks,
computer
accordance
Germany.
mainly
m
after
3
with the
de-
and
increased
m
after
to
134
127
4
m
weeks,
study design,
statistical methodswere used. Standard
weeks. The ACD
after
after
from
to
145
scriptive
1
were
to 152
and to
m
m
descriptive summarystatistics
calculated for
after
2
to 167
week,
weeks,
weeks,
variables. In
interferential statistical
3
continuous and
222
m
after
weeks.
4
addition,
categorical
were
a
2-week
23%
the ICD in-
treatment,
analyses
Regarding
exploratory
com-
carried out:
frombaseline were
creased
83 to 102
m)
71
(from
changes
analyzed
Pearson’s
was
only by
m
to
rank test.
with an
in our
with the Wilcoxon
increase of
134%
(from
signed
pared
166
two
between the
correlation
The difference
m)
coefficient, r,
study.
product-moment
used to
analyze
the linear association between
variables.
in mean
of ICD was
of the
and
groups
signifi-
change
treated
in
two continuous
cant
with
favor
0.006)
combination of
group
PGE1
(p
infusions
a
training
Table
The difference between
to the ACD
(see
the
3).
II,
Figure
with
was
groups
as well:
regard
significant
to
m
there was anincrease from 132
with
260
127
and
and from
to
(97%)
PGEI,
Results
training
with
152
m
0.002).
(20%)
training only (p =
Exercise Test and ABI
Constant-Load
Exercise Test
Cardiopulmonary
with
a com-
the
2
weeks of treatment
and
Following
bination of
time measured
the initial
134%
The absolute
The
exercise
PGE1
training,
significantly by
peak walking
during graded
a
physical
the
showed
SELT
distance increased
to 166 meters
using
protocol,
sig-
walking
from
increase after the 2-week
from
nificant
225 to
the end ofthe
same
71
treatment,
(p < 0.01).
at
distance also showed
a
in-
and reached 421 seconds
397
seconds,
significant
walking
Atthe
meters
crease from 132 to 260
4).
(97%)
2).
follow-up period (Figure
peak
from
(Figure
workload increased
ankle-brachial
cise remained
at rest and after exer-
both follow-
treatment and at the end of
The
index
virtually unchanged,
time,
significant-
W
W
to 71
34
(after
(baseline)
108%,
ly by
and
W
79
The
the
2weeks of
treatment),
(follow-up).
ing
follow-up pe-
in functional
was reflect-
riod
(Table III).
capacity
improvement
ed
the
increase in
significant
to
peak oxygen up-
by
and
re-
take from 15.7
17.3
19.1
of the ICD and ACD with the
Group
mL/kg/min,
Comparison
at the same
load
Control
while,
time,
Historical
peak oxygen
work
spectively
work
load)
(peakV02/peak
uptake per
anidentical train-
decreased
In the
41%
5).
by
(Figure
previous
receiving
significantly
a
study
in
a
there was
reduction
the
the
exer-
butwithout
21
whichserved as
PGE18
Overall,
significant
ing program
into
from
rate of increase
were included
historical
the
in V02
the
control,
during
graded
patients
cise
coefficient &dquo;b&dquo;
TheICD increased
by
regression
analysis.
(expressed
per-protocol
with
orwithout
PGE1
Table II.
Difference
baseline.
and
after
ACD
2
weeks
of ICD
training
to
compared
Downloaded from ang.sagepub.com at The University of Iowa Libraries on June 9, 2015

386
Downloaded from ang.sagepub.com at The University of Iowa Libraries on June 9, 2015

387
Differences ofthe initial
4.
Peak
time
(sec)
3.
Figure
during
walking
exercise
Figure
claudication distance
and absolute
(ICD)
cardiopulmonary
testing
2
see &dquo;Methods&dquo; and
distance
after weeks
claudication
(ACD)
(SELT-protocol,
Table
after
before and after
and
or without
with
(this
I)
PGE,
study)
therapy
training
to
PGE1 (historical control8)
baseline.
compared
follow-up.
ratio ofincrease
in V02
to increase in treadmill
the
2
the
16 - 20
weeks oftreatment
as
mL/kg/min). Following
at
The
54%.
and
the end of
exercise
work
time) -of
predicted physical
follow-up,
majoritybelonged
in functional
increased
class
B (V02max
20
100%,
by
capacity
significantly
mL/kg/min)
from
until
and
to
and remained
or class
At
24
A (V02max >
49%,
baseline,
unchanged up
mL/kg/min).
6
of
10
the end of
blood
The
heart rate
peak
were
in
limited
their walk-
all the
patients
follow-up.
highly
end
as also
ofthe
values,
peak
pressure
capillary
signifi-
was
not
ing ability; by
follow-up period,
blood lactate concentrations showed no
showedan
their
SELT test criteria
patients
tolerance
improvementin
walking
The
cant
anaerobic threshold
on the basis of the
of
change.
in
of the cases. All the relevant data
reached
in
terms of
severe claudi-
any
(impairment
walking
ability
physi-
<
PWC 20%
are shown in Table III.
Betweenworkload and
cal work
capacity:
there
cor-
PWC26%-50%
moderate
cation;
claudication;
oxygenuptake,
with
r
a
a
correlation
PWC
mild
51%-75% -
was
0.94;
good
tight
claudication/walking
wasfoundbetween absolute
and
PWC
walkingdis-
relation
tance
> 75%
from
through;
asymptomatic),
<
lib
to
Fontaine
Fontaine
25%)
(r
(PWC
(graded protocol)
oxygen uptake
stage
stage
or better.
into account the functional
the
classifi-
IIa
26%-50%)
0.91).
cation
(PWC
Taking
of
the 2-week examination
reveals
be-
10 - 16
no
Weber, 27
peak V02
clearly
period,
During
neither
to
most of the
undesirable effects
treatment nor
treatment,
class
occurred,
training.
PGE1
during
that,
patients
prior
longed
C
in functional
(V02 max
during
Downloaded from ang.sagepub.com at The University of Iowa Libraries on June 9, 2015

388
in
distance have
from
provements
walking
ranged
see reference
to 300%
44%
On
(for
5).
review,
of
a
the basis
of 21
meta-analysis
methodologi-
studies on
train-
meet current
widely
cally
physical
differing
however no
ing-which,
longer
trial recommendations-GardnerandPoehlmann
that
conclude
to be
an
needs
is there-
optimal training program
carried outfor at
6
It
least
months.9
in
fore all the more
combination of
this
a
that,
noteworthy
study,
infusion and
14
train-
rel-
PGE1
physical
achieved-after
ing
only
in
with those
days-clinically
evant
were
distance that
for
improvements
walking
comparable
reported
training
over several months.
programs applied
results are
with those
Our
compatible
report-
dis-
ed
who
Scheffler,
by
tance
investigated walking
intensive
under
improvement
supervised
treatment
with
added
(IV
compar-
of
PGE1
BID)
physical training
infusion
in
during pedal ergometry
An
alone.
ison with
the results
showed
physical training
analysis
of all
the
4
(15
patients
per group),
after
weeks of treatment in the
that,
combined
the ICD of81
m
PGE1/training group,
m.23 If
distance to more than
with
increased by 604%-to570
patients
in
an increase
are
walking
m
the
was still
after 2
excluded,
remarkable 263% after
1,000
improvement
a
4
90%
weeks;
It
weeks.
be
that
must, however,
study
program
weekends)
supervised gymnastics
emphasized
involved an
thatwas
Scheffler’s
demand-
twice
morethan
extremely
applied
5.
exercise test
Figure
(SELT-protocol): Improvement
due to
Cardiopulmonary
a
exercise
ing
day
of
walking
and
2
(including
comprised
a
increase in
efficiency
significant
and treadmill
hours of
left
V02;
peakoxygen uptake (peak
figure)
as well as
the infusions.
hours of
4
pedal
training
ergometry
,
a
decrease in the ratio of
and
significant
during
workload
peak oxygen uptake per
V02/peak
(peak
In
the same 1-hour exercise
contrast,
program
WL;
right figure).
in
was
our
carried out in
that served as
investigation
multicenter
employed
the
a
study
previous
historical control.8Eventhe
data of
demographic
in
our
the
were similar to those
patients
a
study;
ofthe results would seem
thus,
comparison
ap-
The
difference between the
Discussion
propriate.
significant
z
increase in ICD of
in the
and
134%
present study
the
small increase of 23% in the
Exercise
previous study
the
Training
be
(without
additive
PGE1)
might
explained only by
For
more
than
has
30
exercise
infusion.
PGE1
years,
training
improve walking capacity
with intermittent claudication.l2 In the
been
recommended to
in
.
patients
Additive
Baseline
PGE,
a
studies have
in
increases
considerable numberof
meantime,
been
carried
which
of
all of
out,
report
Findings
distance,
varying magnitude.
walking
although
dif-
Due
to
Due
and
for
to its
antithrombotic,
inhomogeneous patient populations,
leukocyte-
vasodilatory,
differences in the
ferences in
intensity,
has
modalities,
PGE1
training
properties,
endothelium-stabilizing
and duration of such
of the
been an
the
pro-
frequency
part
therapeutic
years
integral
differences in the de-
im-
and
ofsevere
in
treatment
ar-
methodological
grams,
strategy
terial
peripheral
limb
termination of
occlusive disease
distances,
(critical
ischemia).
walking
reported
Downloaded from ang.sagepub.com at The University of Iowa Libraries on June 9, 2015

389
controlled studies
canbe seen
duration
Data
available
anincrease of 100%
numerous
are also
from
exercise
8 and
26
of
following
varying
even in
training
for intermittent
(between
claudication,
distance
weeks),
showing
in
on
after,
walking
healthy, elderly persons.32-38
In
In in
of treatment. 16-22
most of
our
weeks
both the
4
addition,
average,
these
was administered
study,
improve-
dose of 60
a
mentin
efficiency and
utilization
PGE1
that
studies,
once-daily
walking
J.Lg
oxygen
change
were reflected in
file of
a
in the
intravenously-aregimen
significant
pro-
coef-
in our
Onthe basis of
to
we also used
hemo-
intermit-
exercise
V02
&dquo;b&dquo;)
study.
response
and
(regression
in
with
ficient
a
dynamic investigations
significant
in peakoxy-
(W).
Assuming
decrease
workload
patients
tent
it is known that
(V02)
claudication,
intravenously
gen uptake
per
at
a
of
dose 60
administered
limb
the transcutaneous
increases
that the onset ofclaudication is due to an
oxygen
PGE1
J.Lg
to
At the
of
161%.
same
the
given
distances
time,
mismatch,
demand/delivery
perfusion by up
optimization
and the skin
Withthe
was
a
kinetics of
and the
at
P02
lower V02
temperature
oxygen
increase
ofthe
adminis-
ex-
workload
significantly. 21
exception
may permit
walking
longer
the
before claudication
These results are
Scheffler,23 PGE1
study by
always
pain stops
activity.
tered
at rest. It therefore
in
with earlier
to
patients
appeared
conformity
to have
muscular exer-
infusion while
that
a
substantial
of the
toler-
pedient
patients perform
findings showing
part
walking
cise
sion
and after
was
in
PGE1
during
perfu-
training-related improvement
ance is caused
of the
For this
distribution of
the
leg
improved.
purpose,
since the
muscle ex-
by regional
available blood flowto the active
is
muscles39,40 and
suitable,
eminently
pedal ergometry
increases in local aerobic work
that
seated,
patient, comfortably
performs
by
capacity
increased
oxygen
in
ercise for the duration of the 2-hour
infu-
be
part,
PGE1
might,
explained by
sion. It
be assumed that the combination of
extraction 40,41 and
more effective
may
by
peripheral
due to metabolic
an
in
muscle exercise and simultaneous infusion of
utilization
oxygen
adaptation
that effects not
an in-
muscle.42-44 In
biomechanical efficiency due to
nation of the
in
coordi-
PGE1-a
crease in blood
the utilization
addition,
prostanoid
only
leg
improvement
an
improvementin
but also
flow,
of
improved
and
or
a
decrease of
which
muscles,
working
oxygen
glucose29-leads to
an enhanced activation of the oxidative
intramuscular
capacity
in-between-step
is an
pressure,45
of the muscle.
data obtained
mechanismin
has also been
Our
during spiroer-
important pathophysiological
the SELT test
the
intermittent
claudication, 10,46,47
gometry using
support
hypoth-
esis that the increase in
distance is relat-
demonstrated in our
from
and
we
this,
study. Apart
walking
in
to
a
cost ofthe exer-
in
with other
lower metabolic
ed,
authors, 39,44,46,48
part,
agreement
all the
an increase in
not
found no
namics
in
in
or arterial
cise .2,30
demonstrated
Thus,
patients
distance,
changes
general
hemody-
but also an
of
the
increase
134%
walking
cardiopulmonary
measured
capable
explaining
distance.
only
improvementin
as re-
function,
pain-free walking
in all the
The use of the
flected
SELT
developed
parameters
There was
byspiroer-
protocol
by
merely
perfor-
a
correlation between
us25
of the
onaccount not
of the increase in
of
high
proved advantageous
gometry.
walking
distance and
(r
quantification
peak oxygen uptake
but also of the
the end ofthe 2-weektreatment
0.91).
mance,
such
By
period,
possibility
eliminating
example,
had
factors
for
the latter
to
increased
from 15.7
data were
as,
confounding
significantly,
in
on the determination of
Almost identical
17.3
changes
mL/kg/min.
by
bodyweight,
12-week
distance. Since the first
load
Hiatt and co-workers after
to
a
be-
walking
already
reported
at
0.25
the
work
16.9
(15.0
the
gins
W/kg,
physical
training program
mL/kg/min) .30
capacity,
in
had
of the
which correlates
can
with
While
our
positively
oxygen uptake,
study
uptake
peak oxygen
be estimated and used as
a
increased to
the end
suitable
19.1
parame-
by
mL/kg/min
col-
ter for
the
and
Hiatt
ofthe
claudication or
3-month treatment-free
assessing
severity
follow-up,
the effects of treatment.49
observed
a
value of
17.8
only
mL/kg/min
were
leagues
Our
intermittent
has confirmed
weeks of
that
with
after
Similar
24
study
claudication
are
patients
training.
figures
to
characterized both
also found in
a
conducted
Gardner
and
study
by
in
out in
weeks
ex-
a
restricted functional
and
correlation
a
low
three different
exercise
highly
capacity
compare
an
protocols,
A
linear
exercise tolerance.
carried
positive
investigation
by Regensteiner
the
found between
and
has been
claudication-limited
of
with intermittent claudication
6
patients
a
with
to
after
impairment
exercise
oxygen uptake
peak
walking
with
peak
bypass operation
regard
time and
performance. Ashort-term
ercise
(maximum
program
performance
walking
in an
resulted
in
on
and
additive
cant
PGE1
impressively signifi-
lifestyle,
Depending
peak VO2).10,31
age,
and
similar
increases in
conditions,
performance
walking
training
peak V02
improvement
Downloaded from ang.sagepub.com at The University of Iowa Libraries on June 9, 2015

390
der
in
In:
4.
5.
Kommissionf&uuml;r
thereafter in functional
that the
exercise
It is
Mitglieder
der
Qualit&auml;tssicherung
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der Gef&auml;&szlig;e.
Angiologie:
Erkrankungen
effect on
de-
oxygen
probable
lowering
Classen
Rationelle
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Dierkesmann
M,
(eds):
H,
in
R,
Heimpel
Therapie
Fischer,
mand
microcircu-
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und
der Inneren
Diagnostik
enhanced
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first
the
for the
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increase in ICD and
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134%
ACD
the
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Exercise test-
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Hiatt WR:
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