Comparison of two treadmill training programs on walking ability and endothelial function in intermittent claudication

BackgroundIn this randomized trial we compared two treadmill trainings, based on exercises performed to moderate claudication pain vs pain-free training, with respect to their effects on walking ability and endothelial function.MethodsA total of sixty patients with stable intermittent claudication were randomized to the pain-free treadmill training (repetitive intervals to onset of claudication pain) or moderate treadmill training (repetitive intervals to moderate claudication pain). In both groups exercises were performed 3 times a week for 3 months. Changes in flow mediated dilatation (FMD) and treadmill walking performance as well as plasma levels of C-reactive protein (hs-CRP) and fibrinogen were assessed before and after the program.ResultsFifty-two patients completed the training program. Post-training maximal walking time was prolonged by 100% (p < 0.001) vs 98% (p < 0.001), and pain-free walking time by 120% (p < 0.001) vs 93% (p < 0.001) in the moderate training group as compared to the pain-free training group, respectively. FMD increased by 56% (p < 0.001) in the moderate training group and by 36% (p < 0.01) in the pain-free training group. No significant changes in the levels of hs-CRP and fibrinogen were seen after treadmill program in either group.ConclusionsBoth pain-free treadmill training and the moderate treadmill training have similar efficacy on walking ability in patients with claudication. The improvement of post-training FMD indicates systemic effect of both treadmill programs on endothelial function. Both programs appear to be safe therapeutic modes, since none of them escalates the inflammation. Pain-free treadmill training seems useful and effective therapeutic option for patients with claudication.