Efficacy of a short-course intensive rehabilitation program in patients with moderate-to-severe intermittent...

Many rehabilitation programs for intermittent claudication include physical training for several months, since the outcome of short-course protocols is still unclear. The aim of this study was to evaluate the efficacy of a short course of exercise therapy in patients with moderate-to-severe intermittent claudication in terms of walking distance variations.

Twenty-six patients (males 88%, mean age 59 +/- 8 years, ankle-brachial index < or = 0.8 and < or = 0.5 before and after exercise respectively) were evaluated. Moderate-to-severe stenoses or occlusions were localized at color Doppler scanning of the abdominal aorta/iliac arteries and femoral/popliteal/tibial arteries in 15 and 31% of patients respectively, while in 54% of cases both the proximal and distal sites were involved. The initial and absolute claudication distances were recorded by means of the constant treadmill test (3 km/hour speed, 0% grade) at the time of presentation and after a short-course comprehensive rehabilitation program (4 week duration) including physical training, educational intervention, psychological support, and cardiovascular risk management.

At the end of the program, 1 patient (4%) became asymptomatic (walked > 1000 m without pain). In 25 patients who still developed pain, the average increase in the initial claudication distance was 132% (from 75 to 174 m). Among these, 20 patients (77%) were still unable to complete the treadmill test due to maximal claudication pain, but the absolute claudication distance increased by 87% from 204 to 381 m (p < 0.05). No cardiovascular complication occurred during the study period. Major clinical variables failed to predict an unsatisfactory increase in walking capacity.

Short-course training programs enhance the walking ability even in patients with moderate-to-severe intermittent claudication and seem to be well tolerated, supporting their widespread use in rehabilitation centers.