Background: Treadmill walking is the most commonly recommended exercise modality in supervised exercise therapy (SET) for peripheral artery disease (PAD); however, other modalities may be equally effective and more tolerable for patients. The primary aim of this single-blind, randomized pilot study was to compare the feasibility, safety, and preliminary efficacy of a treadmill walking (TM) versus a total body recumbent stepping (TBRS) exercise program for treatment of PAD. Methods: Participants ( n = 19) enrolled in a 12-week SET program and were randomized to either a TM ( n = 9) or TBRS ( n = 10) exercise group that followed current SET exercise guidelines. Feasibility, safety, and efficacy outcomes were assessed. Results: SET attendance was 86% and 71%, respectively, for TBRS and TM groups ( p = 0.07). Session exercise dose (metabolic equivalents of task [MET] minutes) (mean [SD]) for TM was 117.6 [27.4] compared to 144.7 [28.7] in the TBRS group ( p = 0.08). Study-related adverse events were nine in 236 training hours and three in 180 training hours for the TBRS and TM groups, respectively. There were no significant differences between groups for improvement in 6-minute walk distance (mean [SD]) (TM: 133.2 ft [53.5] vs TBRS: 154.8 ft [49.8]; p = 0.77) after adjusting for baseline 6-minute walk distance. Conclusion: This is the first randomized study comparing TBRS to TM exercise in SET using current SET guidelines. This pilot study showed that TBRS is a feasible and safe exercise modality in SET. This study provides preliminary efficacy of the use of TBRS exercise in SET programs following current guidelines. Larger studies should be conducted to confirm these findings.

Second Life is an online virtual environment populated by 3-dimensional graphical representations of over 330,000 people. The Second Life Library 2.0 project endeavors "to utilize the programs currently offered online to librarians and library users to extend the programs to the Second Life virtual reality game" (http://infoisland.org/ about/ accessed October 13, 2006). The virtual environment of Second Life offers the potential for radical changes in the way information and services are provided and also in the way librarians, library users and information interact. Practical issues that may affect library services in the Second Life environment include issues of appropriate copy, permissions, authentication, and limitations of functionality in Second Life for security reasons (e.g., XML-related scripts in Second Life are currently non-functional due to concerns over their potential for use in dangerous or illegal ways such as to create denial of service attacks). Librarians in Second Life are collaborating with users to bring them resources and services in numerous areas, including science, in traditional and new, innovative ways.

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