Walking economy before and after the onset of claudication pain in patients with peripheral arterial disease

Abstract

Purposes To determine the walking economy before and after the onset of claudication pain in patients with peripheral arterial disease (PAD), and to identify predictors of the change in walking economy following the onset of claudication pain. Methods A total of thirty-nine patients with PAD were studied, in which 29 experienced claudication (Pain group) during a constant load walking economy treadmill test (speed = 2.0 mph, grade = 0%) and 10 were pain-free during this test (Pain-Free group). Patients were characterized on walking economy (i.e., oxygen uptake during ambulation), as well as on demographic characteristics, cardiovascular risk factors, baseline exercise performance measures, and the ischemic window calculated from the decrease in ankle systolic blood pressure following exercise. Results During the constant load treadmill test, the Pain group experienced onset of claudication pain at 323 ± 195 seconds (mean ± standard deviation) and continued to walk until maximal pain was attained at 759 ± 332 seconds. Walking economy during pain-free ambulation (9.54 ± 1.42 ml.kg−1.min−1) changed (p < 0.001) after the onset of pain (10.18 ± 1.56 ml.kg−1.min−1). The change in walking economy after the onset of pain was associated with ischemic window (p < 0.001), hypertension (p < 0.001), diabetes (p = 0.002), and height (p = 0.003). In contrast, the Pain-Free group walked pain-free for the entire 20-minute test duration without a change in walking economy (p = 0.36) from the second minute of exercise (9.20 ± 1.62 ml.kg−1.min−1) to the nineteenth minute of exercise (9.07 ± 1.54 ml.kg−1.min−1). Conclusion Painful ambulation at a constant speed is associated with impaired walking economy, as measured by an increase in oxygen uptake in patients limited by intermittent claudication, and the change in walking economy is explained, in part, by severity of PAD, diabetes, and hypertension.

Sildenafil improves skeletal muscle oxygenation during exercise in men with intermittent claudication

“…These findings underscore the complexity of the genesis of functional impairment in individuals with IC (2). It is well established that walking impairment in these patients stem from a combination of several mechanisms that range from intrinsic skeletal muscle abnormalities to poor walking economy (2,16,40). In essence, targeting only one of the multiple mechanisms that underlie the exercise intolerance in these individuals might be insufficient to promote an acute improvement in performance (8).…”

Clinical Interest of Ambulatory Assessment of Physical Activity and Walking Capacity in Peripheral Artery Disease

“…The authors computed the ratio of walking events to upright events to provide an Event-Based Claudication Index and reported that this index was greater in PAD patients with intermittent claudication than in controls. Other studies reported associations in PAD patients between walking pattern and clinical, physiological, or biological features (Gardner et al, 2010b(Gardner et al, , 2010c(Gardner et al, , 2011b(Gardner et al, , 2012b(Gardner et al, , 2014cRitti-Dias et al, 2011;Gardner et al, 2015).…”

“…Besides the assessment of additional dimensions of PA by measuring the intensity or the duration of ambulation, the study of ambulatory walking pattern is of particular interest in PAD patients since it can be modified because of claudication (McDermott et al, 2001b;Gardner et al, 2010c). The StepWatch 3 ™ (Gardner et al, 2007b(Gardner et al, , 2008(Gardner et al, , 2010b(Gardner et al, , 2010c(Gardner et al, , 2011b(Gardner et al, , 2012b(Gardner et al, , 2014cRitti-Dias et al, 2011;Gardner et al, 2015) and the activPAL ™ (Clarke et al, 2013;Stansfield et al, 2015) are the two ambulatory devices currently used in PAD patients for such purpose (Supporting Information Appendix S2 and S3). Although these devices have been extensively used and validated across different populations, validity studies Physical activity and walking capacity in PAD conducted specifically in PAD patients are lacking.…”

Walking economy and aerobic power in Parkinson’s disease after endurance exercise training: A pilot study

“…Walking economy (WE), defined as the steady-state aerobic demand for a given submaximal speed of walking, 1 is abnormal in some vascular, neurological and orthopedic disorders. 2 Increased energy expenditure during walking (i.e, poor economy) has been linked to such conditions as peripheral arterial disease, 3 stroke, 4 spinal cord injury, 5 amputation, 6 and cerebral palsy. 7 In men with Parkinson's disease (PD), there was a trend for energy to be increased relative to healthy age and sex-matched controls.…”