DIFFERENCES IN EXERCISE PERFORMANCE AND LEISURE-TIME PHYSICAL ACTIVITY IN OLDER MEN AND WOMEN

PURPOSES

(a) To compare exercise performance and leisue-time physical activity (LTPA) between older men and women, (b) to assess the relationship between exercise performance and LTPA, and (c) to determine whether group differences in exercise performance persist after controlling for LTPA.

METHODS

A total of 105 women and 155 men who were 65 years of age and older participated in this study. Subjects were characterized on exercise performance by a 6-minute walk test, and by a short physical performance battery (SPPB) consisting of a repeated chair rise test, a standing balance test, and a 4-meter walk test. Additionally, LTPA was assessed using the Minnesota LTPA questionnaire.

RESULTS

Women had a 7% lower SPPB value (P < 0.001), a 12% shorter 6-minute walk distance (P < 0.001), and a 28% lower LTPA value (P < 0.011) than the older men. LTPA was significantly related (P < 0.01) to both SPPB and 6-minute walk distance in the older men and women. Group differences in SPPB and 6-minute walk distance between older men and women were no longer present (P > 0.05) after controlling for LTPA.

CONCLUSIONS

Older women have impaired exercise performance and lower LTPA compared to older men. Furthermore, sex differences in exercise performance no longer exist after controlling for LTPA.

Assessment of free-living daily physical activity in older claudicants: validation against the doubly labeled water technique

BACKGROUND

The purpose of this study was to compare physical activity assessed by monitoring devices and questionnaires with the criterion method of physical activity using doubly labeled water (DLW) in free-living peripheral arterial occlusive disease (PAOD) patients.

METHODS

Twenty-two older nonsmoking PAOD patients with intermittent claudication (age = 68.7 +/- 7.3 years, ankle/brachial index = 0.67 +/- 0.21) were recruited from the Vascular Clinic at the Baltimore Veterans Affairs Medical Center. The energy expenditure of physical activity (EEPA) was calculated using DLW. Physical activity values were also obtained by activity monitors (an accelerometer and a pedometer worn on each hip over a 48-h period) and by three activity questionnaires (the Minnesota Leisure-Time Physical Activity, the Peripheral Arterial Disease Physical Activity Recall, and the NASA Johnson Space Center questionnaire).

RESULTS

As expected, the claudicants were sedentary, as EEPA was 378 +/- 190 kcal/day. The activity value from the accelerometer was highly correlated with EEPA, yielding a regression equation of EEPA (kcal/day) = 81.6 + (0.599 x accelerometer kcal/day); R = .834, R2 = .696, standard error of estimate = 77 kcal/day, p = .001. The activity value from the pedometer was also correlated with EEPA, yielding a regression equation of EEPA (kcal/day) = 76.6 + (0.048 x pedometer steps/day); R = .614, R2 = .377, standard error of estimate = 124 kcal/day, p = .002. None of the physical activity questionnaires was significantly correlated with EEPA, as the correlation coefficients ranged between .037 and .326.

CONCLUSION

Free-living daily physical activity of older PAOD patients with intermittent claudication can be accurately predicted with an accelerometer, and to a lesser extent with a pedometer, worn over a 48-h period.

Association between lower-extremity function and arterial compliance in older adults

The purpose was to identify the association between lower-extremity function and arterial compliance in older men and women. Participants included 46 healthy men (n = 18) and women (n = 28) 60 years of age or older. Lower-extremity functional performance was assessed by the summary performance score (SPS) that includes tests of 5 timed repeated chair rises, standing balance, and 4-meter walking velocity. Arterial compliance and arterial pressure were analyzed through pulsewave analysis. Small arterial compliance (3.74 +/- 2.14; mean +/- SD) was related (r = 0.34, P = .028) to SPS (11.09 +/- 1.19) after adjusting for body surface area, hyperlipidemia, and hypertension. Systolic blood pressure (138 +/- 14) also was related to SPS (r = -0.314, P = .040). These results suggest diminished lower-extremity function is associated with decreased small arterial compliance and elevated arterial pressure in older men and women.

Age-related differences in arterial compliance are independent of body mass index

The aim of this study is to examine the effect of age on large and small arterial compliance in apparently healthy adults, and to determine whether this effect is independent of body mass index. The subjects consisted of 126 men and women, aged 45 years and above. The subjects rested supine while pulse contour analysis was measured from the radial artery to evaluate large and small arterial compliance. Large (12.0 +/- 4.2 mL/mm Hg x 10, mean +/- standard deviation) and small (3.3 +/- 1.9 mL/mm Hg x 100) arterial compliance were lower in the oldest group (P = .007, P = .002, respectively) compared with the youngest group (15.2 +/- 4.6 mL/mm Hg x 10 and 5.0 +/- 2.5 mL/mm Hg x 100, respectively). After adjusting for body mass index, large and small arterial compliance remained lower in the oldest group. Large and small arterial compliance are decreased with advancing age, independent of body mass index.

The effect of hypercholestrolemia on calf muscle hemoglobin oxygen saturation in patients with intermittent claudication

The purpose was to compare calf muscle hemoglobin oxygen saturation and exercise performance in hypercholesterolemic and normocholesterolemic patients with peripheral arterial disease. Hypercholesterolemic and normocholesterolemic patients had similar ankle/ brachial index (0.72 +/- 0.24 vs 0.79 +/- 0.28, [mean +/- SD]; P = .334). Hypercholesterolemic patients had shorter initial claudication distance (214 +/- 168 m vs 331 +/- 185 m, P = .026), absolute claudication distance (391 +/- 219 m vs 549 +/- 211 m, P = .035), and lower calf muscle hemoglobin oxygen saturation at the occurrence of initial claudication distance (27 +/- 21% vs 39 +/- 20%; P = .013), and absolute claudication distance (26 +/- 21% vs 36 +/- 21%; P = .021). Hypercholesterolemia is associated with shorter walking distances and calf muscle hemoglobin oxygen saturation during exercise in patients limited by intermittent claudication.

Physical activity is a predictor of all-cause mortality in patients with intermittent claudication

OBJECTIVE

We examined whether all-cause mortality was predicted by physical activity level in peripheral arterial disease (PAD) patients limited by intermittent claudication.

METHODS

This retrospective, natural history follow-up study determined survival status of each patient. Patients with stable symptoms of intermittent claudication were evaluated in the Geriatrics, Research, Education, and Clinical Center at the Maryland Veterans Affairs Health Care System (MVAHCS) at Baltimore between 1994 and 2002, and were classified into a physically sedentary group (n = 299) or a physically active group (n =135), and followed in 2004 using the Social Security Death Index.

RESULTS

Median follow-up was 5.33 years (range = 0.25 to 8.33 years) for the physically active group, and 5.0 years (range = 0.17 to 8.5 years) for the sedentary group. At follow-up, 108 patients (24.9%) had died, consisting of 86 (28.8%) in the sedentary group and 22 (16.3%) in the active group. Unadjusted risk of mortality was lower (P = .005) in the physically active group (hazard ratio [HR] = 0.510, 95% CI = 0.319 to 0.816). In multivariate Cox proportional hazards analysis, age (HR = 1.045, 95% CI = 1.019 to 1.072, P < 0.001), body mass index (BMI) (HR = 0.943, 95% CI = 0.902 to 0.986, P = 0.009), ankle-brachial index (ABI) (HR = 0.202, 95% CI = 0.064 to 0.632, p = 0.006), and physical activity status (HR = 0.595, 95% CI = 0.370 to 0.955, P = .031) were predictors of mortality.

CONCLUSION

Patients limited by intermittent claudication who engage in any amount of weekly physical activity beyond light intensity at baseline have a lower mortality rate than their sedentary counterparts who perform either no physical activity or only light-intensity activities. The protective effect of physical activity persists even after adjusting for other predictors of mortality, which include age, ABI, and BMI.

The influence of obesity on falls and quality of life

Objective

To determine (1) whether obese older adults had higher prevalence of falls and ambulatory stumbling, impaired balance and lower health-related quality of life (HRQL) than their normal weight counterparts, and (2) whether the falls and balance measures were associated with HRQL in obese adults.

Methods

Subjects who had a body mass index (BMI) greater than 30 kg/m² were classified into an obese group (n = 128) while those with BMI between 18.5 and 24.9 kg/m² were included into a normal weight group (n = 88). Functional tests were performed to assess balance, and questionnaires were administered to assess history of falls, ambulatory stumbling, and HRQL.

Results

The obese group reported a higher prevalence of falls (27% vs. 15%), and ambulatory stumbling (32% vs. 14%) than the normal weight group. Furthermore, the obese group had lower HRQL, (p ≤ 0.05) for physical function (63 ± 27 vs. 75 ± 26; mean ± SD), role-physical (59 ± 40 vs. 74 ± 37), vitality (58 ± 23 vs. 66 ± 20), bodily pain (62 ± 25 vs. 74 ± 21) and general health (64 ± 19 vs. 70 ± 18). In the obese group, a history of falls was related (p ≤ 0.05) to lower scores in 4 domains of HRQL, and ambulatory stumbling was related (p ≤ 0.01) to 7 domains.

Conclusion

In middle-aged and older adults, obesity was associated with a higher prevalence of falls and stumbling during ambulation, as well as lower values in multiple domains of HRQL. Furthermore, a history of falls and ambulatory stumbling were related to lower measures of HRQL in obese adults.

Cognitive-behavioral treatment for specific phobias with a child demonstrating severe problem behavior and developmental delays

Cognitive-behavioral treatments (CBTs) are widely used for anxiety disorders in typically developing children; however, there has been no previous attempt to administer CBT for specific phobia (in this case study, one-session treatment) to developmentally or intellectually disabled children. This case study integrates both cognitive-behavioral and behavior analytic assessment techniques in the CBT of water and height phobia in a 7-year-old male with developmental delays and severe behavior problems. One-session treatment [Ost, L. G. (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27, 1-7; Ost, L. G. (1997). Rapid treatment of specific phobias. In G. C. L. Davey (Ed.), Phobias: A handbook of theory, research, and treatment (pp. 227-247). New York: Wiley] was provided for water phobia and then 2 months later for height phobia. The massed exposure therapy sessions combined graduated in vivo exposure, participant modeling, cognitive challenges, reinforcement, and other techniques. Both indirect and direct observation measures were utilized to evaluate treatment efficacy. Results suggested CBT reduced or eliminated behavioral avoidance, specific phobia symptoms, and subjective fear. Negative vocalizations were reduced during height exposure following treatment. Vocalizations following treatment for water phobia were less clear and may have been indicative of typical 7-year-old protests during bath time. Findings indicate CBT can be effective for treating clinical fears in an individual with developmental disabilities and severe behavior. Future research in this population should examine CBT as an alternative to other techniques (e.g., forced exposure) for treating fears.

Patterns of ambulatory activity in subjects with and without intermittent claudication

PURPOSE

This study compared the patterns of ambulatory activity in subjects with and without intermittent claudication.

METHODS

The study participants were 98 subjects limited by intermittent claudication and 129 controls who were matched for age, gender, and race. Subjects were assessed on their ambulatory activity patterns for 1 week with a small, lightweight step activity monitor attached to the ankle using elastic Velcro (Velcro Industries BV, Manchester, NH) straps above the lateral malleolus of the right leg. The step activity monitor recorded the number of strides taken on a minute-to-minute basis, the time spent ambulating, and the time and number of strides measured at low (<15 strides/min), medium (15 to 30 strides/min), and high (>30 strides/min) cadences.

RESULTS

Subjects with intermittent claudication took fewer total strides each day than the controls (3149 +/- 1557 strides/d vs 4230 +/- 1708 strides/d; P < .001) and fewer strides at medium (1228 +/- 660 strides/day vs 1638 +/- 724 strides/day; P = .001) and high (766 +/- 753 strides/day vs 1285 +/- 1029 strides/day; P < .001) cadences. Subjects with intermittent claudication also had a lower daily average cadence than the controls (11.8 +/- 2.9 strides/min vs 13.5 +/- 3.1 strides/min; P < .001) and spent less total time ambulating each day (264 +/- 109 min/day vs 312 +/- 96 min/day; P = .034), primarily at medium (58 +/- 30 min/day vs 75 +/- 32 min/day; P < .001) and at high (19 +/- 17 min/day vs 30 +/- 22 min/day; P = .001) cadences.

CONCLUSION

Intermittent claudication is associated with lower total daily ambulatory activity owing both to less time ambulating and to fewer strides taken while ambulating, particularly at moderate and high cadences.

Effects of antecedent variables on disruptive behavior and accurate responding in young children in outpatient settings

The effects of manipulations of task variables on inaccurate responding and disruption were investigated with 3 children who engaged in noncompliance. With 2 children in an outpatient clinic, task directives were first manipulated to identify directives that guided accurate responding; then, additional dimensions of the task were manipulated to evaluate their influence on disruptive behavior. With a 3rd child, similar procedures were employed at school. Results showed one-step directives set the occasion for accurate responding and that other dimensions of the task (e.g., preference) functioned as motivating operations for negative reinforcement.

Exercise performance in patients with peripheral arterial disease who have different types of exertional leg pain

OBJECTIVE

This study compared the exercise performance of patients with peripheral arterial disease (PAD) who have different types of exertional leg pain.

METHODS

Patients with PAD were classified into one of four groups according to the San Diego Claudication Questionnaire: intermittent claudication (n = 406), atypical exertional leg pain causing patients to stop (n = 125), atypical exertional leg pain in which patients were able to continue walking (n = 81), and leg pain on exertion and rest (n = 103). Patients were assessed on the primary outcome measures of ankle-brachial index (ABI), treadmill exercise measures, and ischemic window.

RESULTS

All patients experienced leg pain consistent with intermittent claudication during a standardized treadmill test. The mean (+/- SD) initial claudication distance (ICD) was similar (P = .642) among patients with intermittent claudication (168 +/- 160 meters), atypical exertional leg pain causing patients to stop (157 +/- 130 meters), atypical exertional leg pain in which patients were able to continue walking (180 +/- 149 meters), and leg pain on exertion and rest (151 +/- 136 meters). The absolute claudication distance (ACD) was similar (P = .648) in the four respective groups (382 +/- 232, 378 +/- 237, 400 +/- 245, and 369 +/- 236 meters). Similarly, the ischemic window, expressed as the area under the curve (AUC) after treadmill exercise, was similar (P = .863) in these groups (189 +/- 137, 208 +/- 183, 193 +/- 143, and 199 +/- 119 AUC).

CONCLUSION

PAD patients with different types of exertional leg pain, all limited by intermittent claudication during a standardized treadmill test, were remarkably similar in ICD, ACD, and ischemic window. Thus, the presence of ambulatory symptoms should be of primary clinical concern in evaluating PAD patients regardless of whether they are consistent with classic intermittent claudication.

The relationship between arterial elasticity and metabolic syndrome features

The purpose of this study was to examine the effects of metabolic syndrome (MS) features on arterial elasticity of the large and small arteries in apparently healthy adults, to examine the effect of clustered features of MS, and to determine which features are most predictive of large and small artery elasticity. The subjects for this study consisted of 126 men and women, age 45 years and older. The subjects rested supine while pulse contour analysis was measured from the radial artery by using an HDI/Pulsewave CR-2000 instrument (Hypertension Diagnostic, Inc) to assess arterial elasticity in the large and small arteries. Medical history was obtained along with body mass index, waist circumference, body surface area, and blood pressure. Large artery elasticity was lower (p = 0.002) in subjects with hypertension (12.7 -/+ 4.3 mL/mm Hg x 10) than in those with normotension (15.0 -/+ 4.2 mL/mm Hg x 10; mean -/+ SD), and small artery elasticity was lower (p = 0.001) as well (3.9 -/+2.3 mL/mm Hg x 100 vs 5.3 -/+ 2.5 mL/mm Hg x 100). Large artery elasticity was lower (p = 0.02) in obese subjects (12.2 -/+ 4.9 mL/mm Hg x 10) than in nonobese subjects (14.2 -/+ 4.5 mL/mm Hg x 10), and large artery elasticity was lower (p = 0.04) in subjects with abdominal obesity (12.2 -/+ 4.5 mL/mm Hg x 10) than in those without (14.5 -/+ 4.8 mL/mm Hg x 10). Large artery elasticity decreased as the number of features of MS increased (p < 0.01). Multiple regression showed that body mass index and the presence of hypertension were predictors of large artery elasticity (R = 0.61, R2 = 0.37, p = 0.003, SEE = 3.60 mL/mm Hg x 10), and hypertension was a predictor of small artery elasticity (R = 0.53, R2 = 0.28, p = 0.001, SEE = 2.12 mL/mm Hg x 100). Hypertension and obesity are the features of MS that are most predictive of impairment in large and small artery elasticity in apparently healthy middle-aged and older adults. Furthermore, impairment in large artery elasticity is more evident in subjects with at least three features of MS.

The influence of obesity on calf blood flow and vascular reactivity in older adults

OBJECTIVE

To determine whether differences in vascular reactivity existed among normal weight, overweight, and obese older men and women, and to examine the association between abdominal fat distribution and vascular reactivity.

METHODS

Eighty-seven individuals who were 60 years of age or older (age = 69 +/- 7 yrs; mean +/- SD) were grouped into normal weight (BMI < 25; n = 30), overweight (BMI > or = 25 and < 30; n = 28), or obese (BMI > or = 30; n = 29) categories. Calf blood flow (BF) was assessed by venous occlusion strain-gauge plethysmography at rest and post-occlusive reactive hyperemia.

RESULTS

Post-occlusive reactive hyperemia BF was lower (p = 0.038) in the obese group (5.55 +/- 4.67%/min) than in the normal weight group (8.34 +/- 3.89%/min). Additionally, change in BF from rest to post-occlusion in the obese group (1.93 +/- 2.58%/min) was lower (p = 0.001) than in the normal weight group (5.21 +/- 3.59%/min), as well as the percentage change (75 +/- 98% vs. 202 +/- 190%, p = 0.006, respectively). After adjusting for age, prevalence in hypertension and calf skinfold thickness, change in BF values remained lower (p < 0.05) in obese subjects compared to the normal weight subjects. Lastly, the absolute and percentage change in BF were significantly related to BMI (r = -0.44, p < 0.001, and r = -0.37, p < 0.001, respectively) and to waist circumference (r = -0.36, p = 0.001, and r = -0.32, p = 0.002).

CONCLUSION

Obesity and abdominal adiposity impair vascular reactivity in older men and women, and these deleterious effects on vascular reactivity are independent of conventional risk factors.

The Baltimore activity scale for intermittent claudication: a validation study

The purpose of this study was to develop and cross-validate the Baltimore Activity Scale for Intermittent Claudication (BASIC) questionnaire in patients with peripheral arterial disease limited by intermittent claudication, and to determine whether the BASIC questionnaire score changed following a supervised program of exercise rehabilitation. A total of 702 consecutive patients with peripheral arterial disease and stable intermittent claudication were characterized on physical activity level using the BASIC questionnaire and an accelerometer. The first 351 patients tested were included in the validation group, whereas the final 351 patients were included in the cross-validation group. Subsequently, 61 of these patients participated in a randomized, controlled trial in which 28 patients completed 6 months of exercise rehabilitation and 24 patients completed usual care control. The sum of 5 questions from the BASIC questionnaire (0-10 point scale) was predictive of daily physical activity using the following regression equation: Daily Physical Activity (kcal/day) = 102.2 + (49.6 x BASIC score); R = 0.76, R(2) = 0.58, standard error of estimate = 52.0 kcal/day, P < .0001. This equation was successfully cross-validated on an independent group of patients, as the predicted daily physical activity (339 - 181 kcal/day, mean - SD) was similar (P = .501) to measured daily physical activity (347 - 266 kcal/day, mean - SD). Furthermore, the BASIC score increased 38% following 6 months of exercise rehabilitation (P < .01), whereas no change was observed in the control group (P > .05). A composite of 5 questions obtained from the self-administered BASIC questionnaire accurately estimates daily physical activity in patients with peripheral arterial disease limited by intermittent claudication, and is sensitive to change in physical activity following a program of exercise rehabilitation.

The relationship between ankle-brachial index and leisure-time physical activity in patients with intermittent claudication

The purpose of the study was to examine the relationship between ankle-brachial index (ABI) and leisure-time physical activity (LTPA) in patients with peripheral arterial disease limited by intermittent claudication. Patients included 342 sedentary men and women between the ages of 45 and 85 with intermittent claudication confirmed by a resting ABI of less than 0.90. Patients were categorized into either a low ABI group (ABI <0.50; n=84), a middle ABI group (ABI = 0.50 to 0.69; n=164), or a high ABI group (ABI = 0.70 to 0.89; n=94). The Minnesota LTPA questionnaire was used to estimate physical activity patterns, and a treadmill test, 6- minute walk test, and Walking Impairment Questionnaire were used to measure ambulatory function. A progressive decrease (p=0.030) in the total LTPA was observed among the high ABI (180 +/-131 kcal/day; mean +/- SD), middle ABI (138 +/-127 kcal/day), and low ABI (110 +/-89 kcal/day) groups. Progressive decrements in LTPA spent at moderate intensity (p=0.016) and high intensity (p=0.009), as well as the mean intensity of LTPA (p=0.024) were observed among the three respective ABI groups. Group differences in the LTPA measurements were no longer present (p>0.05) after adjusting for group differences in the absolute claudication distance during a treadmill test, and the 6-minute walk distance. The decline in total daily LTPA with progressively lower ABI in patients with intermittent claudication was due to their decreased participation in physical activities requiring moderate and high intensities. In addition, group differences in the LTPA measurements were explained by differences in ambulatory function.

Metabolic syndrome impairs physical function, health-related quality of life, and peripheral circulation in patients with intermittent claudication

PURPOSE

This study was conducted to (1) examine the effect of metabolic syndrome on intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and (2) determine whether peripheral vascular function was predictive of intermittent claudication and physical function in patients with metabolic syndrome.

METHODS

Patients limited by intermittent claudication and who had metabolic syndrome (n = 133) were compared with those without metabolic syndrome (n = 201). Patients were assessed on metabolic syndrome characteristics, PAD-specific measures consisting of ankle/brachial index and claudication distances, physical function measures, health-related quality of life, and calf blood flow and transcutaneous oxygen tension responses after 3 minutes of vascular occlusion.

RESULTS

Initial claudication distance (mean +/- SD) was 29% shorter (P = .018) in patients with metabolic syndrome than in the controls (128 +/- 121 meters vs 180 +/- 166 meters), and absolute claudication distance was 22% shorter (P = .025) in those with metabolic syndrome (319 +/- 195 meters vs 409 +/- 255 meters). Furthermore, patients with metabolic syndrome had lower peak oxygen uptake (P = .037), a shorter 6-minute walk distance (P = .027), lower values on six domains of health-related quality of life (P < .05), reduced calf hyperemia (P = .028), and greater calf ischemia (P < .001) after vascular occlusion. In the group with metabolic syndrome, calf ischemia was correlated with initial claudication distance (r = 0.30, P = .004), absolute claudication distance (r = 0.40, P < .001), and peak oxygen uptake (r = 0.52, P < .001).

CONCLUSION

Metabolic syndrome worsens intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with PAD. Calf ischemia in those with metabolic syndrome was predictive of intermittent claudication and physical function. The additive burden of metabolic syndrome thus places patients who are limited by intermittent claudication at an even greater risk for living a functionally dependent lifestyle. Aggressive risk-factor modification designed to treat components of metabolic syndrome should be evaluated for efficacy in modifying physical and vascular function in patients with intermittent claudication.

Physical activity is related to quality of life in older adults

Background

Physical activity is associated with health-related quality of life (HRQL) in clinical populations, but less is known whether this relationship exists in older men and women who are healthy. Thus, this study determined if physical activity was related to HRQL in apparently healthy, older subjects.

Methods

Measures were obtained from 112 male and female volunteers (70 ± 8 years, mean ± SD) recruited from media advertisements and flyers around the Norman, Oklahoma area. Data was collected using a medical history questionnaire, HRQL from the Medical Outcomes Survey short form-36 questionnaire, and physical activity level from the Johnson Space Center physical activity scale. Subjects were separated into either a higher physically active group (n = 62) or a lower physically active group (n = 50) according to the physical activity scale.

Results

The HRQL scores in all eight domains were significantly higher (p < 0.05) in the group reporting higher physical activity. Additionally, the more active group had fewer females (44% vs. 72%, p = 0.033), and lower prevalence of hypertension (39% vs. 60%, p = 0.041) than the low active group. After adjusting for gender and hypertension, the more active group had higher values in the following five HRQL domains: physical function (82 ± 20 vs. 68 ± 21, p = 0.029), role-physical (83 ± 34 vs. 61 ± 36, p = 0.022), bodily pain (83 ± 22 vs. 66 ± 23, p = 0.001), vitality (74 ± 15 vs. 59 ± 16, p = 0.001), and social functioning (92 ± 18 vs. 83 ± 19, p = 0.040). General health, role-emotional, and mental health were not significantly different (p > 0.05) between the two groups.

Conclusion

Healthy older adults who regularly participated in physical activity of at least moderate intensity for more than one hour per week had higher HRQL measures in both physical and mental domains than those who were less physically active. Therefore, incorporating more physical activity into the lifestyles of sedentary or slightly active older individuals may improve their HRQL.

The effect of exercise intensity on the response to exercise rehabilitation in patients with intermittent claudication

PURPOSE

The purpose of this randomized trial was to compare the efficacy of a low-intensity exercise rehabilitation program vs a high-intensity program in changing physical function, peripheral circulation, and health-related quality of life in peripheral arterial disease (PAD) patients limited by intermittent claudication.

METHODS

Thirty-one patients randomized to low-intensity exercise rehabilitation and 33 patients randomized to high-intensity exercise rehabilitation completed the study. The 6-month exercise rehabilitation programs consisted of intermittent treadmill walking to near maximal claudication pain 3 days per week at either 40% (low-intensity group) or 80% (high-intensity group) of maximal exercise capacity. Total work performed in the two training regimens was similar by having the patients in the low-intensity group exercise for a longer duration than patients in the high-intensity group. Measurements of physical function, peripheral circulation, and health-related quality of life were obtained on each patient before and after the rehabilitation programs.

RESULTS

After the exercise rehabilitation programs, patients in the two groups had similar improvements in these measures. Initial claudication distance increased by 109% in the low-intensity group (P < .01) and by 109% in the high-intensity group (P < .01), and absolute claudication distance increased by 61% (P < 0.01) and 63% (P < .01) in the low-intensity and high-intensity groups, respectively. Furthermore, both exercise programs elicited improvements (P < .05) in peak oxygen uptake, ischemic window, and health-related quality of life.

CONCLUSION

The efficacy of low-intensity exercise rehabilitation is similar to high-intensity rehabilitation in improving markers of functional independence in PAD patients limited by intermittent claudication, provided that a few additional minutes of walking is accomplished to elicit a similar volume of exercise.