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Eileen G. Collins, et al ABSTRACT Patients with atherosclerotic
peripheral vascular disease, or PAD, often suffer from intermittent
claudication of the lower extremities with increased activity.
This can adversely affect the quality of life, or QOL, by affecting
relationships, work, social relationships, and independence.
While not many studies have been performed that look at how the QOL
of affected by PAD, others have looked at the improvement seen with
different therapeutic approaches. Some
studies have shown increased walking distances of 78-243% after taking
vitamin E, while others have shown no change at all.
It is theorized that taking vitamin E results in an antioxidative
reaction and protects polyunsaturated fatty acids and other oxygen
sensitive substances from oxidation.
Also, vitamin E decreases platelet aggregation.
Many other studies have shown that walking distance increases with
exercise, but various flaws in the studies leave questions to be asked.
The purpose of this study was to find out how PoleStriding exercise
and vitamin E increases exercise tolerance and QOL in individuals with
PAD. A total of 52 subjects with PAD
were randomized into 4 groups: PoleStriding
and vitamin E, PoleStriding and placebo, vitamin E only, and placebo only.
Patients utilized the Borg scale for exertion, along with the
Walking Impairment Questionnaire, the SF-36, and the Physical Activity
Recall Questionnaire. The treadmill protocol used had
small increases in percent grade that occurred every 30 seconds, and after
the first 6 minutes, speed was increased every 3 minutes. Exercise began at 0% grade and 2.9 km/hr, and the protocol
was designed so that metabolic requirements increased by 1 MET every 3
minutes. Patients used
walking poles made by EXERSTRIDER, which are poles similar to those used
in cross-country skiing, and may serve to reduce leg forces and slow
metabolic waste production by taking some of the force and energy by the
arms. Training occurred 3x/week for 24 weeks, and each session
lasted approximately 45-60 minutes. After the information at baseline
and at the 6-month point was analyzed, it was found that there was a
significant PoleStriding exercise effect, and no vitamin E effect.
After 6 months, the PS and Vitamin E group increased their
treadmill duration by 47%. The group with PS and placebo increased theirs
by 57%, and the vitamin E group reduced theirs by 14%, and the placebo
group increased by 1%. During the constant work treadmill
test, the group with vitamin E and PS increased their baseline time by
304%, or 1.13km, while the PS and placebo group increased theirs by 151%,
or 0.98km. The vitamin E
alone and placebo alone groups did not have any improvement. Arterial blood flow to the legs,
measured pre-exercise and 2 minutes post exercise showed no significant
differences for any of the groups. For
the rating of self-perceived pain, the PS group was the only one to show
improvement, which also happened with the results for the SF-36 form.
In addition, the WIQ and PAR questionnaires only showed improvement
for the PS group, not the others and there were no signs of positive
interaction. The results of this double blind
controlled clinical trial indicate that 24 weeks of pole striding exercise
resulted in significant increases in actual and perceived walking
distance, while vitamin E appeared to have no effect. COMMENTS A very well written and presented study, that has so much
information it is hard to present here in abstract or summarized format.
For those truly interested, grab the actual article and references.
The authors cover all avenues that could be implicated as problems
with the study, and there explanations of these potential problems are
quite adequate. This is not
the first study that I have written that indicates exercise can improve
the function of those with PAD. Often,
we treat these patients for something else, and they tell us about this
problem, and indicate that their physician told them nothing could be
done. There are medications
that are under trials at this time that could work very well with a
protocol to improve function and QOL in these people.
A good marketing idea for those who have never tackled the
physicians who treat this patient population.
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