A moderate 500-m treadmill walk for estimating peak oxygen uptake in men with NYHA class I-II heart failure and reduced left ventricular ejection fraction.

BACKGROUND: Maximal cardiopulmonary exercise testing (CPX) is the gold-standard for cardiorespiratory fitness assessment in chronic heart failure (CHF) patients. However, high costs, required medical supervision, and safety concerns make maximal exercise testing impractical for evaluating mobility-impaired adults. Thus, several submaximal walking protocols have been developed and currently used to estimate peak oxygen consumption (VO2peak) in CHF patients. However, these tests have to be performed at close to maximum exercise intensity. The aim of this study was to examine the validity of a 500-m treadmill-walking test carried out at moderate intensity for estimating VO2peak in community-dwelling adult and elderly patients with CHF and reduced left ventricular ejection fraction (HFrEF). METHODS: Forty-three clinically stable men with HFrEF (age 67.7 ± 9.2 years, and left ventricular ejection fraction, LVEF 38% ± 6%) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patients completed a CPX, and a moderate and self-paced (11-13/20 on the Borg scale) 500-m treadmill-walking test. Age, weight, height, walk time, and heart rate during the 500-m test were entered into prediction equations previously validated for VO2peak estimation from a 1000-m walking test in patients with cardiovascular disease and preserved LVEF. RESULTS: Directly measured and estimated VO2peak values were not different (21.6 ± 4.9 vs 21.7 ± 4.6 mL/kg/min). The comparison between measured and estimated VO2peak values yielded a correlation of R = 0.97 (SEE = 0.7 mL/kg/min, P < 0.0001). The slope and the intercept coincided with the line of identity (Passing and Bablock analysis, P = 0.50). Residuals were normally distributed, and the examination of the Bland-Altman analysis do not show systematic or proportional error. CONCLUSIONS: A moderate and self-regulated 500-m treadmill-walking test is a valid tool for VO2peak estimation in patients with HFrEF. These findings may have practical implications in the context of transitioning from clinically based programs to fitness facilities or self-guided exercise programs in adults and elderly men with HFrEF.

[From research to medical advice: prescription of physical activity to 1,005 subjects with type 2 diabetes mellitus by 48 family doctors. Results]. / Dalla ricerca alla pratica medica: prescrizione di attività motoria a 1.005 soggetti con diabete mellito di tipo 2 da parte di 48 medici di famiglia. Risultati.

OBJECTIVES: to involve a group of general practitioners (GPs) in a programme for prescribing physical activity (PhA) for patients with type 2 diabetes; to document, for each patient, the amount of physical activity carried out and the modifications in biomedical variables and in the medical expenses possibly occurring after the PhA programme. SETTING AND PARTICIPANTS: 48 GPs joined the project. The beneficial effects of regular PhA on diabetes were presented to each patient enrolled. Walking daily for at least 15 minutes was suggested. A booklet with specific instructions and a step meter were given to each patient. Diet programmes were not modified. MAIN OUTCOME MEASURES: average daily PhA; values of Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, blood glucose and HbA1c, blood cholesterol (total, LDL, HDL) and triglycerides determined before and at the end of the programme; pharmaceutical expenses attributed to the enrolled patients in 2008 (the year preceding the PhA programme) and in 2010 (the year of end of the PhA programme). RESULTS: of the 1,005 patients enrolled, 766 indicated their daily PhA. In all patients, and especially in those who presented values outside the norm in the variables considered at the start of the programme, improvements up to normalization were observed. A reduction in pharmaceutical expenses proportional to the PhA carried out was documented in the more active group of patients, who walked 1 km or more daily. CONCLUSIONS: the domiciliary PhA recommended by 48 GPs for 1,005 patients with type 2 diabetes enrolled in the programme was carried out by 766 subjects. The biomedical improvements and the reduction in pharmaceutical expenses, proportional to the PhA carried out, are in keeping with other reports in the literature. The major finding of this project is that GPs can effectively prescribe PhA to their patients who suffer form sport-sensitive diseases, such as type 2 diabetes.

Guided walking reduces blood pressure in hypertensive sedentary subjects including those with resistant hypertension.

Hypertension poorly responsive to medications is defined resistant hypertension. We have previously shown that 1-year of guided walking is followed by highly significant reduction of systolic blood pressure in hypertensive subjects. Aim of this study was to assess the effect of a 1-year of guided walking on the blood pressure of sedentary hypertensive subjects including patients with resistant hypertension. Two hundred and fifty-nine sedentary subjects with systolic pressure ≥130 mmHg were subdivided in a group without blood pressure medications and in a group taking three or more antihypertensive drugs, including diuretics. Blood pressure, body weight, body mass index, waist circumference, and walking speed were determined at enrollment and after 1-year of walking, supervised by exercise physiologists. At baseline, systolic pressure was significantly higher in the subjects under therapy (144.6 ± 12.2 vs. 140.2 ± 10.7). Two hundred and three subjects (124 without and 79 with therapy) completed the program. During the 1-year program each subject walked ~220 h. After 1-year a significant decrease (P < 0.0001) of systolic pressure was observed in both groups. The decrease was significantly higher (P < 0.0001) in the subjects under therapy. The decrease of systolic pressure was directly proportional to baseline values. Diastolic blood pressure decreased significantly in both groups. In conclusion, habitual walking may lead to clinically significant reductions of blood pressure in therapy resistant hypertensive subjects.

Identification of a Vo2 deflection point coinciding with the heart rate deflection point and ventilatory threshold in cycling.

The purposes of this study were to compare the patterns of the work rate (WR)-Vo2 and WR-heart rate (HR) relationships in incremental cycling, to ascertain the occurrence of a Vo2 deflection (Vo2def) coinciding with the HR deflection point (HRdef ), and to determine whether the Vo2def, if present, coincides with the ventilatory anaerobic threshold (VT). Twenty-four professional cyclists performed a maximal incremental test on a wind-load cycle ergometer. Work rate, HR, Vo2, and Vco2 were recorded. The WR-Vo2 relationships obtained were linear up to submaximal WR and curvilinear thereafter and thus described a Vo2def. The WR and Vo2 at Vo2def were mathematically determined for all subjects. The ratio of DeltaWR.DeltaVo2 up to Vo2def was significantly lower than that above Vo2def (90 +/- 11 W.L.min versus 133 +/- 35 W.L.min, p < 0.0001). The WR-HR relationships obtained were linear up to submaximal WR and curvilinear thereafter. The WR and HR at HRdef were mathematically determined for all subjects. The WR values at Vo2def and at HRdef (329 +/- 32 W and 326 +/- 34 W) were significantly correlated (R = 0.96, p < 0.0001) and in good concordance (limits of agreement from -4.7% to 3.2%, Bland-Altman analysis). The Vo2 at VT was then determined for all subjects. The Vo2 values at Vo2def and at VT were significantly correlated (R = 0.99, p < 0.0001) and in strong concordance (limits of agreement from -1.9% to 1.0%, Bland-Altman analysis). In conclusion, a Vo2def coinciding with HRdef and VT was shown. This confirms that the determination of the WR-HR relationship and of HRdef is a practical and noninvasive means of identifying anaerobic threshold.

Walking and hypertension: greater reductions in subjects with higher baseline systolic blood pressure following six months of guided walking.

BACKGROUND: The aim of the study was to assess the effects of walking on the blood pressure in sedentary adults with differing degrees of systolic blood pressure (SBP). METHODS: A total of 529 subjects with SBP above 120 mmHg were enrolled. Blood pressure, body weight, body mass index, waist circumference and walking speed were determined at enrolment and after six months. Walking sessions were supervised by exercise physiologists. RESULTS: The weekly walking time of the subjects completing the project was uniform and reached 300 minutes by the second month. 56% of participants completed the 6 months intervention (182 women 59.6 ± 9.0 years, and 114 men, 65.4 ± 8.6 years) 27 had a baseline SBP >160 mm Hg, 35 between 150-159, 70 between 140-149, 89 between 130-139 and 75 between 120-129 mmHg. Following six months of supervised walking, SBP was significantly reduced in all subgroups (p < 0.001), with the greatest reduction (-21.3 mmHg) occurring in subjects with baseline SBP >160 and the smallest reduction (-2.6 mmHg) occurring in subjects with baseline SBP of 120-129 mmHg. Diastolic blood pressure, body weight, body mass index and waist circumference were also significantly reduced following the walking intervention (p < 0.001). These reductions were nearly identical within the various groups. DISCUSSION: In a large group of sedentary adults with varying degrees of SBP, 6 months of supervised walking elicited a marked reduction in systolic blood pressure with the largest reductions in pressure occurring in individuals with higher baseline SBP.

500-meter and 1000-meter moderate walks equally assess cardiorespiratory fitness in male outpatients with cardiovascular diseases.

BACKGROUND: The walking speed maintained during a moderate 1-km treadmill walk (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak), and to be inversely related to long-term survival and hospitalization in outpatients with cardiovascular disease (CVD). We aimed to examine whether 500-meters and 1-k moderate treadmill-walking tests equally estimate VO2peak in male outpatients with CVD. METHODS: One hundred forty-two clinically stable male outpatients with CVD, aged 34-92 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, time to walk 500-meter and the entire 1000-meter, and the corresponding heart rates were entered into validated equations to estimate VO2peak. RESULTS: VO2peak estimated from the 500-meters test was not different from that estimated from the 1k test (25.2±5.1 vs. 25.1±5.2 mL/kg/min). The correlation coefficient between the two was 0.98. The slope and the intercept of the relationship between the 500-meter and 1k tests were not different from the line of identity. Bland-Altman analysis demonstrated that 96% of the data points were within two standard deviations (from -1.9 to 1.7 mL/kg/min). CONCLUSIONS: The 500-meter treadmill-walking test is a reliable method for estimating VO2peak in stable male outpatients with CVD. A shorter version of the test, 500-meter, provides similar information as that from the original 1k test, but is more time efficient. These findings have practical implications in the context of transitioning patients from clinically based and supervised programs to fitness facilities or self-guided exercise programs.

Determining the best percent-predicted equation for estimated VO2 peak by a 1-km moderate perceptually-regulated treadmill walk to predict mortality in outpatients with cardiovascular disease.

OBJECTIVES: To determine the prognostic ability of established percent-predicted equations of peak oxygen consumption (%PRED) estimated by a moderate submaximal walking test in a large cohort of outpatients with cardiovascular disease (CVD). DESIGN: Population-based prospective study. METHODS: A total of 1442 male patients aged 25-85 years at baseline, underwent a moderate perceptually-regulated (11-13 on the 6-20 Borg scale) treadmill walk (1k-TWT) for peak oxygen consumption estimation (VO2 peak). %PRED was derived from ACSM, Ades et al, Morris et al, and the Wasserman/Hansen equations, and their prognostic performance was assessed. Overall mortality was the end point. Participants were divided into quartiles of %PRED, and mortality risk was estimated using a Cox regression model. RESULTS: During a median 8.2year follow-up, 167 all-cause deaths occurred. The Wasserman/Hansen equation provided the highest prognostic value. Mortality rate was lower across increasing quartiles of %PRED. Compared to the first quartile, after adjustment for confounders, the mortality risk decreased for the second, third, and fourth quartiles, with HRs of 0.75 (95% CI 0.44-1.29, p=0.29), 0.67 (95% CI 0.38-1.18, p=0.17), and 0.37 (95% CI 0.10-0.78, p=0.009), respectively (p for trend <0.0001). Each 1% increase in %PRED conferred a 4% improvement in survival. CONCLUSIONS: The percent-predicted VO2 peak determined by Wasserman/Hansen equations applied to the 1k-TWT is inversely and significantly related to survival in cardiac outpatients. The 1k-TWT is a simple and useful tool for stratifying mortality risk in patients participating in secondary prevention programs.

Outdoor Reproducibility of a 1-km Treadmill Walking Test to Predict Peak Oxygen Uptake in Cardiac Patients.

INTRODUCTION: The aim of this study was to determine whether the 1-km treadmill walking test, previously developed to predict peak oxygen uptake ((Equation is included in full-text article.)O2peak) in stable cardiac outpatients, could be reproduced outdoors. METHODS: Fifty male cardiac outpatients performed the 1-km walking test on a treadmill and on a flat track within 1 week. (Equation is included in full-text article.)O2peak was estimated for both testing conditions considering age, height, weight, walking speed, and heart rate. RESULTS: Average walking speed was slightly higher during outdoor conditions (5.73 ± 0.77 km/h vs 5.55 ± 0.84 km/h), whereas mean heart rates were similar for both testing conditions (102 ± 18 beats/min vs 103 ± 16 beats/min). (Equation is included in full-text article.)O2peak values for treadmill and outdoor tests were not significantly different (26.4 ± 4.1 mL/kg/min vs 26.8 ± 4.5 mL/kg/min) and were strongly correlated (r = 0.93, P < .0001). The slope and the intercept of the (Equation is included in full-text article.)O2peak values were not different from the line of identity. CONCLUSIONS: This moderate and perceptually regulated 1-km walking test administered outdoors gives similar results compared with a similar test performed on a treadmill. Therefore, (Equation is included in full-text article.)O2peak can be reasonably estimated using both testing modalities. This suggests that the outdoor 1-km test can be applied for indirect estimations of cardiorespiratory fitness in an outpatient setting.

Oxygen Uptake Attenuation at Ventilatory Threshold in Men With Coronary Artery Disease.

PURPOSE: Maximal oxygen uptake ((Equation is included in full-text article.)O2) and ventilatory threshold (VT) are widely used to assess cardiorespiratory fitness in healthy people, as well as in patients with various clinical conditions. The aim of this study was to determine whether an attenuation of (Equation is included in full-text article.)O2 occurs above the VT in patients with stable coronary artery disease. METHODS: A total of 33 male patients participating in an outpatient cardiac rehabilitation/secondary prevention program underwent maximal incremental cycle ergometry at increasing pedaling cadences up to the limit of tolerance. Ventilatory gas-exchange variables were measured breath by breath while work rate was recorded continuously. Ventilatory threshold was determined by a dual linear regression model (V-slope analysis). RESULTS: Four patients were excluded from the analysis because they were unable to pedal at the increasing cadences required by the protocol. The remaining 29 patients successfully completed the test without complications or evidence of significant ST segment depression. The slope of the (Equation is included in full-text article.)O2/work rate relationship above the VT decreased significantly (-44.6% on average) in 23 of the 26 patients in which VT was able to be determined. (Equation is included in full-text article.)O2 at the start of (Equation is included in full-text article.)O2 attenuation ((Equation is included in full-text article.)O2att) and at VT were highly correlated and in strong agreement (1637 ± 451 mL/min vs 1650 ± 473 mL/min, r = 0.96, P < .01). CONCLUSIONS: (Equation is included in full-text article.)O2att does occur and coincides with the VT in the majority of patients tested with stable coronary artery disease.

Improved walking speed is associated with lower hospitalisation rates in patients in an exercise-based secondary prevention programme.

OBJECTIVE: To determine the relationship between walking speed (WS) maintained during a 1 km test and its improvement on hospitalisation in cardiac outpatients who were referred to an exercise-based secondary prevention programme. METHODS: Hospitalisation was assessed in 1791 patients 3 years after enrolment and related to the WS achieved during a 1 km walk at moderate intensity on a treadmill. Hospitalisation was also assessed during the fourth-to-sixth years as function of improvement in WS in 1111 participants who were re-evaluated 3 years after baseline. RESULTS: Three-year hospitalisation rate across tertiles of baseline WS was 50% for the slow walkers (2.7±0.6 km/hour), 41% for the moderate (4.1±0.3 km/hour) and 25% for the fast walkers (5.2±0.5 km/hour) (p for trend <0.0001), with adjusted HRs (95% CI) of 0.93 (0.74 to 1.17, p=0.53) for intermediate and 0.58 (0.43 to 0.78, p=0.0003) for fast. Every 1 km/hour increase in WS was associated with a 21% reduction in hospitalisation (p<0.0001). Hospitalisation from the fourth-to-sixth years was lower across tertiles of improved WS, with 44% for the low (0.2±0.4 km/hour), 34% for the intermediate (0.8±0.2 km/hour) and 30% for the high tertile (1.6±0.4 km/hour) (p for trend <0.0001). Adjusted HRs were 0.68 (p=0.002) for the intermediate and 0.58 (p<0.0001) for the high tertile. Every 1 km/hour increase in WS was associated with a 35% reduction in hospitalisation (p<0.0001). CONCLUSION: Improvement in WS is associated with a significant, dose-dependent lower rate of all-cause hospitalisation in cardiac outpatients. WS is a simple, easily applied and clinically useful tool for cardiac patients undergoing secondary prevention.

Association between VO2 peak estimated by a 1-km treadmill walk and mortality. A 10-year follow-up study in patients with cardiovascular disease.

PURPOSE: The aim of this study is to assess the association between peak oxygen uptake (VO2 peak), determined using a perceptually regulated 1-km walking test (1k-TWT), and all-cause mortality in cardiac patients. METHODS: 1255 male patients, aged 25-85 years, completed a moderate 1k-TWT to estimate VO2 peak. Subjects were followed for all-cause mortality for up to 10 years. Cox proportional hazard models were employed to determine variables associated with mortality. Based on the estimated VO2 peak, the sample was subdivided into quartiles and mortality risks were calculated. To assess the discriminatory accuracy of the estimated VO2 peak for estimating survival, receiver-operating-characteristics curves were constructed. RESULTS: During a median 8.2 year follow-up, a total of 141 deaths from any cause occurred, yielding an average annual mortality of 1.4%. The strongest predictor of all-cause mortality was the estimated VO2 peak (c-statistic 0.71, 95% confidence intervals: 0.69-0.74, P<0.0001). Survival decreased in a graded fashion from the highest estimated VO2 peak quartile to the lowest quartile. Compared to the lowest quartile, the hazard ratios (95% confidence intervals) for the second, third, and fourth quartiles were 0.77 (0.35-1.33), 0.43 (0.20-0.91), and 0.16 (0.05-0.54) respectively (P for trend <0.0001). An 89% reduction in mortality risk was observed among a subset of subjects in the fittest quartile who improved their estimated VO2 peak over the follow-up period relative to subjects in the least fit quartile who did not improve. CONCLUSION: VO2 peak estimated by a novel 1k-TWT predicts survival in subjects with stable cardiovascular disease.

Treadmill walking speed and survival prediction in men with cardiovascular disease: a 10-year follow-up study.

OBJECTIVE: To determine whether the walking speed maintained during a 1 km treadmill test at moderate intensity predicts survival in patients with cardiovascular disease. DESIGN: Population-based prospective study. SETTING: Outpatient secondary prevention programme in Ferrara, Italy. PARTICIPANTS: 1255 male stable cardiac patients, aged 25-85 years at baseline. MAIN OUTCOME MEASURES: Walking speed maintained during a 1 km treadmill test, measured at baseline and mortality over a median follow-up of 8.2 years. RESULTS: Among 1255 patients, 141 died, for an average annual mortality of 1.4%. Of the variables considered, the strongest predictor of all-cause mortality was walking speed (95% CI 0.45 to 0.75, p<0.0001). Based on the average speed maintained during the test, participants were subdivided into quartiles and mortality risk adjusted for confounders was calculated. Compared to the slowest quartile (average walking speed 3.4 km/h), the relative mortality risk decreased for the second, third and fourth quartiles (average walking speed 5.5 km/h), with HRs of 0.73 (95% CI 0.46 to 1.18); 0.54 (95% CI 0.31 to 0.95) and 0.20 (95% CI 0.07 to 0.56), respectively (p for trend <0.0001). Receiver operating curve analysis showed an area under the curve of 0.71 (p<0.0001) and the highest Youden index (0.35) for a walking speed of 4.0 km/h. CONCLUSIONS: The average speed maintained during a 1 km treadmill walking test is inversely related to survival in patients with cardiovascular disease and is a simple and useful tool for stratifying risk in patients undergoing secondary prevention and cardiac rehabilitation programmes.

Peak oxygen uptake prediction from a moderate, perceptually regulated, 1-km treadmill walk in male cardiac patients.

PURPOSE: To determine whether a moderate 1-km treadmill walking test (1KTWT) could be used to predict peak oxygen uptake VO(2)peak) in patients with cardiovascular disease. METHODS: One hundred seventy-eight male patients, aged 38 to 83 years, completed a VO(2)peak treadmill test and a 1KTWT using a self-regulated intensity of 11 to 13 of 20 on the Borg scale. Multivariable regression analysis was used to develop equations for predicting VO(2)peak in a development group (n = 110), both for subjects prescribed and not prescribed a ß-blocking agent (BB/NBB, 66/44). These equations were then applied to a cross-validation and reproducibility group (n = 68, BB/NBB, 37/31), who completed the protocol twice within 2 weeks. RESULTS: Analysis from 1KTWT in the development group showed that age, body mass index, walking speed, and heart rate were the most potent predictors of VO(2)peak. Measured and predicted VO(2)peak were not significantly different, and were strongly associated among both the NBB (r = 0.81, P < .0001) and BB (r = 0.69, P < .0001) groups, with a mean residual of approximately 1.0 mL·kg(-1)·min(-1). When applied to the cross-validation and reproducibility group, the equations similarly yielded strong associations (r = 0.64, P < 0.001 and r = 0.71, P < 0.001 for the NBB and BB groups, respectively), with no significantly differences between measured and predicted VO(2)peak. Mean test-retest differences for measured and predicted VO(2)peak were between 0.1 and -0.5 mL·kg(-1)·min(-1). CONCLUSIONS: Equations developed from the 1KTWT accurately predicted VO(2)peak in patients with cardiovascular disease. The model may represent a valid, low cost, and simple tool for indirect estimations of cardiorespiratory fitness in an outpatient setting.

Incremental exercise using progressive versus constant pedaling rates: a study in cardiac patients.

PURPOSE: Cardiopulmonary exercise testing is widely used in clinical assessment and exercise prescription. However, significant differences in physiological responses can occur depending on testing protocol. The aim of this study was to evaluate the cardiopulmonary responses to different incremental cycle pedaling cadences in cardiac patients. METHODS: Eleven men with coronary artery disease (CAD) and 12 men with chronic heart failure (CHF) performed 2 maximal cycle tests at constant cadence (60-70 rpm, at fixed cadence) and at progressive cadence. Peak values for oxygen uptake (V(O(2)peak)), workload (W(peak)), and heart rate (HR(peak)); ventilatory threshold (VT); and the oxygen uptake (VO2) per unit work rate (WR) increment (ΔV(O(2))/ΔWR) obtained using 2 protocols were determined. RESULTS: V(O(2)peak) and W(peak), respectively, were higher during increasing cadence (INCR) compared with fixed cadence (FIX) protocol both in patients with CAD (32.7 ± 5.4 vs 28.1 ± 7.0 mL · kg(-1) · min(-1), P = .01; 214 ± 42 vs 150 ± 28 W, P = .001) and in patients with CHF (20.3 ± 7.4 vs 17.2 ± 5.5 mL · kg(-1) · min(-1), P = .006; 133 ± 45 vs 104 ± 33 W, P = .005). No differences were seen in HR(peak). Both in patients with CAD and in patients with CHF, V(O(2)) (21.7 ± 5.5 vs 16.8 ± 5.3 and 12.3 ± 7.4 vs 9.3 ± 2.8 mL · kg(-1) · min(-1)) and HR (114 ± 14 vs 98 ± 13 and 92 ± 17 vs 80 ± 17 bpm) at VT were significantly higher in INCR than in FIX protocol. No differences were seen in workload at VT. ΔV(O(2))/ΔWR during INCR protocol were higher in patients with CAD (13.4 ± 1.8 vs 9.5 ± 2.6 mL · kg(-1) · W(-1), P = .006) and patients with CHF (13.6 ± 4.1 vs 8.7 ± 1.9 mL · kg(-1) · W(-1), P = .006). DISCUSSION: These findings indicate that in tests at fixed cadence, there occurs an earlier activation of the anaerobic mechanisms leading to a premature exhaustion before a cardiopulmonary endpoint has been achieved.

Training rather than walking: the test in -train out program for home-based rehabilitation in peripheral arteriopathy.

BACKGROUND: Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E). METHODS AND RESULTS: A total of 143 patients with claudication (117 men, average age 68+/-10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise heart rates (HR), systolic/diastolic brachial pressure (SBP/DBP), ankle pressure (AP), ankle-brachial index (ABI). Ti-To involved 2 daily 10-min home walking sessions at maximal asymptomatic speed and the patient attending monthly check-ups at hospital. Tr-E involved 20-30 min of daily walking at self-selected speeds up to pain tolerance. A total of 126 patients (Ti-To, n=74; Tr-E, n=52) completed the program. Ti-To induced better relief from claudication (p=0.001). Functional parameters improved significantly for both groups (p<0.0001) with significant intergroup difference for Ti-To (p<0.0001). SBP and exercise HR decreased significantly in both groups, with Ti-To improving resting HR (p=0.0002), DBP (p=0.003), lowest AP worse limb (p=0.004) and ABI worse limb (p=0.0002). CONCLUSIONS: In patients with PAD, a Ti-To program had more positive effects on perceived claudication, and functional and hemodynamic parameters than did a Tr-E program.

Home-centred physical fitness programme in morbidly obese individuals: a randomized controlled trial.

OBJECTIVE: To assess the effectiveness of domiciliary physical fitness programmes in obese individuals. DESIGN: Nine-month randomized controlled trial. SETTING: Home-based intervention with outpatient visits. SUBJECTS: Morbidly obese subjects (body mass index (BMI) > or = 30) aged 25-65 years suitable for physical activities at home. INTERVENTION: At the end of a preliminary one-month in-hospital rehabilitation programme (baseline), 52 patients were randomly assigned either to a structured educational programme (intervention group) of daily incremental physical activity at home (walking and skeletal muscle resistance training, with booklets and written instructions) or to a programme of general advice (control group) regarding exercise and long-term fitness. MAIN MEASURES: Both groups were evaluated at baseline and every three months for: (1) time, metabolic equivalents (METs), and heart rate reserve (HRR) during a standardized 2-km walking test (2kmWT); (2) anthropometric measures (body weight, BMI, abdominal and neck circumference); (3) the Polar Fitness Test index (PFTI), and (4) time to exhaustion while sustaining consecutive isoload extensions in the dominant leg (isoload LE). Time during 2kmWT was the study primary outcome. RESULTS: Body weight, BMI and abdominal circumference improved significantly (P < 0.05) over time in the intervention group. The cardiopulmonary fitness variables changed significantly (P < 0.05) over time in both study groups. However, all variables improved in the intervention patients, while some worsened or remained stable in the controls. Thus, the mean group difference in changes was significant (P < 0.05) for 2kmWT time (-77.4 seconds), HRR (11.7%), and PFTI (5.4 points). CONCLUSION: This structured domiciliary fitness programme is feasible and provides sustained anthropometric and physiological benefits in some morbidly obese individuals.

An incremental test to identify the pain threshold speed in patients with intermittent claudication.

The purpose of this study was to develop a test for identifying the speed of onset of claudication, or pain threshold speed (PTS), in 16 patients affected by intermittent claudication. An echo-Doppler examination and the ankle-brachial index (ABI) determination were also performed. Test repeatability was evaluated in 10 patients retested within a few days. All 16 patients underwent the incremental walking test 3 times during a 6-month rehabilitation training program to verify the test's sensitivity in detecting the expected functional modifications. PTS was identified in all patients examined and the test-retest correlation coefficient (R) for PTS was 0.98. During the 6-month rehabilitation period, the ABI rose from 0.43 +/-0.16 to 0.72+/-0.15 for the worst limb and PTS also rose significantly from 3.9+/-1.4 km/h to 6.1+/-1.1 km/h. The average increments of ABI and PTS were significantly correlated. An incremental walking test for the identification of the walking speed at which claudication occurs has been developed. The PTS is a reproducible parameter that can be combined with other test results to establish the severity of the disease and to check any modifications that occur during rehabilitation.