Effect of supervised exercise on physical function and balance in patients with intermittent claudication.

BACKGROUND: The aim of the study was to identify whether a standard supervised exercise programme (SEP) for patients with intermittent claudication improved specific measures of functional performance including balance. METHODS: A prospective observational study was performed at a single tertiary vascular centre. Patients with symptomatic intermittent claudication (Rutherford grades 1-3) were recruited to the study. Participants were assessed at baseline (before SEP) and 3, 6 and 12 months afterwards for markers of lower-limb ischaemia (treadmill walking distance and ankle : brachial pressure index), physical function (6-min walk, Timed Up and Go test, and Short Physical Performance Battery (SPPB) score), balance impairment using computerized dynamic posturography with the Sensory Organization Test (SOT), and quality of life (VascuQoL and Short Form 36). RESULTS: Fifty-one participants underwent SEP, which significantly improved initial treadmill walking distance (P = 0·001). Enrolment in a SEP also resulted in improvements in physical function as determined by 6-min maximum walking distance (P = 0·006), SPPB score (P < 0·001), and some domains of both generic (bodily pain, P = 0·025) and disease-specific (social domain, P = 0·039) quality of life. Significant improvements were also noted in balance, as determined by the SOT (P < 0·001). CONCLUSION: Supervised exercise improves both physical function and balance impairment.

Postconditioning: current controversies and clinical implications.

OBJECTIVES: Postconditioning of ischaemic tissue, via mechanical or pharmacological manipulation, offers an exciting avenue towards amelioration of ischaemia-reperfusion injury. Born from the concept of ischaemic preconditioning, postconditioning is advantageous in that prior knowledge of the ischaemic insult is not required, and thus clinical translation may be further reaching. This review explores the current evidence and controversies in both animal and human studies and multiple organ systems. METHODS: A Medline search was conducted to identify English-language articles with 'postconditioning' as a keyword. Two independent researchers scrutinised the literature search for potentially relevant articles. Reference lists from selected articles were manually searched for further relevant articles. RESULTS AND CONCLUSIONS: Postconditioning has been shown to be successful in reducing ischaemia-reperfusion injury in both animal models and clinical trials. Human studies are presently limited to cardiac studies, but there is scope for research into other organ systems with potential beneficial effects, particularly within the field of vascular surgery where ischaemia-reperfusion occurs by nature of both - the disease and the intervention.