Training guided by pain threshold speed - Effects of a home-based program on claudication

Aim. To verify the effectiveness of a 120 day home-based program guided by the pain threshold speed (PTS). Methods. Twenty-nine patients with stable claudication were measured for ankle pressure (AP), ankle-brachial index (ABI), PTS, maximal speed (S-max) on treadmill. Daily walking sessions at a speed 20-30% below PTS were prescribed. Determination of the training speed was supervised and facilitated at home. The program included a daily record of exercise data and symptoms, an intermediate PTS reevaluation to adjust the training speed, and the reassessment of all the parameters after 120 days. Results. Overall patients showed a reduction of systemic blood pressure (151.3 +/- 14.3 to 147.6 +/- 18.3 mmHg; 77.1 +/- 9.1 to 72.4 +/- 8, p=0.008) while AP did not. ABI increased from 0.65 +/- 0.13 to 0.71 +/- 0.18 (p=0.01). PTS and S-max rose from 3.2 +/- 1.1 to 4.2 +/- 1.5 km/h (p=0.0001) and from 3.9 +/- 1.3 to 4.6 +/- 1.3 km/h (p=0.0001), respectively. According to their compliance, patients were divided into 3 groups: 1) trained (T, n=14): exercise at the prescribed speed, 2) free-walkers (FW, n=7): walking speed markedly below PTS and 3) untrained (U, n=8): incomplete program compliance. T group showed symptom reduction up to pain disappearance. The ABI change (0.72 +/- 0.09 to 0.82 +/- 0.16, p < 0.02) was correlated to AP increase (r=0.879). PTS and S a rose from 3.6 +/- 1.1 to 5.4 +/- 0.8 km/h (p < 0.02) and from 4.7 +/- 1.2 to 5.7 +/- 0.7 (p < 0.02), respectively. FW showed improvement of all parameters, and U a better walking efficiency. Conclusion. In patients with claudication, a low-cost home-based program driven by PTS allows dramatic improvements of functional parameters.