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PubMed2003

Adherence and attrition with intermittent and continuous exercise in overweight women.

Few people are active to the levels recommended by Healthy People 2010. Intermittent exercise has been promoted as an exercise prescription which may enable more people to meet recommended guidelines. However, few data are available on intermittent exercise over the long-term. The purpose of the current study was to compare the effects of long-term (72 weeks) continuous (CON) and intermittent (INT) exercise on attrition and adherence in previously sedentary, moderately obese females. Participants were randomized to continuous walking at 60 to 75% of maximum aerobic capacity, 3 days per week, 30 minutes per session, or intermittent exercise for two 15-minute sessions, 5 days per week. Adherence was calculated as the number of sessions completed compared to the number of sessions prescribed. At 12-week intervals, attrition was calculated as the number of participants in the study compared to the total number of participants originally enrolled. For the participants who completed the study, body weight decreased for CON from 80.17 +/- 5.75 kg at baseline to 79.70 +/- 5.40 at 16 months (p < 0.05). For INT, body weight did not change from baseline (85.85 +/- 13.13 kg) to 16 months (85.05 +/- 12.90 kg). By design, INT walked significantly (p < 0.05) further (819 +/- 128 km) compared to CON (527 +/- 46 km). Attrition was 58% for both groups baseline to 72 weeks. However, attrition was greater for CON (38 %) compared to INT (16%) in the first 24 weeks. Adherence was excellent for both groups (> 83%) throughout the study. These results suggest that intermittent and continuous exercise both have considerable attrition rates within 72 weeks of exercise initiation; however, the pattern of attrition differs considerably. That is, it appears that intermittent exercise may reduce attrition in the first 24 weeks of an exercise program; however, attrition does not appear to be different than continuous exercise at 72 weeks.

Adult↗
PubMed2005

The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial.

OBJECTIVES: To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific, influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity. DESIGN: Secondary analysis of a two-center, observer-blinded, randomized, controlled trial. SETTING: General community. PARTICIPANTS: Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke. INTERVENTION: Task-oriented interventions targeting walking or upper extremity (UE) function were provided three times a week for 6 weeks. MEASUREMENTS: Activities-specific Balance Confidence Scale, Six-Minute Walk Test, 5-m walk, Berg Balance Scale, and Timed "Up and Go" administered at baseline and postintervention. RESULTS: The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention. Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practiced. In the walking group, change in balance self-efficacy correlated with change in functional walking capacity (correlation coefficient=0.45, 95% confidence interval=0.16-0.68). Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age, sex, comorbidity, time poststroke, and functional mobility on change in self-efficacy. CONCLUSION: Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke. Benefits may be partially the result of improvement in walking capacity. The influence of baseline level of self-efficacy, depressive symptoms, and prognostic variables on treatment effects are of clinical importance and must be verified in future studies.

Adult↗
PubMed2002

Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery.

OBJECTIVE: To investigate the effect of practice paradigms that varied treadmill speed during step training with body weight support in subjects with chronic hemiparesis after stroke. DESIGN: Randomized, repeated-measures pilot study with 1- and 3-month follow-ups. SETTING: Outpatient locomotor laboratory. PARTICIPANTS: Twenty-four individuals with hemiparetic gait deficits whose walking speeds were at least 50% below normal. INTERVENTION: Participants were stratified by locomotor severity based on initial walking velocity and randomly assigned to treadmill training at slow (0.5mph), fast (2.0mph), or variable (0.5, 1.0, 1.5, 2.0mph) speeds. Participants received 20 minutes of training per session for 12 sessions over 4 weeks. MAIN OUTCOME MEASURE: Self-selected overground walking velocity (SSV) was assessed at the onset, middle, and end of training, and 1 and 3 months later. RESULTS: SSV improved in all groups compared with baseline (P<.001). All groups increased SSV in the 1-month follow-up (P<.01) and maintained these gains at the 3-month follow-up (P=.77). The greatest improvement in SSV across training occurred with fast training speeds compared with the slow and variable groups combined (P=.04). Effect size (ES) was large between fast compared with slow (ES=.75) and variable groups (ES=.73). CONCLUSIONS: Training at speeds comparable with normal walking velocity was more effective in improving SSV than training at speeds at or below the patient's typical overground walking velocity.

Adult↗
PubMed2005

Physical activity and decreased risk of clinical gallstone disease among post-menopausal women.

BACKGROUND: Physical activity may play a role in preventing gallstone disease. METHODS: The activity/gallstone relationship was examined in post-menopausal women from the Study of Osteoporotic Fractures (SOF; 1986-1988), a prospective study of fracture risk factors in 8010 women (mean age = 71.1 years, SD = 4.9). RESULTS: Multivariate logistic regression indicated women in the lowest two quartiles of physical activity, according to questionnaire, had a 59% {OR = 1.59 (1.11-2.29), P = 0.02} and a 57% higher risk {OR = 1.57 (1.11-2.23), P = 0.01} of developing gallstone disease compared to women in the highest quartile of activity (PTrend = <0.0001). Additionally, this relationship was examined in a cohort of 182 post-menopausal women (mean age 74.2 years, SD = 4.1) who participated in a randomized controlled trial of a walking intervention. Women in the randomized clinical trial in the lowest tertile of physical activity determined by a physical activity monitor had a higher risk of developing gallstone disease than women in the highest tertile of physical activity, 13% {OR-1.13 (1.01-1.28), P = 0.05, PTrend = <0.04}. CONCLUSION: Physical activity appears to be inversely related to the development of gallstone disease in post-menopausal women independent of body mass index.

Aged↗
PubMed1986

[Isovolemic hemodilution in stage-IIb peripheral arterial occlusive diseases. Prospective randomized double-blind comparison of middle-molecule hydroxyethyl starch and electrolyte solution].

Blood-letting to a haematocrit of 0.40 to 0.42 was performed over a period of six weeks on 30 randomized patients with peripheral vascular disease (intermittent claudication), stage IIb (after Fontaine), in addition to standardized gymnastics and physical exercise (walking). Subsequently, 15 randomly selected patients received after each blood-letting middle-molecular hydroxyethyl starch solution, another 15 randomized patients received isotonic sodium chloride solution, both groups under a double-blind protocol, gymnastics and walking exercise being continued. At the beginning of the study both groups were comparable with respect to clinical and vascular parameters and results of laboratory tests. Those of the former group had a significantly greater increase in pain-free walking distance than the latter. Blood pressure levels remained unchanged in the former, but significantly rose in the latter. Peak flow during reactive hyperaemia increased significantly in both legs in the first group, remaining unchanged in the second. An increase in spontaneous platelet aggregation occurred only in the second group; alpha 2-macroglobulin concentration rose only in patients of the first group, while fibrinogen decreased significantly in both.

Adult↗
PubMed1992

A study on optimum load for physical work.

Five healthy men were chosen as experimental subjects and were divided into groups at random. The subjects walked with a load in a shoulder-waist-back manner on the treadmill at the speed of 5, 7 and 9 km h-1. The parameters measured were as follows: oxygen expenditure, energy consumption, heart rate and self appraisal. Based on the experimental results and analysis of multiple regression, the authors suggested that physical loading should not exceed 25 kg (i.e. roughly equal to 39% of average body weight of male Chinese), when the walking speed was at 5 km h-1. The suitable loading at physical work would be 20 kg (i.e. equal to 31% of the average body weight of male Chinese).

Adult↗
PubMed1997

Brisk walking reduces calcaneal bone loss in post-menopausal women.

1. This study examined the influence of brisk walking on skeletal status in post-menopausal women. 2. Subjects were 84 healthy women aged 60-70 years. Who were previously sedentary and at least 5 years post-menopausal. Subjects were randomly assigned to walking (n = 43) and control (n = 41) groups. Walkers followed a 12-month, largely unsupervised programme of brisk walking. The bone mineral density of the lumbar spine, femoral neck and calcaneus and broadband ultrasonic attention of the calcaneus were measured at baseline and after 12 months. 3. Forty control subjects and 38 walkers completed the study. Walkers built up to 20.4 +/- 3.8 min/day (mean +/- SD) of brisk walking. Body mass increased in control subjects relative to walkers [mean change (SE) +0.9 (0.3) and -0.1 (0.3) kg respectively; P = 0.04]. Predicted maximum oxygen uptake increased in walkers by 2.1 (0.9) ml min-1 kg-1 (P = 0.02). Bone mineral density in the lumbar spine and calcaneus fell in control subjects [-0.005 (0.004) and -0.010 (0.004) g/cm2, respectively] but not in walkers [+0.006 (0.004) and +0.001 (0.004) g/cm2]. The difference in response between groups was significant in the calcaneus (P = 0.04) but not in the lumbar spine (P = 0.08). Mean femoral neck bone mineral density did not change significantly in either group, although changes in walkers were related to the amount of walking completed (r = 0.51, P = 0.001). The change in broadband ultrasonic attenuation of the calcaneus differed between groups [control subjects, -3.7 (0.8); walkers, -0.7 (0.8) dB/MHz; P = 0.01]. 4. Walking decreased bone loss in the calcaneus and possibly in the lumbar spine. It also improved functional capacity and enabled walkers to avoid the increase in body mass seen in control subjects.

Absorptiometry, Photon↗
PubMed1995

Walking program reduces elevated cholesterol in women postmenopause.

OBJECTIVE: To examine the effect of a moderate exercise regimen on total serum cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), body composition and cardiovascular fitness (VO2 max) in mildly hyperlipidemic women, postmenopause. DESIGN: Randomized assignment to walking (n = 24) or control (n = 16) groups. SETTING: Community based intervention. PARTICIPANTS: Over 300 volunteers were screened to obtain the sample of 40 eligible women. Participants were mildly hyperlipidemic, postmenopause (mean age 62.0 +/- 5.7 years), sedentary, nonsmokers and not on hormone replacement therapy. Results are reported for the 25 subjects (15 walkers, 10 controls) who completed the study. INTERVENTION: Exercisers walked an average of 54.3 +/- 7.7 mins/day, 4.9 +/- 1.7 days/week, at an intensity of 54% maximum heart rate reserve, for six months. Participants were counselled not to change their diets. MAIN RESULTS: Total serum cholesterol, triglyceride, total serum cholesterol: HDL-C ratio, weight and fat mass decreased significantly in the walkers compared with the controls (P < 0.05), as did body mass index (P < 0.01). Walking resulted in a significant increase in VO2 max (P < 0.01). Changes in serum lipids were significantly related to changes in body fat, but not to change in aerobic fitness. There were no changes in dietary intake. CONCLUSIONS: A moderate intensity exercise program induces favourable alterations in total serum cholesterol and other atherogenic indices in hyperlipidemic women postmenopause, and these changes are related more to loss of body fat than to increased fitness level.

Body Mass Index↗
PubMed2002

A comparison of physiological responses and rating of perceived exertion in two modes of aerobic exercise in men and women over 50 years of age.

OBJECTIVES: To compare the physiological responses and ratings of perceived exertion to aerobic dance and walking sessions completed at a self selected pace. METHODS: Six women and six men with a sample mean (SD) age of 68 (7) years completed aerobic dance and walking sessions in random order. A treadmill test was performed by each subject from which peak oxygen uptake (.VO(2)) and maximum heart rates (HRmax) were determined. During the aerobic dance and walking sessions, heart rate and .VO(2) were measured continuously throughout. Rate of perceived exertion (RPE) was measured every three minutes throughout the session. RESULTS: The sample means (SD) for %peak .VO(2) were 67 (17)% for the aerobic dance sessions and 52 (10)% for the walking sessions, and the %HRmax sample means (SD) were 74 (12)% for the aerobic dance sessions and 60(8)% for walking sessions. The sample mean (SD) RPE for the aerobic dance sessions was 11(2), and for the walking sessions it was 10(2). CONCLUSIONS: %peak .VO(2), %HRmax, and RPE were significantly higher for aerobic dance than for walking. However, both the aerobic dance and walking sessions were of adequate intensity to improve aerobic fitness in most subjects. Further investigation into the relation between RPE and %peak .VO(2) in a field setting over representative exercise time periods would be useful.

Aged↗
PubMed1997

The physiological responses to walking with and without Power Poles on treadmill exercise.

Power Poles are specially constructed, rubber-tipped ski poles designed for use during walking. Using Power Poles simulates the arm motion of cross-country skiing, thus increasing the muscle mass used during walking. This study investigated the potential increases in exercise intensity and energy cost associated with the use of walking poles. Thirty-two apparently healthy volunteers (16 men and 16 women) between the ages of 19 and 33 years participated. Each completed a treadmill maximal oxygen consumption (VO2max) test and two randomly assigned, submaximal walking trials (one with poles and one without poles) on separate days. Each walking trial was conducted on a level treadmill, for 20 minutes, at an identical self-selected pace. Expired gases, heart rate in beats per minute (bpm), and ratings of perceived exertion (RPE) were recorded each minute. Results between trials were compared using repeated measures analysis of variance and Tukey's post hoc tests. It was found that walking with poles resulted in an average of 23% (4.4 ml.kg-1.min-1) higher VO2, 22% higher caloric expenditure (1.5 kcal.min-1), and 16% (18 bpm) higher heart rate responses compared to walking without poles on a treadmill. RPE values averaged 1.5 units higher with the use of the poles, and the pattern of responses between conditions was similar for men and women. It is concluded that the use of Power Poles can increase the intensity of walking at a given speed and, thus, may provide additional training benefits to walkers.

Adult↗
PubMed1997

Effect of verapamil in intermittent claudication A randomized, double-blind, placebo-controlled, cross-over study after individual dose-response assessment.

BACKGROUND: The calcium antagonist verapamil is a vasodilator drug that has been shown to increase oxygen extraction of ischemic tissues in coronary and peripheral vascular disease. METHODS AND RESULTS: Since the balance between the positive and the negative effects of vasodilation may be delicate in ischemic diseases a dose-response study (dose range, 120 to 480 mg) was established to determine optimal, individual dosages of slow-release verapamil in 44 patients with stable intermittent claudication (Fontaine classification stage II) with respect to walking capacity. A randomized, double-blind, placebo-controlled, cross-over study (4 weeks) was performed to assess clinical and hemodynamic effects of verapamil. The optimal daily dose of verapamil on maximal walking ability was 120 (8 patients), 240 (8 patients), 360 (14 patients), and 480 mg (14 patients). Walking distances were measured at a metronome-controlled speed of 60 steps per minute on level surface. Optimal individual doses of verapamil increased mean pain-free walking distance by 29% from 44.9 to 57.8 meters (P < .01) and maximal walking distance by 49% from 100.7 to 149.8 meters (P < .001) compared with placebo. The increase in maximal walking distance correlated positively only with initial systolic ankle pressure (r = .49, P < .001) and ankle/brachial pressure index (r = .37, P < .013). Verapamil had no effect on systolic ankle pressure, ankle/brachial pressure index, peripheral leg temperature, or blood pressure, which suggests that the drug may have extrahemodynamic effects, possibly brought about through improved oxygen metabolism. CONCLUSIONS: Verapamil showed significant clinical benefits in patients with moderate intermittent claudication in this short-term study. Individual optimization of drug dosage should be considered an option both in trials and in the clinical setting in these patients.

Aged↗
PubMed2006

The effects of resistance training and walking on functional fitness in advanced old age.

The authors assessed the effects of resistance training and walking exercise on measures of functional fitness. Sixty-four volunteers (average age 83.5 years) from an independent-living facility were randomly assigned to walking, resistance training, or control groups. Participants in the walking and resistance-training groups engaged in two exercise sessions per week for 16 weeks. Measures of functional fitness included upper and lower body strength, hip and shoulder flexibility, agility and balance, coordination, blood pressure, and resting heart rate. Repeated measures analysis of variance was used to examine pretest to posttest differences. Both exercise groups showed significant improvements relative to control group in upper and lower body strength, shoulder flexibility, and agility and balance exercise. Findings demonstrate that exercise can lead to improvements in multiple domains of functional fitness even among very old, previously sedentary individuals, possibly making activities of daily living easier to perform.

Aged↗
PubMed2002

Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study.

This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 19 degrees, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.

Botulinum Toxins, Type A↗
PubMed2004

Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study.

OBJECTIVE: To improve walking and other aspects of physical function with a progressive 6-month exercise program in patients with multiple sclerosis (MS). METHODS: MS patients with mild to moderate disability (Expanded Disability Status Scale scores 1.0 to 5.5) were randomly assigned to an exercise or control group. The intervention consisted of strength and aerobic training initiated during 3-week inpatient rehabilitation and continued for 23 weeks at home. The groups were evaluated at baseline and at 6 months. The primary outcome was walking speed, measured by 7.62 m and 500 m walk tests. Secondary outcomes included lower extremity strength, upper extremity endurance and dexterity, peak oxygen uptake, and static balance. An intention-to-treat analysis was used. RESULTS: Ninety-one (96%) of the 95 patients entering the study completed it. Change between groups was significant in the 7.62 m (p = 0.04) and 500 m walk tests (p = 0.01). In the 7.62 m walk test, 22% of the exercising patients showed clinically meaningful improvements. The exercise group also showed increased upper extremity endurance as compared to controls. No other noteworthy exercise-induced changes were observed. Exercise adherence varied considerably among the exercisers. CONCLUSIONS: Walking speed improved in this randomized study. The results confirm that exercise is safe for multiple sclerosis patients and should be recommended for those with mild to moderate disability.

Adult↗
PubMed2003

A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial.

OBJECTIVE: To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and handicap associated with poor walking performance after stroke. DESIGN: Randomized, placebo-controlled clinical trial with a 3-month follow-up. SETTING: General community. PARTICIPANTS: A volunteer sample of 29 ambulatory individuals (less 2 dropouts) who were living in the community after having suffered a stroke more than 6 months previously. INTERVENTIONS: The experimental group participated in a 30-minute treadmill and overground walking program, 3 times a week for 4 weeks. The control group received a placebo consisting of a low-intensity, home exercise program and regular telephone contact. MAIN OUTCOME MEASURES: Walking speed (over 10 m), walking capacity (distance over 6 min), and handicap (stroke-adapted 30-item version of the Sickness Impact Profile) measured by a blinded assessor. RESULTS: The 4-week treadmill and overground walking program significantly increased walking speed (P=.02) and walking capacity (P<.001), but did not decrease handicap (P=.85) compared with the placebo program. These gains were largely maintained 3 months after the cessation of training (P</=.05). CONCLUSIONS: The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke. This suggests that the routine provision of accessible, long-term, community-based walking programs would be beneficial in reducing disability after stroke.

Aged↗
PubMed1990

The relation of endogenous sex steroid hormone concentrations to serum lipid and lipoprotein levels in postmenopausal women.

The relation of concentrations of endogenous estrogens and androgens to lipid and lipoprotein levels was examined in 176 white, postmenopausal women (mean age, 58 years) with an average of 9 years since the onset of menopause. All of the women were participants in a clinical trial of the effect of walking on postmenopausal bone loss. In that trial, women were randomized into either a walking group or a control group and were followed for 3 years. There were no differences in the serum hormones or lipids by randomized group, and hence, results from this study are presented for both groups combined. None of the women were on estrogen replacement therapy. Data were available from year 1 (1982-1983) of the trial for the estrogens, lipids, and lipoproteins. Information on androgens was available for 143 of these women. Hormone levels were determined by highly specific methods involving extraction, column chromatography, and radioimmunoassay. About 50% of the women had estradiol levels at or below the sensitivity level (2.5 pg/ml) of the assay; therefore, estradiol levels were viewed as dichotomous (measurable/not measurable), and the estradiol results should be interpreted with caution. There was little relation of the androgens to the lipid values. Univariate analyses suggested a direct relation between total cholesterol, low density lipoprotein cholesterol, and triglyceride levels with estradiol. An inverse relation was suggested between serum estrone and estradiol and total high density lipoprotein (HDL) cholesterol and HDL2 cholesterol, although none of these associations were statistically significant. Multiple regression analyses revealed that the primary determinant of the HDL cholesterol and triglyceride levels was the degree of obesity as estimated by the body mass index (weight (kg)/height (m)2). Addition of estrone or estradiol to the models did not contribute to the prediction of lipid levels. These results do not support the hypothesis of there being a relation between endogenous sex hormone levels and lipid levels in postmenopausal women. The results suggest that sex hormones cannot explain the sex difference in lipid levels and may not contribute to the rise in coronary heart disease that occurs in women around menopause.

Androstenedione↗
PubMed1994

Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation.

The purpose of this study was to investigate the relationship between performance on the shuttle walking test and maximal oxygen uptake (VO2max) during a conventional treadmill test in patients with chronic airflow limitation. Two different techniques were used to measure oxygen consumption, i.e. conventional Douglas bag techniques (treadmill test) and a portable oxygen consumption meter (shuttle test). Initially, 19 patients performed a shuttle walking test (after one practice walk) and a maximal treadmill walking test, in a randomized, balanced design. Subsequently, 10 patients, (after one practice) completed an unencumbered shuttle walking test and one supporting the portable oxygen consumption meter, in random order. The results of the first experiment revealed a strong relationship between performance during the shuttle walking test and VO2max during the treadmill walking test (r = 0.88). The results of the second experiment consistently demonstrated an incremental increase in oxygen consumption and ventilation in response to the increasing intensity of the shuttle walking test. Again, a strong relationship between VO2max and performance on the shuttle test was demonstrated (r = 0.81). We concluded that the shuttle walking test is a valid field exercise test of functional capacity. Performance on the test relates strongly to VO2max, the traditional indicator of cardiorespiratory capacity.

Exercise Test↗
PubMed2006

Brief communication: ramipril markedly improves walking ability in patients with peripheral arterial disease: a randomized trial.

BACKGROUND: Peripheral arterial disease (PAD) affects up to 12% of adults older than 50 years of age. Conventional therapies have only modest effects in improving symptoms. OBJECTIVE: To examine the effects of angiotensin-converting enzyme inhibition on walking ability in patients with PAD. DESIGN: Randomized, double-blind, placebo-controlled trial initiated in March 2003 and completed in January 2005. SETTING: The Alfred Hospital, Melbourne, Australia. PARTICIPANTS: 40 older adults with symptomatic PAD and no history of diabetes or hypertension. INTERVENTION: 10 mg of ramipril (n = 20) or placebo (n = 20) once daily for 24 weeks. All patients completed the trial. MEASUREMENTS: Pain-free and maximum walking time were recorded during a standard treadmill test, and the standard Walking Impairment Questionnaire was administered. RESULTS: After adjustment for the baseline pain-free walking time, mean pain-free walking time after ramipril treatment was 227 seconds (95% CI, 175 seconds to 278 seconds; P < 0.001) longer than that after placebo treatment. Similarly, maximum walking time improved by 451 seconds in the ramipril group (CI, 367 seconds to 536 seconds; P < 0.001) but did not change in the placebo group. Ramipril improved the Walking Impairment Questionnaire median distance score from 5% (range, 1% to 39%) to 21% (range, 12% to 58%; P < 0.001), speed score from 3% (range, 3% to 39%) to 18% (range, 8% to 50%; P < 0.001), and stair-climbing score from 17% (range, 4% to 80%) to 67% (range, 38% to 88%; P < 0.001). No adverse events were reported. LIMITATIONS: The sample size is modest, and the strict inclusion criteria limit the applicability of the results to patients with claudication and infrainguinal disease and those without diabetes. CONCLUSION: Ramipril improved pain-free and maximum walking time in some adults with symptomatic PAD.

Aged↗