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Changes in Function After a 6-Month Walking Intervention in Patients With Intermittent Claudication Who Are Obese or Nonobese

Addison, Odessa DPT, PhD1,2; Ryan, Alice S. PhD1,2; Prior, Steven J. PhD1,2; Katzel, Leslie I. MD, PhD1,2; Kundi, Rishi MD3; Lal, Brajesh K. MD3; Gardner, Andrew W. PhD4

Journal of Geriatric Physical Therapy: October/December 2017 - Volume 40 - Issue 4 - p 190–196
doi: 10.1519/JPT.0000000000000096
Research Reports

Background and Purpose: Both obesity and peripheral artery disease (PAD) limit function and may work additively to reduce mobility. The purpose of this study was to compare the effects of a 6-month, center-based walking program on mobility function between adults who are weight-stable obese and nonobese with PAD.

Methods: This is a secondary data analysis of 2 combined studies taken from previous work. Fifty-three adults with PAD and intermittent claudication participated in 6 months of treadmill training or standard of care. Patients were divided into 4 groups for analyses: exercise nonobese (Ex), exercise obese (ExO), standard-of-care nonobese (SC), and standard-of-care obese (SCO). Mobility was assessed by a standardized treadmill test to measure claudication onset time (COT) and peak walking time (PWT) as well as the distance walked during a 6-minute walk distance (6MWD) test.

Results: There was a significant (P < .001) interaction (intervention × obesity) effect on 6MWD, wherein both exercise groups improved (Ex = 7%, ExO = 16%; P < .02), the SC group did not change (0.9%; P > .05), and the SCO group tended to decline (−18%; P = .06). Both exercise intervention groups significantly improved COT (Ex = 92%, ExO = 102%; P < .01) and PWT (Ex = 54%, ExO = 103%; P < .001). There was no change (P > .05) in either standard-of-care group.

Conclusions: Individuals who are obese and nonobese with PAD made similar improvements after a 6-month, center-based walking program. However, patients who are obese with PAD and do not exercise may be susceptible to greater declines in mobility. Exercise may be particularly important in patients who are obese with PAD to avoid declines in mobility.

1Department of Medicine, Division of Gerontology, University of Maryland, Baltimore.

2Department of Veterans Affairs and Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Centers, Baltimore, Maryland.

3Department of Surgery, Division of Vascular Surgery, University of Maryland, Baltimore.

4Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.

Address correspondence to: Odessa Addison, DPT, PhD, Department of Veterans Affairs and Veterans Affairs Medical Centers, 10 North Greene St, Baltimore, MD 21201 (

This work was presented at the American Physical Therapy Association Combined Sections Meeting, February 2016, Anaheim, California.

This work was supported by grants from the National Institute on Aging (NIA) (R01-AG-16685 and K01-00657; AWG), a Claude D. Pepper Older Americans Independence Center grant from NIA (P60-AG12583), National Institute of Aging Training Grant (AG000219), a VA Senior Research Career Scientist Award to ASR, a Paul B. Beeson Career Development Award in Aging (K23-AG040775 and the American Federation for Aging Research) to SJP, and a Geriatric, Research, Education, and Clinical Center grant from Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore. Final peer-reviewed version is subject to NIH Public Access Policy, and will be submitted to PubMed Central.

The authors declare no conflicts of interest.

Richard W Bohannon was the Decision Editor.

© 2017 Academy of Geriatric Physical Therapy, APTA
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