Low-Intensity Pain-Free Treadmill Exercise for Intermittent Claudication

Benefits of low-intensity pain-free treadmill exercise on functional capacity of individuals presenting with intermittent claudication due to peripheral arterial disease.  Angiology. 2009 Aug-Sep;60(4):477-86. Barak S, Stopka CB, Archer Martinez C, Carmeli E.

Patients with intermittent claudication due to peripheral arterial disease (PAD) experience muscle aching during walking secondary to ischemia.  The purpose of this study was to examine the effects of low-intensity pain-free exercise (LIPFE) on functional capacity of individuals with PAD.  A total of 12 participants with PAD underwent training on treadmill for 6 weeks, twice a week, for about 45 minutes. Outcome measures included walking distance (WDI), walking duration (WDU), mean walking rate (WR), estimated oxygen consumption (EVO(2)), metabolic equivalent (MET), estimated total energy expenditure (ETEE), and estimated rate of energy expenditure (EREE).  Mean improvement of WDI, WDU, and MWR were 104% (an addition of 1.0 km), 55% (an addition of 13.3 minutes), and 41% (0.9 km/h faster), respectively.  Mean improvement of EVO(2), MET, ETEE, and EREE, were 20%, 20%, 80%, and 20%, respectively.  In conclusion, it appears that LIPFE training is an effective intervention for individuals presenting with PAD.

My comments:

This program used a reasonably standard 5 point pain scale but added a 0.5 point, which meant “tiredness, heaviness, or tightness in the legs without pain” before level one which was mild pain.  The subjects aimed to walk with pain <1.0 on the scale. The exercise was done 3 times per week for 6 weeks with continuous walking averaging 24 minutes at first and working to 37 minutes at the end of the 6 weeks.  Rather than a form of intervals in the other program, this one was continuous exercise with the speed decreased if any pain was felt. Progress was made in walking distance, duration, and speed.  Speed on average increased from 2.2 kpm (1.3 mph) to 3.0 kpm (1.86 mph) which while meaningful is still pretty slow.  Improvements per week and workout are as follows:

  • Walking Distance / week = 17.5%
  • Walking Duration / week = 9.3%
  • Walking Speed / week = 13.7%
  • Walking Distance / workout = 9.7%
  • Walking Duration / workout = 3.1%
  • Walking Speed / workout = 2.3%

The increases look reasonably good, however the patients started off at a very low rate and short distance. Even at the end of 6 weeks they were only walking 1.86 mph, which isn’t fast enough to safely get you across an intersection. Also, even with percents per week and workout it is difficult to compare to other studies with speed and duration all separated out. That’s why I still think the most objective measure would and should be the 6 minute walk test as both speed and endurance are taken into account, rather than trading off one for another.

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember SpineFit Yoga for you or someone you know in the future.

Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.


2 responses to “Low-Intensity Pain-Free Treadmill Exercise for Intermittent Claudication”

  1. I’ve had a leg problem for almost two years and went to an orthopedic and PT and after various tests, neither could diagnose what I had. PT believed it was due to high arches and so I got custom insoles a year ago that hasn’t really helped. Is there a way to diagnose claudication by myself or can only a doctor do so? Thanks… I just found this site, hence a reply to a post from two years ago.

    1. Chad Reilly

      Hi Adam,

      It’s hard to say. If it’s foot pain I’d be inclined to think it’s a foot problem. Claudication usually doesn’t hurt so much in the feet but more in the leg muscles, the calves especially, as pain starts to rise from poor circulation. I would think high blood sugar and/or high cholesterol to be risk factors as well as atherosclerosis. So a cardiologist might be the best doctor to see if you think you have intermittent claudication. Neurogenic claudication, from stenosis of the spine can cause similar symptoms, and would be something to rule out too. So yeah, should probably see a doctor.

      If it’s just foot pain with walking I’d suspect plantar fasciitis, or maybe posterior tibial tendinopathy. Shin pain could be shin splints (aka medial tibial stress syndrome), or a stress fracture, but I would expect a good orthopedic to be able to diagnose that. Hope that helps.

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