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Melissa N. Galea Holmes, John A. Weinman and Lindsay M. Bearne

Peripheral arterial disease (PAD) is an age-related condition characterized by atherosclerotic narrowing or occlusion in the arteries of the lower limb, and it affects up to 20% of older adults ( Selvin & Erlinger, 2004 ). A common symptom of PAD is intermittent claudication (IC), a debilitating

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Melissa N. Galea, Steven R. Bray and Kathleen A. Martin Ginis

This study aimed to identify barriers and facilitators associated with walking for exercise among people who experience intermittent claudication. Fifteen individuals (7 men and 8 women) participated in 3 focus groups that were tape-recorded and content analyzed. A social-cognitive framework was used to categorize barriers and facilitators as those related to the person, to the activity, or to the environment. Variables identified included those specific to intermittent claudication and those common among the general population. Barriers to walking included irregular or graded walking surfaces, uncertainty about the outcome of walking, ambiguity regarding pain, the need to take rest breaks, and the presence of leg pain. Facilitating factors included availability of a resting place, use of cognitive coping strategies, companionship support, and availability of a treadmill-walking program. Findings are interpreted in light of current research on exercise determinants and encourage prospective examinations of the predictive validity of these factors for walking.

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Jennifer M. Yentes, Jessie M. Huisinga, Sara A. Myers, Iraklis I. Pipinos, Jason M. Johanning and Nicholas Stergiou

Peripheral arterial disease (PAD) is a manifestation of atherosclerosis resulting in intermittent claudication (IC) or leg pain during physical activity. Two drugs (cilostazol and pentoxifylline) are approved for treatment of IC. Our previous work has reported no significant differences in gait biomechanics before and after drug interventions when PAD patients walked without pain. However, it is possible that the drugs are more efficacious during gait with pain. Our aim was to use advanced biomechanical analysis to evaluate the effectiveness of these drugs while walking with pain. Initial and absolute claudication distances, joint kinematics, torques, powers, and gait velocity during the presence of pain were measured from 24 patients before and after 12 weeks of treatment with either cilostazol or pentoxifylline. We found no significant improvements after 12 weeks of treatment with either cilostazol or pentoxifylline on the gait biomechanics of PAD patients during pain. Our findings indicate that the medications cilostazol and pentoxifylline have reduced relevance in the care of gait dysfunction even during pain in patients with PAD.

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Michael R.M. McGuigan, Roger Bronks, Robert U. Newton, John C. Graham and David V. Cody

Peripheral arterial disease (PAD) is associated with impaired lower extremity function. This study investigated differences in PAD and control participants and the relationship between lower limb strength and clinical measures of PAD severity. Participants were evaluated by 6-min-walk distance, normal and maximal walking speed over 10 m, isometric plantar-flexion strength, and dynamic dorsi-/plantar-flexion strength. Hemodynamic measures of the lower limbs were recorded at rest and after maximal treadmill testing. PAD participants walked significantly less far during the 6-min walk, and there were large differences in normal and maximal walking speeds. Small to moderate differences were found for isometric plantar-flexion strength. In the diseased legs of the PAD participants, resting systolic hallux photoplethysmography was significantly correlated with isokinetic plantar-flexion strength and onset of claudication pain during the 6-min-walk test. In addition to confirming the documented loss of walking endurance, these data suggest that loss of strength of the plantar flexors is associated with increasing PAD impairment.

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Jessie M. Huisinga, Iraklis I. Pipinos, Nicholas Stergiou and Jason M. Johanning

Pharmacological treatment has been used to alleviate the claudication symptoms and improve walking performance in peripheral arterial disease (PAD) patients. However, the effects of claudication treatments on gait mechanics have not been objectively indentified with biomechanical techniques. For this study, 20 PAD patients were assigned to take either pentoxifylline (n = 11) or cilostazol (n = 9), the two FDA-approved pharmacological therapies used to treat intermittent claudication symptoms. All patients completed a gait evaluation protocol that involved the acquisition of kinematic and kinetic gait data before use of the medication and after 12 weeks of treatment. Results showed that treatment with either pentoxifylline or cilostazol resulted in limited overall improvement in gait parameters including joint angles and joint moments. Walking speed was unchanged, in either treatment group, as a result of the medication. These results suggest that to improve biomechanical walking parameters of PAD patients, clinicians cannot rely on drug therapies alone.

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Adilson Santos Andrade de Sousa, Marilia A. Correia, Breno Quintella Farah, Glauco Saes, Antônio Eduardo Zerati, Pedro Puech-Leao, Nelson Wolosker, Gabriel G. Cucato and Raphael M. Ritti-Dias

Peripheral artery disease (PAD) affects more than 202 million people globally ( Fowkes et al., 2013 ). Intermittent claudication (IC), the main symptom of PAD, is defined as muscle discomfort in the legs caused by exercise, and is relieved by short periods of rest ( Norgren et al., 2007 ). IC

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John D. McCamley, Eric L. Cutler, Kendra K. Schmid, Shane R. Wurdeman, Jason M. Johanning, Iraklis I. Pipinos and Sara A. Myers

is known as intermittent claudication, and it can affect one or both legs. 2 , 3 Patients with PAD have reduced physical activity and typically experience diminished mobility and quality of life. 1 , 2 , 4 , 5 The American Heart Association reports PAD currently affects more than 8 million

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Kelly A. Brock, Lindsey E. Eberman, Richard H. Laird IV, David J. Elmer and Kenneth E. Games

was largely completed using animal models 16 or in blood-flow compromised patients (intermittent claudication 19 and limb amputation 20 ). Our study found an increase in O 2 Hb levels of 42% and THb increases of 138% compared with the control condition in non-blood-flow compromised participants

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Sang-Ho Lee, Steven D. Scott, Elizabeth J. Pekas, Jeong-Gi Lee and Song-Young Park

-term study of policosanol in the treatment of intermittent claudication . Angiology . 2001 ; 52 : 115 – 125 . PubMed ID: 11228084 doi:10.1177/000331970105200205 11228084 10.1177/000331970105200205 13. Hernandez F , Illnait J , Mas R , et al . Effect of policosanol on serum-lipids and lipoproteins

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Ali M. McManus, Nathan R. Sletten and Daniel J. Green

nonexercising upper limb. There are known regional differences in vascular responses to exercise ( 22 ), alongside evidence that vascular disease risk is often detectable in the blood vessels of the legs rather than the arms (ie, intermittent claudication, peripheral arterial disease) ( 29 ). Furthermore, the