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Cindy M.T. van der Avoort, Luc J.C. van Loon, Lex B. Verdijk, Paul P.C. Poyck, Dick T.J. Thijssen, and Maria T.E. Hopman

Peripheral arterial disease (PAD) is caused by atherosclerosis, which leads to arterial obstruction and impaired blood flow to the lower extremities, claudication pain, and severe exercise intolerance ( Hamburg & Creager, 2017 ). Pathophysiological factors contributing to PAD include endothelial

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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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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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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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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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Antonio Henrique Germano-Soares, Rafael M. Tassitano, Breno Quintela Farah, Aluísio Andrade-Lima, Marília de Almeida Correia, Aleš Gába, Nikola Štefelová, Pedro Puech-Leao, Nelson Wolosker, Gabriel Grizzo Cucato, and Raphael Mendes Ritti-Dias

functional implications of leg ischemia . Circ Res . 2015 ; 116 ( 9 ): 1540 – 1550 . PubMed ID: 25908727 doi:10.1161/CIRCRESAHA.114.303517 10.1161/CIRCRESAHA.114.303517 25908727 3. Muller MD , Reed AB , Leuenberger UA , Sinoway LI . Physiology in medicine: peripheral arterial disease . J Appl

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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

, VA RR&D ( 1I01RX000604 ), and the National Institutes of Health ( 1R01AG034995 , P20GM109090 , 1R01HD090333 , R01 AG049868 ). The authors have no conflicts of interest to disclose. References 1. Hallett JW . Peripheral arterial disease . Am J Respir Crit Care Med . 2008 ; 168 ( 4 ): 425

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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

intermittent claudication . Journal of Aging and Physical Activity, 16 ( 1 ), 69 – 84 . PubMed ID: 18212396 doi:10.1123/japa.16.1.69 10.1123/japa.16.1.69 Gardner , A.W. ( 2002 ). Sex differences in claudication pain in subjects with peripheral arterial disease . Medicine & Science in Sports & Exercise

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Anita Kulik, Ewelina Rosłoniec, Przemysław Madejski, Anna Spannbauer, Leszek Zguczyński, Piotr Mika, and Dorota Pilecka

level ( Sun, Norman, & While, 2013 ). Walking is recommended for various ailments. With some illnesses such as peripheral arterial disease, it is a fundamental component of conservative treatment ( Mika et al., 2013 ) and is also prescribed as primary prophylaxis for a variety of other diseases or