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Nelson Wolosker, PhD; Lívio Nakano, MD; Ruben Aizyn Rosoky, MD; Pedro Puech-Leão, PhD

Arch Intern Med. 2003;163:2296-2300.

Background  The use of physical training in the treatment of intermittent claudication is well established. However, current data do not provide enough information about the prognosis for each case, and there are no data on how walking distances evolve over time with conservative treatment. The goal of this study was to evaluate improvement in walking capacity among patients with intermittent claudication who underwent unsupervised clinical treatment, observing whether sustained treatment would increase or decrease maximum walking distance, whether after 6 months there was a change in the maximum distance, and whether abstinence from smoking and well-conducted walking exercise had independent effects on the outcome.

Methods  Five hundred patients with intermittent claudication were surveyed in a prospective, nonrandomized, and uncontrolled study. Maximum walking distance and treatment compliance over time were analyzed.

Results  Nonsmoking patients who walked achieved a mean increase during the first 6 months of 33.70 m/mo and a mean increase thereafter of 4.24 m/mo. Smokers who walked achieved an increase during the first 6 months only (mean, 42.92 m/mo). Patients who did not practice physical training exhibited no effect (smokers) or negligible effect (nonsmokers) from the treatment (mean, 7.58 m/mo).

Conclusions  Patients who adhered to physical training exhibited a significant increase in maximum walking distance during the first 6 months of treatment only. Patients who did not practice physical training exhibited no effect (smokers) or negligible effect (ex-smokers) from the treatment.

From the Division of Vascular Surgery, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil. The authors have no relevant financial interest in this article.

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