Abstract 505: Diabetic Women are Poor Responders to Exercise Rehabilitation in the Treatment of Claudication
Introduction. It is not clear whether subgroups of patients with peripheral artery disease (PAD) and claudication respond more favorably to exercise rehabilitation than others. We determined whether sex and diabetes were factors associated with the response to exercise rehabilitation in patients with claudication.
Hypothesis. Women will experience less improvement in the primary outcome measures of claudication onset time (COT) and peak walking time (PWT), that the presence of diabetes will blunt the improvement in the primary outcomes, and that the effect of diabetes will be greater in women than in men.
Methods. Eighty patients were randomized to home-based and supervised exercise programs, and 60 completed with complete exercise intervention data. Exercise consisted of intermittent walking to near maximal claudication pain for 12 weeks. Primary outcome measures included COT and PWT. Patients were partitioned into diabetic and non-diabetic groups, and then further partitioned by sex to form four groups.
Results. Overall, exercise adherence was high (84%), and there was no significant difference (p > 0.05) in the amount of exercise completed among the four groups. All groups had significant improvements (p < 0.05) in COT and PWT following exercise rehabilitation, except for diabetic women (p > 0.05). Only 37% of women with diabetes had an increase in COT compared to 100% of men (p < 0.01), and their risk ratio for non-response was 9.2 (p < 0.0001).
Conclusions. Women with PAD and claudication, particularly those with diabetes, represent a vulnerable subgroup of patients who respond poorly to a program of exercise rehabilitation. Diabetic women with PAD and claudication may need greater exercise volume to achieve similar improvements in claudication measures compared to non-diabetic women and to diabetic and non-diabetic men.
- © 2013 by American Heart Association, Inc.