Trained Legs for Cardiovascular Fitness in Peripheral Arteriopathy In their paper Dr Ng and colleagues1 hypothesize that in peripheral arteriopathy (PAOD) exercise-increased walking distance is not related to improved cardiopulmonary fitness but to other factors (muscle metabolism, inflammation, endothelial function). As suggested by the authors the lack of cardiovascular improvement could depend on the training protocol but also on the testing procedure employed. When programming PAOD rehabilitation, training protocols capable of improving both walking ability and cardiovascular function should be planned, with a proper combination of frequency-duration of sessions, number of bouts, periods of recovery. The authors searched for cardiovascular modifications through a protocol, that compared to others in use2 has shorter duration (8 vs 12-18 weeks), sessions length (15 vs 30 min), bouts of exercise (90 s vs 3-5 min) and low total volume (360 vs 1500-2500 min). No explanation is given why this protocol was used instead of ‘alternative protocols geared towards improving cardiopulmonary fitness’. The authors base their conclusions on the lack of increase in VO2 peak or maximum heart rate. However, patients were tested on a cycle ergometer, therefore, reducing the possibility to detect the possible muscular aerobic adaptations determined by the walking program.3 In addition, an unchangedlowered maximum heart rate despite an increased exercise time could represent a positive adaptation to training (improved walking economy, cardiovascular efficiency). In our experience, in PAOD rehabilitation4,5 walking performance and cardiovascular fitness are related. However, only when the claudication symptoms are reduced and the walking intensity is consequently increased the cardiovascular recovery is switched on. The daily application of a home-based protocol (24 weeks-3000 min: 10 min-2 times/day, 5 min/bout at maximal asymptomatic speed, 6 days/week) is followed by significant functional improvements within 4-8 weeks. Favourable modifi- cations of resting blood pressure, heart rate at any workload, ankle pressure, and ABI become evident only later. The endpoint of PAOD patients rehabilitation cannot be ‘leg training’ but the improvement of cardiovascular fitness through properly planned walking protocols.
Trained legs for cardiovascular fitness in peripheral arteriopathy
MANFREDINI, Fabio;MALAGONI, Anna Maria;ZAMBONI, Paolo;MANFREDINI, Roberto;CONCONI, Francesco
2006
Abstract
Trained Legs for Cardiovascular Fitness in Peripheral Arteriopathy In their paper Dr Ng and colleagues1 hypothesize that in peripheral arteriopathy (PAOD) exercise-increased walking distance is not related to improved cardiopulmonary fitness but to other factors (muscle metabolism, inflammation, endothelial function). As suggested by the authors the lack of cardiovascular improvement could depend on the training protocol but also on the testing procedure employed. When programming PAOD rehabilitation, training protocols capable of improving both walking ability and cardiovascular function should be planned, with a proper combination of frequency-duration of sessions, number of bouts, periods of recovery. The authors searched for cardiovascular modifications through a protocol, that compared to others in use2 has shorter duration (8 vs 12-18 weeks), sessions length (15 vs 30 min), bouts of exercise (90 s vs 3-5 min) and low total volume (360 vs 1500-2500 min). No explanation is given why this protocol was used instead of ‘alternative protocols geared towards improving cardiopulmonary fitness’. The authors base their conclusions on the lack of increase in VO2 peak or maximum heart rate. However, patients were tested on a cycle ergometer, therefore, reducing the possibility to detect the possible muscular aerobic adaptations determined by the walking program.3 In addition, an unchangedlowered maximum heart rate despite an increased exercise time could represent a positive adaptation to training (improved walking economy, cardiovascular efficiency). In our experience, in PAOD rehabilitation4,5 walking performance and cardiovascular fitness are related. However, only when the claudication symptoms are reduced and the walking intensity is consequently increased the cardiovascular recovery is switched on. The daily application of a home-based protocol (24 weeks-3000 min: 10 min-2 times/day, 5 min/bout at maximal asymptomatic speed, 6 days/week) is followed by significant functional improvements within 4-8 weeks. Favourable modifi- cations of resting blood pressure, heart rate at any workload, ankle pressure, and ABI become evident only later. The endpoint of PAOD patients rehabilitation cannot be ‘leg training’ but the improvement of cardiovascular fitness through properly planned walking protocols.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
