Claudication pain and hemodynamic responses to exercise in younger and older peripheral arterial disease patients

Background. Claudication patients who are candidates for exercise can frequently walk to maximal pain without experiencing exaggerated blood pressure and heart rate, as well as other clinical symptoms. However, these concomitant problems are more likely to become apparent as patients age. Consequently, this study compared the claudication and hemodynamic responses to exercise in younger and older peripheral arterial disease patients. Methods. Forty younger (mean age 60.4 yr, range 55-62) and 51 older (mean age 75.5 yr, range 73-81) patients with stable claudication symptoms performed a progressive treadmill walking test to maximal leg pain. The times to onset and to maximal claudication pain, peripheral hemodynamic measurements (oximetry, ankle systolic pressure, and ankle-to-brachial systolic pressure index), and central hemodynamic measurements (heart rate and brachial blood pressures) were obtained. Results. Onset and maximal claudication pain occurred 71 sec and 126 sec sooner (p < .05) in the older group, respectively. Greater reductions (p < .05) in foot transcutaneous oxygen tension, ankle systolic pressure, and ankle-to-brachial systolic pressure index were obtained during and following exercise in the older group. Furthermore, smaller increases (p < .05) in heart rate, brachial blood pressures, mean arterial pressure, and rate-pressure product were noted during exercise in the older group. Conclusions. Greater impairment in the peripheral hemodynamic measurements occurs without exaggerated heart rate and blood pressure responses in older claudication patients who walk to maximal leg pain compared with younger patients.