Dae Hyun Kim, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
Kim D.; Exercise and Peripheral Arterial Disease. Ann Intern Med. 2006;144:699. doi: 10.7326/0003-4819-144-9-200605020-00017
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Published: Ann Intern Med. 2006;144(9):699.
TO THE EDITOR:
Dr. McDermott and colleagues (1) found that self-directed walking exercise at least 3 times weekly was associated with a slower rate of functional decline in patients with peripheral arterial disease (PAD) after adjusting for sociodemographic and clinical characteristics, including aspirin, statin, and angiotensin-converting enzyme inhibitor use. They also took into consideration that a proportion of patients benefited from participating in supervised exercise programs. They did not, however, adjust for the use of pharmacologic interventions for claudication, such as pentoxifylline and cilostazol, which might have more significant and direct effects on functional performance than those seen with aspirin, statin, and angiotensin-converting enzyme inhibitor therapy for concurrent cardiovascular risk factor modification. In a recent meta-analysis (2), treatment with pentoxifylline, a methylxanthine derivative, was shown to increase total walking distance on a treadmill by almost 44 meters (95% CI, 14 to 74 meters). Therapy with cilostazol, an inhibitor of phosphodiesterase type 3 with antiplatelet and vasodilator effects, also significantly improved maximal walking distance, quality of life, and functional status in randomized, placebo-controlled trials (3, 4). Therefore, the slower rate of functional decline observed among those who walk for exercise regularly should probably not be attributed to the beneficial effect of self-directed exercise without taking into consideration the use of pentoxifylline or cilostazol therapy.
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