REVI EW ARTI CLE
Th e r a pe u t ic r e sist a n ce e x e r cise s for in dividu a ls w it h pe r iph e r a l a r t e r ia l
obst r u ct ive dise a se : e vide n ce for pr e scr ipt ion
Lu ca s Ca se r i Câ m a r aI; José M a r ia Sa n t a r é mI I; N e lson W olosk e rI I I; Ra ph a e l M e n de s Rit t i D ia sI V
IMSc. st udent , Experim ent al Physiopat hology, Faculdade de Medicina, Universidade de São Paulo
( USP) , São Paulo, SP, Brazil. I nst it ut o Biodelt a de Ensino e Pesquisa ( I BEP) , São Paulo, SP, Brazil. Cent ro de Est udos em Ciências da At ividade Física ( CECAFI ) , Disciplina de Geriat ria, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
I IPhD in Medicine, Faculdade de Medicina, USP, São Paulo, SP, Brazil. I BEP, São Paulo, SP, Brazil.
CECAFI , Disciplina de Geriat ria, Faculdade de Medicina, USP, São Paulo, SP, Brazil.
I I IProfessor, Medicine, Faculdade de Medicina, USP, São Paulo, SP, Brazil. Depart m ent of Vascular
Surgery, Hospit al das Clínicas de São Paulo, USP, São Paulo, SP, Brazil.
I VPhD st udent in Public Healt h, Faculdade de Saúde Pública, USP, São Paulo, SP, Brazil. Scholarship
holder FAPESP ( process 06/ 00759- 3) .
Correspondence
J Vasc Bras. 2007; 6( 3) : 246- 56.
ABSTRACT
A regular physical act ivit y program is part of t he init ial clinical approach t o pat ient s w it h peripheral art erial obst ruct ive disease. Therefore, use of exercises against resist ance loads ( resist ance t raining) has been w idely recom m ended for different populat ions, especially for elderly individuals w it h and wit hout associat ed diseases. The few st udies t hat have used t his form of exercise in pat ient s w it h peripheral art erial obst ruct ive disease dem onst rat ed it s t herapeut ic efficiency. However, report ed effect s of resist ance t raining in ot her populat ions have evidenced im provem ent in physical fit ness and qualit y of life, w it h cardiovascular and m usculoskelet al safet y. These dat a indicat e t he possible benefit s of resist ance t raining in peripheral art erial obst ruct ive disease t herapy. Thus, t his review aim ed at present ing scient ific inform at ion t hat can help prescript ion of resist ance t raining for t his populat ion.
Ke yw or ds: Peripheral vascular disease, int erm it t ent claudicat ion, weight lift ing, exercise t herapy.
A prát ica regular de exercícios é part e do t rat am ent o clínico inicial para pacient es com doença art erial obst rut iva periférica. Nesse sent ido, a ut ilização de exercícios cont ra resist ência ( exercícios resist idos) t em sido am plam ent e recom endada para diferent es populações, especialm ent e para pessoas idosas com e sem doenças associadas. Os poucos t rabalhos encont rados ut ilizando essa form a de exercícios em pacient es com doença art erial obst rut iva periférica docum ent am a sua eficiência t erapêut ica. No ent ant o, os efeit os docum ent ados dos exercícios resist idos em out ras populações t êm evidenciado m elhoria da apt idão física e da qualidade de vida, com segurança cardiovascular e m úsculo- esquelét ica. Essas inform ações fornecem indicat ivos sobre os possíveis benefícios dos exercícios resist idos na t erapia de indivíduos com doença art erial obst rut iva
periférica. Nesse sent ido, est a revisão obj et ivou apresent ar inform ações cient íficas que perm it am auxiliar a prescrição dos exercícios resist idos para essa população.
Pa la vr a s- ch a ve : Doenças vasculares periféricas, claudicação int erm it ent e, levant am ent o de peso, t erapia por exercício.
I n t r odu ct ion
Obst ruct ive at herosclerot ic lesions of vessels dist al t o t he aort ic bifurcat ion, w hich com prom ise or prevent art erial blood flow , result ing in reduced oxygen supply t o peripheral t issues dist al t o t he affect ed sit e, are called peripheral art erial obst ruct ive disease ( PAOD) .1
The chronic ischem ic process generat ed by PAOD seem s t o result in a cycle of progressive disabilit y in pat ient s w it h t his disease. I n t his sense, individuals w it h PAOD have endot helial dysfunct ion, reperfusion ischem ia, syst em ic inflam m at ion and release of free radicals, at rophy and denervat ion of m uscle fibers, change in m uscle m et abolism , reduced st rengt h and m uscle resist ance and
im pairm ent of w alking abilit y.2 Such disorders, in t heir t urn, result from reduct ion in aut onom y and
level of physical act ivit y3 , 4 and consequent ly reduct ion in physical fit ness and qualit y of life of t hese pat ient s.5 , 6
The first clinical m anifest at ion report ed by individuals wit h PAOD is int erm it t ent claudicat ion ( I C) .7 I C consist s of pain, cram p, t ingling or burning in t he lower lim bs ( m ore com m only in t he calves, but also affect ing t highs and glut eus in som e cases) , w hich occur during pract ice of physical act ivit y and only st ops w it h rest .7 , 8
According t o t he Transat lant ic I nt er- Societ y Consensus,7 t he fir st t reat m ent t o be adopt ed in t he
individual w it h I C is t he pract ice of physical exercises. That recom m endat ion is based on several st udies t hat have dem onst rat ed t he effect iveness of t his m et hod t o im prove gait abilit y9 , 1 0 and
qualit y of life of t hese pat ient s,1 1 - 1 5 wit h low er cost t han ot her t reat m ent m et hods.1 6
Am ong m odalit ies of physical exercise, resist ance t raining ( RT) has been w idely used in t he
t reat m ent and rehabilit at ion of elderly individuals and pat ient s wit h chronic diseases.1 7 This m et hod
consist s of perform ing cont ract ions of specific m uscle groups against som e form of ext ernal resist ance ( free w eight s, m achines and elast ic bands) . The m ain advant ages of t his m et hod are expressive im provem ent s in physical fit ness1 8 and qualit y of life of different populat ions,1 9 , 2 0 wit h
proper cont rol of m ovem ent variables ( posit ion and post ure, perform ance speed, m ovem ent am plit ude, volum e and int ensit y) .2 1
st udied, 2 2 , 2 3 so t hat im port ant inform at ion about applicabilit y and st ruct uring of RT program s for
t hat populat ion st ill requires m ore invest igat ion.
Therefore, t his st udy aim ed at present ing t he possible benefit s of RT for individuals w it h PAOD and, based on t he inform at ion available in t he lit erat ure, suggest ing a m odel t o prescribe RT for t hese pat ient s.
M e t h ods
A lit erat ure review was perform ed in elect ronic dat abases LI LACS, PUBMED and SciELO. To do so, t he t er m s resist ance t raining, st rengt h t raining, weight t raining, int erm it t ent claudicat ion and peripheral art erial obst ruct ive disease were used. Aft er obt aining t he references, t he full art icles were acquired from on- line j ournal dat abases ( Sibinet and Port al da Pesquisa) and in libraries in São Paulo, Brazil.
Ph ysica l fit n e ss in in dividu a ls w it h pe r iph e r a l a r t e r ia l obst r u ct ive dise a se
I ndividuals w it h PAOD have reduced t olerance t o physical exercise, especially in w alking abilit y.7 Such physical inabilit y seem s t o be relat ed t o t he st age of disease evolut ion, so t hat t he m ore advanced t he disease, t he higher t he funct ional disabilit y.3 , 4 St udies perform ing out pat ient m easurem ent s by subj ect ive quest ionnaires t o analyze levels of physical act ivit y and gradual
walking t est s, observed t hat physical funct ion and daily levels of physical act ivit y in t hese individuals reduced as t he disease becam e m ore severe.3 , 2 4
Besides reduct ion in w alking abilit y, individuals w it h PAOD have im pairm ent s in ot her com ponent s of physical fit ness, especially t hose relat ed t o m uscle funct ion. I n a st udy carried out by McDerm ot t et al.,2 5 m uscle st rengt h and resist ance of individuals w it h PAOD were reduced as t he disease becam e
m ore severe. Such inform at ion was confirm ed by ot her aut hors, w ho verified low er values of m uscle st rengt h and resist ance in individuals wit h PAOD when com pared w it h cont rol individuals.2 6 - 2 9
According t o Regenst einer et al.2 9 and Gerdle et al.,2 7 reduced st rengt h in individuals w it h PAOD is
direct ly associat ed w it h t heir gait abilit y.
I ndividuals w it h PAOD also have im port ant m orphological changes. I n a st udy perform ed by McDerm ot t et al.,3 0 t here was less m uscle m ass in lower lim bs of individuals affect ed by t hat
disease. These findings were confirm ed by Askew et al.3 1 and Regenst einer et al.,2 9 who observed,
t hrough biopsy in lower lim b m uscles, sm aller size in t ype I and t ype I I a m uscle fibers in t hese pat ient s, com pared t o cont rols.
Considering t hat prevalence of PAOD increases w it h age,3 2 , 3 3 it is im port ant t o not e t hat changes result ing from PAOD m ost ly occur concom it ant ly w it h dysfunct ions secondary t o t he ageing process. Thus, it is possible t o conclude t hat reduced general physical fit ness and m uscle funct ion result ing from ageing occurs even m ore m arkedly in individuals w it h PAOD.
Because of t hat , adopt ion of int ervent ions t hat allow reversion of im pairm ent s associat ed w it h t he ageing process and im provem ent of funct ional lim it at ion of individuals w it h PAOD has been
recom m ended for t he t reat m ent of t hese pat ient s.7 I n t his sense, t he pract ice of RT has been
increasing along t he past decades, since t his m odalit y of exercises seem s t o help prevent ing and t reat ing diseases, as w ell as providing im provem ent s in physical fit ness and healt h in t he
Be n e fit s of r e sist a n ce t r a in in g
According t o t he Am erican College of Sport s Medicine,3 6 regular pract ice of RT can provide im provem ent s in physical fit ness and healt h in t he elderly,3 7 as w ell as help t o prevent and t reat chronic diseases, such as hypert ension,3 8 diabet es m ellit us,3 9 obesit y4 0 and ost eoporosis.4 1
RT are m ovem ent s perform ed against graded resist ances, usually weight s, and have been gaining increasingly m ore at t ent ion from t he scient ific com m unit y, current ly being part of program s of physical condit ioning, aim ing at prevent ion and rehabilit at ion of elderly individuals and in pat ient s wit h varied diseases.1 7 The m ain advant age of t his m et hod is proper cont rol of all m ovem ent
variables ( posit ion and post ure, perform ance speed, m ovem ent am plit ude, volum e and int ensit y)2 1
wit h cardiovascular and m usculoskelet al safet y.3 4 , 4 2 , 4 3 I n addit ion, t he equipm ent used t o perform
RT allows regulat ing overloads t o be used according t o t he individual's level of fit ness, opposed t o classical gym nast ic m ovem ent s, in w hich overload is usually body weight .4 4
As t o RT safet y for elderly individuals and/ or pat ient s w it h disease, Graves & Franklin1 7 claim t hat
Opposit e t o predom inant ly aerobic exercises t hat provide increase only in heart r at e and syst olic blood pressure, RT provides increase in heart rat e, syst olic blood pressure and diast olic blood pressure.4 9 I ncrease in diast olic blood pressure, in it s t urn, has been considered a fact or of
cardiovascular prot ect ion, since it favors coronary flow , increasing oxygen supply t o t he m yocardium and, consequent ly, reducing ischem ic and arrhyt hm ic event s.4 2 I n fact , t he prot ect ive fact or of RT
for reduct ion in ischem ic cardiac and arrhyt hm ic event s has been w idely dem onst rat ed in t he lit erat ure.4 2 , 5 0 - 5 2 An exam ple of t hat are t he result s by Bert agnoli et al.,5 0 who, in a st udy of
coronary pat ient s, verified t hat increm ent of dum bbells in t he hands of pat ient s during aerobic exercises, at t he m om ent of ischem ia onset , result ed in norm alizat ion of coronary flow . I n addit ion, lower venous reflux during RT seem s t o generat e less dist ension of m yocardial w alls, facilit at ing subendocardial coronary circulat ion.3 5 Finally, it is w ort h st ressing t hat t he t hree cases of brain
hem orrhage report ed in t he lit erat ure in associat ion w it h RT were at t ribut ed t o rupt ure of congenit al aneurysm s,5 3 and, in m ore t han 26,000 m axim um load t est s perform ed in a universit y environm ent ,
t here were no cases of cardiovascular incident s.5 4
Wit h regard t o safet y for t he m usculoskelet al syst em , RT, because it allows cont rol of t he m ain t raining variables, provides m it igat ion of risk fact ors for lesions such as sudden accelerat ions and decelerat ions, t orsions, im pact , direct t raum a and risk of falls.3 4 , 4 2 - 4 4 Such cont rol, in it s t urn, has m ade t his m odalit y ext rem ely recom m ended for t he t reat m ent of different m usculoskelet al
disorders, such as j oint inst abilit ies, art hroses, idiopat hic art hralgias, ent hesopat hies, t endinit is and t enosinovit is, capsulit is, reflex dyst rophy, bursit is, fasciit is, fibrosit is/ fibrom yalgia, panniculit is, discopat hies, report ed or irradiat ed pains in t he vert ebral colum n and post ure disorders.3 4 , 4 3 , 5 5 , 5 6
Be n e fit s of r e sist a n ce t r a in in g for pa t ie n t s w it h pe r iph e r a l a r t e r ia l
obst r u ct ive dise a se
Due t o several benefit s provided by RT, t he use of t his m et hod for t he t reat m ent of individuals w it h PAOD st art ed being invest igat ed over t he past years.2 8 , 5 7
Alt hough t he inform at ion available in t he lit erat ure about t he effect iveness of RT in t he t reat m ent of individuals w it h PAOD is st ill scarce, t he result s of t wo published st udies on t his t hem e indicat ed a posit ive effect of t his exercise m odalit y on t he t reat m ent of pat ient s w it h PAOD.2 8 , 5 7
Pract ice of RT in individuals w it h PAOD result ed in im provem ent in w alking abilit y, providing
significant increase in init ial w alking dist ance and in t ot al w alking dist ance,2 8 , 5 7 in m uscle st rengt h, in exercises leg press and plant ar flexion.5 7 Furt herm ore, increase in capillarizat ion of leg m uscles,
verified by m uscle biopsy,5 7 in w alking speed, in abilit y of clim bing st airs and in qualit y of life5 8 was also verified aft er RT program s in individuals w it h PAOD.
An im port ant advant age of RT in relat ion t o ot her exercise m odalit ies, especially w alking, is absence of claudicat ion during t raining program s. I n t he st udies by McGuigan et al.5 7 and Hiat t et al.,2 8 t here was no claudicat ion during RT, a com m on com plaint by individuals w it h PAOD, which has been point ed as one of t he fact ors t hat could com prom ise t reat m ent adherence.5 9
Pr e scr ipt ion of r e sist a n ce t r a in in g for in dividu a ls w it h pe r iph e r a l a r t e r ia l
obst r u ct ive dise a se
program . According t o t hat m anipulat ion, it is possible t o enhance responses t o RT program and increase safet y of t his pract ice.
Therefore, t he fir st st ep t o prescribe RT is definit ion of t he obj ect ives t hat should be achieved using t his int ervent ion. I n individuals wit h PAOD, t he m ain obj ect ive of an RT program is t o im prove general physical fit ness,7 result ing in increased aut onom y and qualit y of life for t hese pat ient s.
However, since it is a populat ion t hat usually has different com orbid condit ions, such as hypert ension, diabet es m ellit us, obesit y, cardiovascular and cerebrovascular diseases, am ong ot hers,6 0 it is prudent t o prescribe RT for individuals w it h PAOD t aking int o account such lim it at ions.
To do so, it is necessary, before st art ing an RT program , t o subm it individuals w it h PAOD t o clinical assessm ent t o diagnose all com orbidit ies and cert ify physical condit ion t o pract ice physical
exercises. According t o Vincent & Vincent ,4 5 cont raindicat ions t o RT, which are also applied t o all ot her form s of exercises in special populat ions, are syst olic blood pressure > 200 m m Hg or diast olic blood pressure > 110 m m Hg, at r est ; drop in ort host at ic art erial pressure > 20 m m Hg, w it h
sym pt om s; hypot ension during effort > 15 m m Hg; unst able angina; uncont rolled arrhyt hm ias; crit ical or sym pt om at ic aort ic st enosis; acut e disease or fever; rest ing heart rat e > 120 bpm ; decom pensat ed heart failure; t hird degree at riovent ricular block w it hout pacem aker; ongoing pericardit is or m yocardit is; recent infarct ion or pulm onary em bolism ; depression of ST segm ent > 2 m V at r est ; severe ort hopedic problem s t hat prevent RT; hypert rophic cardiom yopat hy; coronary bypass up t o 4 weeks; left vent ricular ej ect ion fract ion sm aller t han 30% ; advanced or com plicat ed pregnancy.
The m ain variables t hat are part of an RT program are weekly volum e, exercises, num ber of series, t ype of cont ract ion, num ber of repet it ions, int ensit y, int erval and am plit ude. Next , we discuss fact ors t hat int erfere w it h such variables and t hat should be considered for prescript ion of RT in individuals w it h PAOD.
W e e k ly volu m e
Weekly volum e of t raining is usually represent ed by t he num ber of t raining sessions per w eek. I n t he elder ly, at least t w o weekly sessions of RT can provide im provem ent s in st rengt h,6 1 aerobic power,6 1 body com posit ion6 2 and flexibilit y.4 6 Alt hough st udies on RT in individuals w it h PAOD have
used t hr ee weekly sessions,2 8 , 5 7 it is possible t hat only t wo w eekly sessions are enough t o provide
posit ive adapt at ions, since t hese pat ient s have low levels of physical fit ness. This m akes t he am ount of st im ulus needed t o provide significant adapt at ions relat ively sm all.
Thus, an RT program for individuals w it h PAOD should be com prised of at least t w o weekly sessions, perform ed in alt ernat e days.
Ex e r cise s
The exercises t hat are part of t he t raining program com prehend t wo m ain aspect s: t he num ber of exercises and which m uscle groups are em phasized.
There is st ill no consensus in t he lit erat ure as t o t he ideal num ber of exercises t o be used in RT. However, RT program s for beginners include approxim at ely six t o 10 exercises.3 6 Evidence in t he
lit erat ure suggest s t hat t his am ount of exercises is enough t o cause posit ive adapt at ions in different com ponent s of physical fit ness, being w ell support ed by sedent ary elderly individuals and by t hose wit h PAOD.2 8 , 3 6 , 3 7 , 5 7
exercises t hat r each large m uscle groups and t hat , as t he t raining evolves, specific m uscle groups are exercised.3 6 , 3 7 This recom m endat ion seem s t o have a m aj or im pact on individuals w it h PAOD,
since, in a st udy in which large m uscle groups were em phasized,5 7 t here were m ore m arked
adapt at ions com pared w it h t he st udy t hat only prescribed exercises for t he low er lim bs.2 8
Therefore, RT program for individuals w it h PAOD should cont ain bet ween six and 10 exercises, reaching t he m ain large m uscle groups.
N u m be r of se r ie s
Since it is an effort wit h predom inance of anaerobic m et abolism , RT are usually prescribed in series. The aut hors w ho com pared t he adapt at ions caused by different num bers of series in beginners in RT have present ed cont roversial result s, especially when com paring one series w it h t wo or t hr ee.6 3 , 6 4 I t is known t hat , in t he elderly and in individuals w it h PAOD, perform ance of t wo or m ore series is w ell t olerat ed.2 8 , 3 7 , 5 7 Thus, so far, choice of num ber of ser ies seem s t o depend m ainly on available t im e individuals have for each t raining session.
An RT program for individuals w it h PAOD should use one t o t hree series, according t o t he st udent 's t im e availabilit y.
Type of con t r a ct ion
I n t he RT perform ed w it h free weight s or weight lift ing equipm ent , t wo t ypes of cont ract ion can be used: isom et ric and dynam ic cont ract ions. I som et ric cont ract ions are charact erized by absence of art icular m ovem ent , i.e., t he exercise is perform ed st at ically. Dynam ic cont ract ions can be
subdivided int o concent ric and eccent ric. Concent ric cont ract ions are t hose in which t her e is
reduct ion in art icular angle, i.e., t her e is " short ening of t he skelet al m uscle." Concent ric cont ract ions are t hose in w hich t here is increase in art icular angle, i.e., t here is " w idening of t he skelet al
m uscle."
RT program s prescribed t o im prove physical fit ness of t he elderly are m ainly com prised of dynam ic cont ract ions, bot h concent ric and eccent ric. Alt hough use of t hree t ypes of cont ract ion result s in posit ive adapt at ions for t he elder ly,6 5 use of predom inant ly dynam ic cont ract ions is j ust ified by abnorm al responses of t he cardiovascular syst em t o isom et ric cont ract ions,6 6 , 6 7 which have t his t ype of cont ract ion cont raindicat ed for individuals w it h cardiac diseases.6 7
Therefore, an RT program for individuals w it h PAOD should predom inant ly use dynam ic cont ract ions, bot h concent ric and eccent ric.
N u m be r of r e pe t it ion s
The num ber of repet it ions perform ed in each series seem s t o be relat ed t o t he adapt at ions generat ed by t he t raining. I n t his sense, it has been suggest ed t hat repet it ions from one t o five result in great er adapt at ions in power and m axim um m uscle st rengt h, w hereas a higher num ber of repet it ions ( 15 t o 25) enhances gains of local m uscle resist ance.2 1 , 3 6 , 6 8 However, t he current
relat ionship bet ween num ber of repet it ions and adapt at ions t o t raining has been quest ioned over t he past years.6 9
On t he ot her hand, it is w ell est ablished in t he lit erat ure t hat , t he higher t he num ber of repet it ions perform ed in RT, t he higher t he increase in heart rat e and syst olic art erial pressure.5 4 , 7 0 Thus,
t hat used only six repet it ions.2 8 Therefore, it is suggest ed t hat num ber of repet it ions in an RT
program for individuals w it h PAOD should have bet ween eight and 15 repet it ions.
Ex e r cise in t e n sit y
Exercise int ensit y is usually det erm ined by overload im posed by t he equipm ent or free weight . Posit ive adapt at ions in t he elderly have been observed aft er perform ing RT w it h m oderat e t o high int ensit y.7 1 , 7 2 However, perform ing high int ensit y RT is norm ally followed by effort apnea ( Valsalva's
m aneuver) and increase in isom et ric com ponent of t he m ovem ent ( m ovem ent s are perform ed w it h slower speed) .7 3 Those t wo aspect s, in t heir t urn, result in m arked increase of syst olic art erial pressure during exercise and are considered indicat ive of an inadequat e level of effort for hypert ensive pat ient s and for t hose w it h cardiac diseases.3 5 , 4 5 , 4 9 , 7 3
Thus, RT int ensit y for individuals w it h PAOD should be t hat in which t he individual perform s t he exercise wit hout apnea or reduct ion in m ovem ent speed, which corresponds t o t he level " slight ly t iring" or " t iring" according t o t he subj ect ive effort scale proposed by Bor g.7 4
I n t e r va l
I nt ervals correspond t o t he recovery t im e bet ween series and bet ween exercises. The recovery int erval is direct ly relat ed t o t raining int ensit y, and short er int ervals represent great er effort
int ensit y. Recovery int ervals adopt ed in RT program s in t he elderly generally range bet ween 1 and 2 m inut es.3 6 However, in a recent st udy,7 5 it was dem onst rat ed t hat short int ervals ( less t han 90
seconds) are not enough t o m ake syst olic art erial pressure ret urn t o basal levels before st art ing t he next series. Therefore, t he individual st art s t he ser ies wit h higher syst olic art erial pressure and, consequent ly, during t he effort , reaches higher pressure levels. On t he ot her hand, it has been suggest ed t hat recovery int ervals t hat are excessively long ( m ore t han 3 m inut es) could acut ely reduce t he am ount of circulat ing anabolic horm ones.7 6 , 7 7 Nevert heless, such inform at ion is
cont roversial in t he lit erat ure7 8 and has not been confirm ed in t he elderly yet .
That is w hy recovery int ervals bet ween ser ies of at least 90 seconds are recom m ended in RT for individuals w it h PAOD.
Am plit u de
Movem ent am plit ude can be underst ood as t he dim ension of displacem ent of t he body or it s segm ent s bet ween given point s, m ost of t he t im es expressed in degrees. Alt hough t here is not m uch evidence on t he influence of t his variable in RT responses, it is com m only accept ed t hat , t he higher t he exercise am plit ude, t he higher t he benefit . However, in individuals w it h m usculoskelet al diseases or lesions, m ovem ent am plit ude should be lim it ed by painful feelings, which in som e cases can be very lim it ed, w it h only a few degrees of art icular m ovem ent .3 4 , 4 3 Therefore, RT am plit ude in individuals w it h PAOD and m usculoskelet al lesions should be t hat in w hich t he individual can
perform t he exercise w it hout having pain.
Con clu sion s
Therefore, t his st udy aim ed at discussing aspect s relat ed t o prescript ion of RT for individuals w it h PAOD and proposing a prescript ion m odel based on scient ific evidence, present ed in Table 2.
I t is w ort h st ressing t he need of perform ing new st udies on t he benefit s of RT for individuals w it h PAOD, especially t he effect s of m anipulat ing different t raining variables in t his populat ion.
Re fe r e n ce s
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3. Gardner AW, Wom ack CJ, Siem inski DJ, Mont gom ery PS, Killewich LA, Fonong T. Relat ionship bet ween free- living daily physical act ivit y and am bulat ory m easures in older claudicant s.Angiology. 1998; 49: 327- 37.
4. Garg PK, Tian L, Criqui MH, et al. Physical act ivit y during daily life and m ort alit y in pat ient s w it h peripheral art erial disease. Circulat ion.2006; 114: 242- 8.
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