Embed Size (px)
Citation preview
Univers
ity of
Cap
e Tow
n
II .... II • " I I I I I I
I I .. I
)( )
I . ( ) i
.. I
.. I
The copyright of this thesis vests in the author. No quotation from it or information derived from it is to be published without full acknowledgement of the source. The thesis is to be used for private study or non-commercial research purposes only.
Published by the University of Cape Town (UCT) in terms of the non-exclusive license granted to UCT by the author.
Univers
ity of
Cap
e Tow
n
Univers
ity of
Cap
e Tow
n
I,
or is
is is
in
racanirarl in
or
/
on is LlLh'....,,", is
nor is
or
for
in manner
Univers
ity of
Cap
e Tow
n
E
who in
rew
me were
my me to
2
Univers
ity of
Cap
e Tow
n
5
vascu d
in
in
in is
1 :
3
in
is
vs
vs
in
Univers
ity of
Cap
e Tow
n
common cause
is
A
It is commoner in
means is or
is a
it is
ankle
an L 1
4
Univers
ity of
Cap
e Tow
n
are arm blood
I is 1.0 or
e of
al. 1
is a can
. 1999).
al. 1
as a
1 are
M is
5
k
a
is
on
1
ewman
in
a
can
is
Univers
ity of
Cap
e Tow
n
is one
Univers
ity of
Cap
e Tow
nu
r -
n-
HR-
I -
7
Univers
ity of
Cap
e Tow
n
were exercise
13
L I). venous
IS an I
as was
n 1 [mean
blood as a
in
31
a
not
Univers
ity of
Cap
e Tow
nii) an accumu
in . This is an
31
to
were as was
). venous
8
from
it
with
in
with
a
in
as a
D),
I,
k
Univers
ity of
Cap
e Tow
n
free wa or
accum
A
k as much as "
were
u (1 vs.1
9
to a or
a
as
N
or
R
were
was
in
(1
Univers
ity of
Cap
e Tow
n
vs. 1
not
(119
was
u k
vs.
in
was in
un
on
(1
in In
10
vs.
(1 vs. 1
in o to 116 ±
±
± vs ±
in
is in as
Univers
ity of
Cap
e Tow
n
a as
11
occur
is
an
in
Univers
ity of
Cap
e Tow
n
1. ........................................................... 13
rocnn"lCQ to in ~" ... ~ ....................... ~ ... .
vs in
5.
7 ......................... .......................................... 1
12
Univers
ity of
Cap
e Tow
n
1.
p
the
men
al. 1
. ..................... E
rd is a
1000 women in
it occurs in
).
it causes severe
13
cause
5
N
in in
Univers
ity of
Cap
e Tow
n
as a
1
nurse or
al. 1 al. 1
14
In
a n
1
as
was
this
as a
1
no
. 1 al.
Univers
ity of
Cap
e Tow
n
Table1.1 Review of the randomised controlled trials in exercise and n:::>ltu"n1'''' with vascular disease
[late
9 Jnln
DVfln111!C ~3PVD nun
PT~\
DynCll11ic 16
1 hOUI2X
Abbreviations: k~
SPVD"'supervlsed, PTA'"
n"numbel subjecls, Ovnamic=dvnarnic home"a!
Univers
ity of
Cap
e Tow
n
In a
1
A
were
1
(1
. (1
no
1 ).
same
16
1
was
one
su
on
D
was more
occurs
no
no
in
in
al.
ess
is
Univers
ity of
Cap
e Tow
n
as a result,
in
(1
in
a
was more
a
or
an
is due an
17
more
as
Univers
ity of
Cap
e Tow
n
a in
in the '"'A n,f,-A I
It
).
It
I).
A al. (1
in
in
with
18
is
12 WP.I"!KS
al.
d is
as a
in
Univers
ity of
Cap
e Tow
n
were in
of
al.
19
o 1 in
) .
in an
was not
it
"In
causes an
result is an
Univers
ity of
Cap
e Tow
n
is in in
al.
1
in d
in
This was
can
1 room .. ,"
more
20
Univers
ity of
Cap
e Tow
nin
1
a
It
is
in
is
are common
al. 1
1.1 ).
some
on a
a
21
can
are
1
in
is
will
1
al. 1
or
one
Univers
ity of
Cap
e Tow
n
It
are
were
cone
by
it measures an
1
22
was
a
in
a
on
k
for
in
In
was
assesses
al.
on a
Univers
ity of
Cap
e Tow
n
al.
more
d
a
a I."
on
up
23
vs
on
vs
1
no
12
that
over a ree
1.1 ).
on
on an
or
was
. 1
(1990)
Univers
ity of
Cap
e Tow
n
In 1 more in
in
on
on was as:5e~;SE~a in
a
24
Univers
ity of
Cap
e Tow
n
u
is it is as a
result
A
A
1
of
are
is
25
in
is
in
on
d
e
are
to measure
an
as a
to
al.
Univers
ity of
Cap
e Tow
nan
are
is su
in
k as
26
a
is is
4
occur in
as
Univers
ity of
Cap
e Tow
n
is
screen
a
A
k as as
common to
as
27
in
were recru
3
were
as
a
or
or
Univers
ity of
Cap
e Tow
n
IS lire 2 1
b
1 .. .. .. .. Familiansal10n Wltr! trealinlill
\'''.-~---.--.. " ... !
-10 upper machines 4 upper exerCISf)S
3
Fxercise tost;-.;
on
,a
is WI
2 .. !1P .. .. ..
dumbbell
an
s,
iii
Univers
ity of
Cap
e Tow
n
A h
were
one
an
once
a
mass was a II
were an
al. 1
arm
a
IV) was
a
mercu an
29
Univers
ity of
Cap
e Tow
n
measu
was
II
ree
a
was as
30
or
) was
was
for
were
a
on
Univers
ity of
Cap
e Tow
n
severe
was
1 ).
two
were
no
in a
31
m
a
1
was
sa in
an
was
or
a
as a
Univers
ity of
Cap
e Tow
n
measu
in
was
ill
in
10
I"
R
this
an
4
could
were
The
I,
32
were
a
to ""tT<::.nfi
in a
a
a
Univers
ity of
Cap
e Tow
nhour
in in
33
was
on a
a
were
is
Univers
ity of
Cap
e Tow
n
a
as mean
measures was
across
measures
were C'""nTQ,n as 'r' as
34
Univers
ity of
Cap
e Tow
n
3: IN
p
is a with
are over
on
is
It is
in
1
35
Univers
ity of
Cap
e Tow
n
in
1
as a
1 an in
is commonly
are
A
vascu were
are in 2.
were
in
36
Univers
ity of
Cap
e Tow
n
a
a
HR
venous blood
were
venous
"OinT"', .... as mean
In
venous
37
was
h
on an
m
an
were
the
ing to
were
was
Univers
ity of
Cap
e Tow
n
tests were converted to a single variable for each patient by plotting an area
under the curve for each patient. The data was normalized by expressing the
pain measure (Y axis) relative to 100% of elapsed time (the X-axis).
Results
Patient characteristics on entry to the study
Location of PVD
The location of peripheral vascular disease is shown in Figure 3.1
21%
15%
Figure 3.1 Location of disease in patients with PVD
• Fem-pop
o Iliac
• Below knee
o lIiac/fem-pop
Abbreviations: iliac=iliac arteries, fem-pop=femoral-popliteal arteries, below knee=peroneal, anterior tibial artery or posterior tibial artery, lliaclfem-pop=femoral popliteal and iliac arteries
Thirty one patients with peripheral vascular disease were recruited for the study.
Twenty two patients had bilateral disease and nine patients had unilateral
disease. "Femoral-popliteal disease" in Fig 3.1 refers to disease of the femoral
and popliteal arteries. "Iliac" refers to either or both the internal and external iliac
arteries, and "below knee disease" constitutes disease of one or all of the
peroneal artery, anterior tibial artery and the posterior tibial artery. "lIiadfem-pop"
refers to disease of both the iliac and femoral-popliteal arteries.
- 38-
Univers
ity of
Cap
e Tow
n
N were
are in 3.1
Table 3.1 Patient characteristics on to the
Mean ±SD 63±13 27±5.0
range
Table 3.2 Distribution of of age and 8MI
mass index, %=percentage
N
as by was
over
39
Univers
ity of
Cap
e Tow
n
one
2
in is in
Table 3.3 Medical and risk factor of ",::>t,,,,n1tc:: with PVD on to the trial
40
Univers
ity of
Cap
e Tow
n
vascu
none
a
\IV ..... " ..... , none
l,o,rIT'l/'''o no the were in or
A
never were on
nu
vascu
A
in
41
Univers
ity of
Cap
e Tow
n
in
Table 3.4 Number of medication
with PVD cardiovascular and
Number of n!1llflAlnrc:
15 25
f--c-c.,,--..,,-<C.L---------------/-----------
48 81 16
A
1
serum
were
5 26 14
84 45
are
d are
were on
in
Table 3.5 Pain free distance and maximal distance of n!1lirit>lntc: with PVD on to the the treadmill exercise test walk test
Values are expressed as means ± SO and range
on
was more
42
Univers
ity of
Cap
e Tow
n
d
more
are
Table 3.6 Peak oxygen in with PVD on the
re
ventilation and treadmill exercise test
43.0 ±14.0 r=--~~~--~:~--------------+--
0.97 ±0.13 114 ±22
r-~'--~--~~+-~~~--~~~ ~~-------2.1 ±1.6 3.28 ±1.39 0.59 ±0.41
was
±110
ratio
I--c=~------~--~--~~~------+--- .~------------~----~------------- ------~
~-~~-------__ ~~~~~----~O.43±0.3~9------------~~~~~----------.----~ 31 ±46
VE=minute ventilation, pressure index. Values are <ovn,,,,,,,,,,ri
was
was a
1 vs
u vs
43
Univers
ity of
Cap
e Tow
n
in
in
Table 3.7 Peak oxygen venous lactate concentration in
exercise test
B6 ±5 1.12 ±O.O3 34.3 ±3.5
7B.7 ±5 7.3 ±O.3
in
in are
ratio and
--_ .. -
1.4 ±O.2 17 ±5 26 ±6 17 ±4.2
41.3±13.5 87.5 ±22.1 43 ±14.2 ------_ .. ----5.1 ±2.7 9.7 ±2.7 3.3±1.4
exchange ratio, consumption, VE=minute ventilation, hearl controls, obstructive disease, COPD-CONT=chronic obstructive pulmonary disease controls, PVD=peripheraJ vascular disease. are expressed as means ±SD
in
F
on
a was are
44
Univers
ity of
Cap
e Tow
n
Table 3.8 Results of a correlation treadmill exercise test and
with PVD.
1--=-:-::~~-'---------1 NS I\JS
tolerance on the variables of
I--:---:::-:=--;------::---;-----------t------.--.---------t-c~-------------
NS NS
on
is
venous
NS NS
n=31 P=O.005
NS
NS NS NS NS NS :-::-------------1
NS mass
""n,,,,,,,,,f\n V02=oxygen consumption, RER=respiratory exchange exercise ankle brachial index, Pr=pressure, MWD=maxilllunl walking distance,
m=meters, GTET=graded treadmill exercise test, r Value=correlation coefficient,
I,
mass on
was no
or
re
45
II
Univers
ity of
Cap
e Tow
n
In
on
30
25
20
15
10
5
o o
or
nor was
ora
was
• .-- - -•
200 400 600 800
Maximum distance
between maximum distance and oxygen treadmill exercise test ).
46
Univers
ity of
Cap
e Tow
n
90 c:
80 0 ;l
70 III ;l 60 c: (I.)
50 > (I.) 40 ..... ::s c: 30 E
.lII: 20
III 10 (I.)
0.. 0 0
3.3 ", .. I",t." •• ",
8
7
6
5 4
3
2 .. .lII: 1 III (I.) 0 a..
0
3.4
..
200 400 600
Maximum distance
between maximum treadmill exercise test
..
.. • ..
--- --1
50
Pain free
800
venous lactate distance on the treadmill
47
Univers
ity of
Cap
e Tow
n
1.B • 1.6 1.4 •
iii 1.2 « • • O.B - . * • 0.6 • •
• • • - . • 0.4 •• 0.2 .- --------------
0 -+- • • • -,. 0 200 400 600 BOO
Maximum distance
between distance
1.8 • 1.6 1.4 •
iii 1.2 <C • • 1
0.8 • • • 0.6 • • -. .-- - - --- -----
0.4 • 0.2 •
0 • • , .. • .. 0 100 200 300
Pain free
free distance
48
Univers
ity of
Cap
e Town
if
a was are
between measures of tolerance on the six minute walk test and
with PVD
NS
variables of one
r=O.51 n=31 P=O.003
NS NS NS NS
InnM~T~~==;~~:~----- ----........................... I=r==ro\.~3~'6;--------· ............. - ............ --........................... -,
n=31 P=O.049 1:·--;:-;:--:--:-----::------+--·---··------------------+-:-=-----------------NS NS
I---:::-----:-'::-------:-----:---:-:--::---'--____ =-+-N_S ___________ ---t-:N..:..S:---_____ _ NS NS r=O.52 N=31 P=O.003
r=-~7~~C-~-~·--------------------r~-----------
--+-----------------
NS -.-------------.-------f
NS NS NS NS ----;;----:--::::-:-c---------+.:...:..::'-:--c:::---------------,I---:--'--:=-.-------r=-O.53 NS n=26
!-_-,_-----:cc _____ .. _--;:---_____ t--=--P_=c._O,.006 NS NS
~-..::--:-:-:=--=':_'_____:'----- ----+------------.. -.--1----,-------------r=-O.33 NS n=31 P=O.073
[-iljUi.ir'I.;:;~Ti::T\--------t:::r==rO,=,. 5~4o'-"-----------------·-+r=·····O·······.··5····-c8-.. -------------------]
n=31 n=31 P=O.002 P=O.001
Ir:>iMun·'-,;;-Tr::;::;:------.. ·--------i NS r=O. 39
n=31 P::::O.033
mass DOD=duralion of disease, Pk V02'=oxygen consumption, RER=respiratory exchange ratio,
exercise ankle brachial index, Pr=pressure, HR=lleart rate, bpm=beats PFWD=pain free walking distance, m=melers, GTET=graded
coefficient, NS=non significant
49
Univers
ity of
Cap
e Tow
nd
I,
50
a
ure
were
on
Univers
ity of
Cap
e Tow
n
~ 700 ~
600 • en --------------- -
CIJ • • u 500 I:: III .... 400 fII
"C 300
200 • 100
E :::I 0 E
0 200 400 600 800 'j( III ~ Maximum distance GTET
3.7 distance on the distance on the six
~ 300 ~ • en 250 CIJ u c:: 200 ---- ------- - • .!!I
.!!! 150 "C • 100 ...
• • 50 .- • o·
o 200 400 600 800
Maximum wa distance GTET
distance on the distance on the six minute
51
Univers
ity of
Cap
e Tow
n
~ 300 ::E en 250 IV
g 200 .m .!!! 'C 150
I!! :::I en
120
100
80 60
40
20 en 0 I!! c. -20 CII 32 -40 s:: 4: -60
•
•
• •
o 100
Pain free wa
Maximum
•
200
distance GTET
300
distance on the distance on the six minute
distance SMWT
between ankle pressure distance on the six minute walk test
52
Univers
ity of
Cap
e Tow
n
a
n
In
was
53
vascLi
with
occurrence
as
as
women
a
in
Univers
ity of
Cap
e Tow
n
cause
1 a on
aL 1 1 ).
as a in al.
(1 in
is
is was
are
d it seem
54
Univers
ity of
Cap
e Tow
n
in
orc,'tnr'o in
In
in
in
it is common
al. (2000)
causes an
as a
55
Univers
ity of
Cap
e Tow
nal. (1
su
In
al. 1
1
never
venous
on
1
"
56
to
venous
. 1
. 1
is
in
in
a
never
al.
Univers
ity of
Cap
e Tow
n
or training in
1
was
1
(1
in healthy
it wou Id seem it was more
1
57
cause
venous
al.
in
al.
al.
in
ure
an
aL
Univers
ity of
Cap
e Tow
n
It is
1
in
in
in
in
in
in
. If
58
in
is
1
are
al.
in
is
is a measure of
a
or
by
is
Univers
ity of
Cap
e Tow
n
use a
in
an
In
on
It is is
with
59
were no
on
in du
are
nee
even
use
in
Univers
ity of
Cap
e Tow
n
are
king
vs 317
vs
In
vascu
venous
on
m,
m,
in
so an measure
vs
is
60
is was
a
a
17
k
12
highest venous
or
Univers
ity of
Cap
e Tow
n
not m or
a
in
is
or in
in
61
Univers
ity of
Cap
e Tow
n
in 1,
al. 1
a
were
. 1
62
with
, 1
al. 1
NI
E
al. 1 . 1
walk near
ill
a
in
Univers
ity of
Cap
e Tow
n
in it was
was an
arm cran
one
A
1
in
al.
1
al. 1
if in
occur
if a
with
is su
63
Univers
ity of
Cap
e Tow
n
as as at in
on
were
in in
one a one
wasd cancer.
All All were
64
Univers
ity of
Cap
e Tow
n
were mill
a
an
was measu
were
was
in
a
in 2 in
were as
65
Univers
ity of
Cap
e Tow
n
area
A
A
u
were
measure (Y
in
su
are
anova was
d
in 1.
a an
measures was
in l1
in
in
assess
was assess in
on
66
Univers
ity of
Cap
e Tow
n
Table 4.1 General characteristics of with PVD in the treatment groups and the control group on to the
77 ±14 ----------+-:,-----:-----------4
27±6 30±3 24 ±30 29 ±30
1-:::---.-'--;--.-;:'------:-'--+-:-~=-::--::-------+-=-:15 ±32 16 ±21 I-:=,:~~=-'-':-=-ll:.:-_=_:"-C-'-+_=----'-'==-----·---_l--------------------t------------------------------------ -------i
5 5 4 3
7 Abbreviations: YFyear, squared, nr=number of patients in "I.=npyrpr,I,,,,A of patients in each group, mixed=mixed ancestral origin. SD=standard deviation, training group, CER=conventional exercise rehabilitation group, CONT=control group. Values are ovnH,ccori as means ±SD
were
in group,
of are in
67
Univers
ity of
Cap
e Tow
n
Table 4.2 Medical control group on
The
with PVD in the two treatment groups and the
7
2 2
patients in each group and the percentage of patients in each group
in
in
were
in and
are in
68
Univers
ity of
Cap
e Tow
n
Table 4.3 Patients nnc .. ;::' .. nn medication in the two treatment groups and the control group
CONT=controi group. Values are expressed as number group ingesting the medication
was no
Table 4.4 treatment groups
means ±SD
to exercise
group, CER=conventional patients in each group and the percentage of patients in
in
two
sessions intervention in the two
69
Univers
ity of
Cap
e Tow
n
u
in are
Table 4.5 in from to exit of the programme in the USST group
ue
56 P=O.OO2* 49 ±3 66 ±9 35 P::::0.OO03* -----. 22 ±7 43 ±13 49 P=0.OO03*
-.-----"-.-.-~- -~.--------.
14 ±2 29 ±16 107 I P=0.02* i I ------
41 ±6 58 ±i5 41 P=O.009* 12 ±3 16 ±5 33 P=O.08 31 ±7 41 ±11 32 P=O.OO1* --------22 ±7 34 ±12 55 P=O.OO2* 17 ±9 32 ±i7 88 P=O.02*
-----_.
42 ±7 60 ±10 43 P=O.OO1* ... nnmv,;o'flon,,,· Ib=pounds .• =p<O.05 strength entry vs strength exit. Values expressed as mean ±SD
'r.nnr..-.T in in
in
70
Univers
ity of
Cap
e Tow
n
Table 4.6 Peak VOz• peak VE, peak RER and peak HR during the graded treadmill exercise test on entry to the study and after the six week intervention period
UBST (n=9) CER (n=9) CONT (n=8) Owks 6 wks Owks 6 wks Owks 6 wks
PkV02 19.7 ±4.6 18.7 ±6.1 14.8 ±3.4 19.4±4.6* 18.2±3.9 17.6 ±3.4 mI02'kg-1'min-1 PkVE 47.6 ±20 47.0 ±19 37.9 ±10 45.0 ±12 48.0 ±14 51.0 ±15 l.min-1 Pk RER (units) 0.93 ±0.1 0.95 ±0.7 0.94 ±0.1 0.99 ±0.1 1.02 ±0.2 1.0 ±0.2 Pk HR 107 ±25 110 ±26 118 ±17 122 ±19 122 ±15 128 ±10 bpm Abbreviations: Pk=peak, VOroxygen consumption, VE=ventrlatlon, RER=resplratory exchange rallo, HR=heart rate, wks=weeks, bpm=beats per minute, UBST=upper body strength training, CER=conventional exercise rehabilitation group, CONT=control group. *=p<O.05 CER vs CONT and CER vs UBST. All values expressed as mean ± SO.
There was no significant difference between the groups with respect to peak
V02 , peak VE, peak RER, and peak HR on entry to the study
Peak V02 in the CER group increased significantly more after training than the
control group (29% vs -1 %, CER vs control, p=O.008) (Fig 4.1) and the UBST
group (29% vs -6%, CER vs UBST, p=O.002) (Fig 4.1), indicating a training
response in the CER group.
60
'E 50
~ 40 -"S - 30 "CI'ti f! .! 20 ClQ)
;;.!!! 10 o U > ~ .: ~ 0
~ ·10 I::
~ -20 U
::.E! o -30
-40
-,---
I 'I
-,--
-'--
c::::J UBST
~I CER
ii!iIIIIIIIICONT
Figure 4.1 Percentage change in maximum oxygen consumption after six weeks of intervention ... =p<O.05 CER vs UBST * =p<O.05 CER vs CONT. All values expressed as mean ±SD
- 71 -
Univers
ity of
Cap
e Tow
n
was no
group
in
Table 4.7 Submaximal RER and heart rate measurements treadmill exercise test in the treatment groups and the control group on and after the six week intervention
6wks 13.1±3
--_ .. ------ -----. 14.0±5 13±3.2 14.3±3 14.5±3
32±13 25.3±7 25.6±5 24.9±3
o
---35.1±18 33.2±12 33±6 31.9±6 34±9
O.77±O.O7 O.79±O.O8 O.79±O.13 O.75±O.O9 O.85±O.O9 O.84±O.O9 O.8B±O.07 O.9±O.15 O.86±O.14 O.B9±O.11 92±20 94±21 102±21 92±1 94±15
96±23 111±20 104±14 "+ 103±14
to
was a
2
d
6wks 13.1±4
._-------14.3±4
31.5±10
-----35.6±14
O.B2±O.OB O.89±O.10 109±11
115±10
ventilation, exchange ratio, HR=heart rate %==percentage, per minute, min=minute, wks=weeks, UBST=upper strength training group, CER=conventional exercise rehabilitation group, CONT=control group, All values expressed as mean ± SD * =1"'<0.05 CER vs CONT. 1= p<0.05 CER vs CONT and CER vs UBST.
was
vs 1 vs
72
Univers
ity of
Cap
e Tow
n
group compared to the UBST group (-6% vs 6%, CER vs UBST, p=O.004)
indicating a training response in the CER group.
c::::J UBST E~lCER
_CaNT
Figure 4.2 Percentage change in submaximal heart rate at minute two after six weeks of intervention. • =p<O.05 CER vs CONT. All values expressed as mean ± SD
c=JUBST
CER
IIIII!IIIII!IIICONT
Figure 4.3 Percentage change in submaximal heart rate at minute four after six weeks of intervention. • =p<O.05 CER vs CONT and **=P<O.05 CER vs UBST. All values expressed as mean ± SD
- 73 -
Univers
ity of
Cap
e Tow
n
was no in nOI'"I"<:>nt in
on
are in
Table 4.8 Maximum heart rate and recovery heart rate in the six minute walk test in the treatment groups and the control group on to the and after six weeks of intervention
in
74
94±18
wks=weeks, UBST=upper body group. All values expressed as mean ±
Univers
ity of
Cap
e Tow
n
Table 4.9 mass, 8MI and fat of treatment groups and the control group on and after six weeks of intervention
CONT 6wks 6wks Owks 78.5 76.7 84
±19 ±14 ±13 ±14 26.9 26.7 26.6 29.8 ±5.3 ±5.6 ±5.0 ±3.2
Fat 29.7 30.6 30.06 33.6 ±5.1 ±5.18 ±7.3
Abbreviations: BMI=body mass squared, body strength training group, CER=conventional exercise rehabilitation group, CONT=control group" =p<O.05 UBST vs CONT. All values expressed as mean ± SD
was no in or
on
more vs was
no in mass or
on
on
on
is in 10
75
Univers
ity of
Cape T
own
Table 4.10 Maximum free distance and total the nr~lrI"'rl treadmill exercise test and the six minute walk test in the treatment groups and the control group on to the and after six weeks of intervention
UBST Owks 6wks --390±211 399±186
~-------.. ~.-----.---.,-----.-
128±121 202±175 126±157 256±187 175±123 175±136 ~--------------
441±128 484±122 373±116 425±117 415±144 408±125 ----~----------------.- ---------- .-.. --.. -._---------- .. _-170±165 169±99 119±101 157±1 192±147 11
302±12 271±56 284± 117 251±162 257± 153 251± 1
327±42 391±134 359 ±126 292± 1 359± 108
m=meiers, exercise test, SMWT=six minute walk UBST=upper body training group, rehabilitation group, CONT=control group, wks=weeks * :: p<O.05 CEH vs UBST; t = P<O.05 CEH vs CONT. CER vs CO NT. Values are expressed as means ±SD
was no in
or on or
ill in
vs vs
in
k
was
in vs 1
76
vs
Univers
ity of
Cap
e Tow
n
1 vs vs
in
k
vs
im in
on
77
Univers
ity of
Cap
e Tow
n
Figure 4.4
Figure 4.6
Figure 4.8
ol.E6f DaR IIIIIIICIJI"
ollEr aR
I11III CIJI"
Figure 4.5
Figure 4.7
Figure 4.9
78
DllEf DaR IBIICIJI"
Univers
ity of
Cap
e Tow
n
on venous
on
4.11
Table 4.11 and venous lactate concentrations in the treatment groups and the control group on to the and after six weeks of intervention
3.0 ±1.2
CER=conventional exercise rehabilitation, CONT=control group,. All values expressed as mean ±
on
was no d
venous
on are in 4.12
79
Univers
ity of
Cap
e Tow
n
Table 4.12 blood pressure, exercise ABI and ankle pressure in the treatment groups and the control group on to the and after six
weeks of intervention
pressure
O.6±O.3 OA±OA
32.2±48
CER=conventional exercise rehabilitation group, CONT=controJ group.
were
on in
80
6wks Owks 134±22 161±25
O.l±O.5 O.9±D.2 -------~~------~-------OA±DA O.6±OA
group,
of
Univers
ity of
Cap
e Tow
naS~5e~;SE~d in
was
was a
a
A
as
was
as
in
81
a
in
in
in a
in
in
p was that
in
or
Univers
ity of
Cap
e Tow
n
in in
with
1
a
82
in
a
al.
in
k
ree
an
as
Univers
ity of
Cap
e Tow
n
A in is is a I error
during
in U
k or
was no
was in
in of in
were
we that
83
Univers
ity of
Cap
e Tow
n
did nrll,A/p'dPr it is in
in was in
an
al. 1 an
no
al. 1
I,
84
Univers
ity of
Cap
e Tow
n
study h in
in
only
were
as amant in or
in
9
is an
85
Univers
ity of
Cap
e Tow
n
a u
in
with
is are
Thirdly.
venous
in this
or
arc..T'nr"o the
Id in
86
Univers
ity of
Cap
e Tow
n
this in
is more
Increases in
to an
in
In is a
is
" is an
as a
87
Univers
ity of
Cap
e Tow
n
1
in al. 1 1 on
Table 6.1 Graded treadmill exercise test nrt'1ifnr"n ot al.
STAGE: SPEED GRAm: MINUTES I 3.2km/h 2% 1
2 II 3.2km/h 4% 1
2 III 3.2km/h 6% 1
2 IV 3.2km/h 8°/" 1
2 V 3.2km/h 10% 1
2 ._-_ .. _--VI 3.2km/h 12% 1
2 _ .... ---
VII 3.2km/h 14% 1 2
-_P--.. -···- ---.. -.
Table 6.2 Modified Bruce treadmill exercise test
STAGE
2 3
II 1.7km/h 5% 1 2 3
1 2 3 1 2 3
14% 2 3 1 2 3
-~---- --------"-
88
Univers
ityof
Cape T
own
was
Table 6.3 of scale
-------+-,----""----"'-------1
is in
Table 6.4 Content of the exercise group
#2.
# 1
.. ",ilnin,n sessions scheduled for each week for the CER
is
89
in
Univers
ity of
Cap
e Tow
n
Table 6.5 An of the UBST programme for one of the members of the UBST group
50 c-:-:--:----;:---;-----j------.-
50 25
I--=-----"------j 15
35 30 30
extensions
90
Univers
ity of
Cap
e Tow
n
: N:IIIH" .
1_ i IJi:1 o.,is
I S.nlll"l)m:~
, 1\lrdir:llioll ,
I 1
. '
! (, , ·~4-_,,···
; I , I ~
! I I
I;
I "' I I
I
" I
:n
.~ , . , "
, .-.' ,
#1
-r I
"::<(,IT
Ilike 1m : i I ~ ~'
t, i.'
Ii
.\,. "
'I'-, .
Univers
ity of
Cap
e Tow
n
J
4 f 6
8 ~-~~~-+_L-"---t-=-=+i----j~
II 10 , 11
2
6
?
Univers
ity of
Cap
e Tow
n
2 3 4 6 8 10 11 12
, I ;(
/
Univers
ity of
Cap
e Tow
n
&
1
11.
Univers
ity of
Cap
e Tow
n
1
1
1
15.
1
1
1
1
Univers
ity of
Cap
e Tow
n
nervose van
vs
Univers
ity of
Cap
e Tow
n
in
Univers
ity of
Cap
e Tow
n
Univers
ity of
Cap
e Tow
n
Univers
ity of
Cap
e Tow
n1
70.
71.
in
Univers
ity of
Cap
e Tow
n
or
