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Ann R Coll Surg Engl. 2009 July; 91(5): 442.
PMCID: PMC2758464

Physiological Predictors of Maximum Treadmill Walking Performance in Patients with Intermittent Claudication

Linda de Cossart, Series Editor


Patients with intermittent claudication have a marked impairment in walking performance. As the primary determinants of this impairment are poorly understood, the aim of this study was to identify key physiological predictors of walking performance in claudicants using multiple regression analysis.

Patients and Methods

With Local Research Ethics Committee approval, 45 male claudicants (age 69 ± 9 years; mean ± SD) were recruited from the Sheffield Vascular Institute at the Northern General Hospital, Sheffield, UK. Each patient performed a graded treadmill test to determine maximum walking distance (MWD), peak oxygen uptake, and anaerobic threshold. Calf muscle oxygenation (StO2) at 1 min and time to minimum StO2 were also measured using near-infrared spectroscopy. On other occasions, peak calf blood flow, resting ankle-brachial index, and pulmonary oxygen uptake kinetics during steady-state walking were assessed. A forward stepwise multiple regression analysis was performed to determine predictors of MWD. Statistical significance was set at P ≤ 0.05.


A regression model comprising peak oxygen uptake, StO2 at 1 min, and time to minimum StO2 explained 64% of the variance in MWD. The following prediction equation was generated:

MWD(m)=153+(0.4×time to minimum StO2)+(16.9×peak oxygen uptake)+(5.8×StO2 at 1 min)

Adjusted R2 = 0.64, standard error of the estimate = 154 m (P < 0.001).


The results suggest that cardiopulmonary fitness and the ability to match oxygen delivery to metabolic demand are important determinants of walking performance in claudicants, and that specific near-infrared spectroscopy variables might be useful in studies that evaluate the mechanisms of clinical improvement with different treatment interventions.

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England