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Exercise Testing

PAD testing
Peggy Kraus
A colleague and I developed a PAD program last summer. We have been at odds about which treadmill protocol to use for measuring pre and post program walking ability. We have only had three patients in the program so far (yes, in spite of marketing and patient/provider education, it's an extremely underutilized service) and all three have been very high level. The Gardner-Skinner protocol was not challenging enough for these atypical PAD patients. Besides, it took almost 30 minutes to administer the test. Towards the end of each of the tests, I had to create a few additional stages to challenge the patient to advance their claudication pain.

Has anyone had success with any testing protocols in a PAD program? I'd welcome any suggestions for increasing utilization of this program too.
Lori Saiia
Hi Peggy,

We use the Bronas/Treat-Jacobson Protocol which we found in the AACVPR PAD Exercise Training Toolkit (available on the AACVPR website and a great resource!). Our program is very new as well, but so far this seems to work well with a variety of patients. Please feel free to contact me if you would like to discuss this further!
Angela Lanier
Hello Peggy and Lori,

We also have a very new PAD program, and we do use the Garner/Skinner protocol. Most of our patients are extremely deconditioned so this protocol has worked well except for one patient. This particular patient had been a past marathon runner, and his whole goal was to get back to running with less pain. Of course he reached the highest workload with the highest incline, but we quickly had to lower the incline due to shin splints (not his normal calf pain). This patient did reach his goal by getting back to at least jogging, but he really could've accomplished more had he been able to handle the incline. The most we've had in a PAD class at once has been 4 patients, and all have worked harder than they ever have while exercise training. It would be nice to have anther protocol to use for those advanced patients, so I will check out the Bronas/Treat Jacobson.

Angela Lanier
Lori Saiia
Hi Angela!
Thanks for your reply! If you need help with the protocol let me know. Also if you would like to talk about the PAD program please feel free to contact me!
Jonathan Ehrman
Hi, our experience at Henry Ford Hospital through the years has been with the Gardner/Skinner protocol. It seems to work well with most patients. But i would not hesitate to switch to a less aggressive protocol (e.g., modified Naughton) in low function or early onset pain patients.

If it took 30 minutes for a pt. to reach maximum i question whether the protocol was correct. Maybe needed to be more aggressive? At 2 mph and increasing 2% grade every 2 min. you will reach 20% grade in about 20 minutes. This is a pretty large amount of work for a patient with symptomatic PAD. Did the pt. go more than this? If so, were they ever symptomatic or even close to max. symptoms? just a few things that you might think about. thanks
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