H.J.P Fokkenrood

Innovative strategies for
intermittent claudication

towards a stepped care approach and new outcome measures



  1. Breek JC, Hamming JF, De Vries J, Aquarius AE, van Berge Henegouwen DP. Quality of life in patients with intermittent claudication using the World Health Organisation (WHO) questionnaire. Eur J Vasc Endovasc Surg. Feb 2001;21(2):118-122.
  2. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. Jan 2007;45 Suppl S:S5-67.
  3. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. Mar 21 2006;113(11):e463-654.
  4. Layden J, Michaels J, Bermingham S, Higgins B, Guideline Development G. Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance. Bmj. 2012;345:e4947.
  5. Watson CJ, Phillips D, Hands L, Collin J. Claudication distance is poorly estimated and inappropriately measured. Br J Surg. Aug 1997;84(8):1107-1109.
  6. Frans FA, Zagers MB, Jens S, Bipat S, Reekers JA, Koelemay MJ. The relationship of walking distances estimated by the patient, on the corridor and on a treadmill, and the Walking Impairment Questionnaire in intermittent claudication. J Vasc Surg. Mar 2013;57(3):720-727 e721.
  7. Tew G, Copeland R, Le Faucheur A, Gernigon M, Nawaz S, Abraham P. Feasibility and validity of self-reported walking capacity in patients with intermittent claudication. Journal of vascular surgery. May 2013;57(5):1227-1234.
  8. Fokkenrood HJ, Bendermacher BL, Lauret GJ, Willigendael EM, Prins MH, Teijink JA. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev. Aug 23 2013;8:CD005263.
  9. Fahrig C, Heidrich H, Voigt B, Wnuk G, Hirche H, Roggenbuck U. [What is the value of determining walking distance in peripheral arterial occlusive disease on the treadmill and in daily life? Prospective correlation study]. Med Klin (Munich). Jun 15 1999;94(6):303-305.
  10. Le Faucheur A, Abraham P, Jaquinandi V, Bouye P, Saumet JL, Noury-Desvaux B. Measurement of walking distance and speed in patients with peripheral arterial disease: a novel method using a global positioning system. Circulation. Feb 19 2008;117(7):897-904.
  11. Nicolai SP, Viechtbauer W, Kruidenier LM, Candel MJ, Prins MH, Teijink JA. Reliability of treadmill testing in peripheral arterial disease: a meta-regression analysis. J Vasc Surg. Aug 2009;50(2):322-329.
  12. Jongert M, Hendriks H, van Hoek J, Kaasboer Kogelman K, Robeer G, Simens B. KNGF richtlijn claudicatio intermittens. . Nederlands Tijdschrift voor Fysiotherapie. 2003(6):3-50.
  13. Gardner AW, Skinner JS, Cantwell BW, Smith LK. Progressive vs single-stage treadmill tests for evaluation of claudication. Med Sci Sports Exerc. Apr 1991;23(4):402-408.
  14. Verspaget M, Nicolai SP, Kruidenier LM, Welten RJ, Prins MH, Teijink JA. Validation of the Dutch version of the Walking Impairment Questionnaire. Eur J Vasc Endovasc Surg. Jan 2009;37(1):56-61.
  15. Le Faucheur A, Noury-Desvaux B, Mahe G, et al. Variability and short-term determinants of walking capacity in patients with intermittent claudication. J Vasc Surg. Apr 2010;51(4):886-892.
  16. Sagar SP, Brown PM, Zelt DT, Pickett WL, Tranmer JE. Further clinical validation of the walking impairment questionnaire for classification of walking performance in patients with peripheral artery disease. International journal of vascular medicine. 2012;2012:190641.
  17. Degischer S, Labs KH, Aschwanden M, Tschoepl M, Jaeger KA. Reproducibility of constant-load treadmill testing with various treadmill protocols and predictability of treadmill test results in patients with intermittent claudication. J Vasc Surg. Jul 2002;36(1):83-88.



Figure 1: Bland-Altman plot with linear regression analysis MWD OW – ED.


ED, Estimated Distance; MWD, Maximum walking distance; OW, outside walking
Figure 2: Bland-Altman plot with linear regression analysis MWD OW – GSP.GSP,


Gardner-Skinner protocol; MWD, Maximum walking distance; OW, outside walking.
Figure 3: Bland-Altman plot with linear regression analysis MWD OW – NGTP.


MWD, Maximum walking distance; NGTP, non-graded treadmill protocol ; OW, outside walking.