BACKGROUND: In this randomized trial we compared two treadmill trainings, based on exercises performed to moderate claudication pain versus pain-free training, with respect to their effects on walking ability and endothelial function. METHODS: A total of sixty patients with stable intermittent claudication were randomized to the pain-free treadmill training (repetitive intervals to onset of claudication pain) or moderate treadmill training (repetitive intervals to moderate claudication pain). In both groups exercises were performed 3 times a week for 3 months. Changes in flow mediated dilatation (FMD) and treadmill walking performance as well as plasma levels of c-reactive protein (hs-CRP) and fibrinogen were assessed before and after the program. RESULTS: Fifty-two patients completed the training program. Post-training maximal walking time was prolonged by 100% (p < 0.001) versus 98% (p < 0.001), and pain-free walking time by 120% (p < 0.001) versus 93% (p < 0.001) in the moderate training group as compared to the pain-free training group, respectively. FMD increased by 56% (p < 0.001) in the moderate training group and by 36% (p < 0.01) in the pain-free training group. No significant changes in the levels of hs-CRP and fibrinogen were seen after treadmill program in either group. CONCLUSIONS: Both pain-free treadmill training and the moderate treadmill training have similar efficacy on walking ability in patients with claudication. The improvement of post-training FMD indicates systemic effect of both treadmill programs on endothelial function. Both programs appear to be safe therapeutic modes, since none of them escalates the inflammation. Pain-free treadmill training seems useful and effective therapeutic option for patients with claudication.

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