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Evaluation ProceduresA graded treadmill protocol was performed tomaximal toleration of claudication pain as previouslydescribed.1 Vo2 and carbon dioxide production(Vco2) were measured at rest and during treadmillexercise by an Ametek metabolic system (AmetekThermox, Pittsburgh, Pennsylvania). The respiratoryexchange ratio (RER) was calculated as the ratio ofVco2 to Vo2. Arm blood pressure (by auscultation)and heart rate (by 12-lead electrocardiogram) wereobtained every minute during exercise. Cardiac statuswas monitored continuously throughout thetreadmill test by 12-lead electrocardiogram. Theexercise test began at 2 mph, 0% grade, with asubsequent 3.5% increase in grade every 3 minutesuntil maximal claudication pain forced cessation ofexercise. Peak exercise performance was characterizedby the highest attained walking time, treadmillgrade, and Vo2 during the treadmill test. Duringexercise, the perception of claudication pain severitywas ascertained every 30 seconds using a perceivedpain scale of 1-5 where 1 =no pain, 2=onset of pain,3=mild, 4=moderate, and 5=maximal pain.
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