In Reply: Dr Khattri raises questions about baseline performance and medication use as potential confounders of our study results. Our statistical analyses adjusted for baseline performance. Therefore, changes in performance across the 3 study groups at follow-up are independent of baseline performance.
With regard to the potential for medication use to influence our findings, current clinical practice guidelines suggest that cilostazol improves treadmill walking performance by approximately 40% to 60% and that pentoxifylline improves treadmill walking performance by approximately 20% to 25% among men and women with PAD.1 Statin therapy may also improve treadmill walking performance in persons with PAD.2,3 To our knowledge, there are no data demonstrating that aspirin or clopidogrel improve walking performance in patients with PAD. To minimize changes in medication during the Study to Improve Leg Circulation trial, we mailed a letter to physicians of study participants at the time of randomization, requesting that physicians avoid starting or stopping cilostazol or pentoxifylline, if possible, while their patients were participating in the trial.
McDermott MM, Dyer A. Treadmill Exercise or Resistance Training in Patients With Peripheral Arterial Disease—Reply. JAMA. 2009;301(19):1986-1987. doi:10.1001/jama.2009.650