Circulation, Vol 81, 602-609, Copyright © 1990 by American Heart Association
WR Hiatt, JG Regensteiner, ME Hargarten, EE Wolfel and EP Brass
Patients with atherosclerotic peripheral arterial disease (PAD) of the
lower extremities have impaired walking ability due to exercise-induced
muscle ischemia and the resultant pain of intermittent claudication. To
evaluate the benefit of exercise training as a treatment for patients with
PAD, as well as possible mechanisms associated with improvement, we
randomly assigned 19 men with disabling claudication to treated and control
groups. Treatment consisted of supervised treadmill walking (1 hr/day, 3
days/wk, for 12 weeks) with progressive increases in speed and grade as
tolerated. Graded treadmill testing was performed to maximal toleration of
claudication pain on entry and after 12 weeks of training to define changes
in peak exercise performance. After 12 weeks, treated subjects had
increased their peak walking time 123%, peak oxygen consumption 30%, and
pain-free walking time 165% (all p less than 0.05). Control subjects had no
change in peak oxygen consumption, but after 12 weeks, peak walking time
increased 20% (p less than 0.05). In treated subjects, maximal calf blood
flow (measured by a plethysmograph) increased 38 +/- 45% (p less than
0.05), but the change in flow was not correlated to the increase in peak
walking time. Elevated plasma concentrations of acylcarnitines have been
associated with the functional impairment of PAD and may reflect the
metabolic state of ischemic skeletal muscle. In treated subjects, a 26%
decrease in resting plasma short-chain acylcarnitine concentration was
correlated with improvement in peak walking time (r = -0.78, p less than
0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Benefit of exercise conditioning for patients with peripheral arterial disease
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262.
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