Abstract 11379: Supervised Exercise Training Has No Effect on Inflammation and Platelet Activation in Peripheral Arterial Disease
BACKGROUND. Supervised exercise training (SET) improves walking capacity in patients with peripheral arterial disease (PAD). Various mechanisms were postulated, by which SET might exert its beneficial effects, however, most studies were performed in an era before PAD patients received current pharmacotherapy for secondary prevention. In this prospective randomized controlled trial we investigated if SET further improves markers of inflammation and platelet activation in PAD patients receiving best medical treatment (BMT) for cardiovascular risk factor modification.
METHODS. PAD patients (Rutherford category 2 and 3) were randomized to SET on top of BMT (SET+BMT group) for 6 months or to BMT only (BMT group). Inflammatory (high sensitivity C-reactive protein, serum amyloid A, fibrinogen, interleukin-6, tumor necrosis factor - alpha) and platelet activation (soluble P-selectin) markers were determined after 3, 6 and 12 months by immunoassays. Monocyte-platelet aggregates (MPA) were analyzed by flow cytometry at the same time points. Maximum walking distance (MWD) was recorded in all patients by standardized treadmill testing.
RESULTS. Forty patients with a mean age of 69±10 (mean±SD) years and Rutherford category 2 (85%) or 3 (15%) were randomized. The ankle-brachial index was 0.61±0.15 in the SET+BMT group and 0.52±0.21 in the BMT group. All patients were on an antiplatelet therapy and the majority received statins (SET+BMT: 100%, BMT 95 %) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (SET+BMT: 65/20%, BMT 65/25%). MWD increased significantly after 6 months of training (median (IQR), baseline: 101.5m (65.5m, 154.5m) vs. 6 months: 134.0m (98.0m, 177.0m), P<0.05), and this benefit was sustained 6 months after training. No significant changes of inflammatory and platelet activation markers were found within the SET+BMT group during the training period. Compared to BMT no improvements of these markers were observed in response to training at any time point (all P>0.05).
CONCLUSIONS. Irrespective of the observed increase in walking capacity, exercise training adds no further anti-inflammatory or anti-platelet effect in PAD patients receiving optimal pharmacotherapy according to current guidelines.
- © 2011 by American Heart Association, Inc.