Abstract 319: Effects of Muscle Stretching on Flow-Mediated Dilation of Popliteal Artery in Patients With Peripheral Artery Disease

Patients with peripheral artery disease (PAD) frequently have walking impairment due to lower extremity claudication. Our preliminary results in a rat model of aging indicate that a program of daily calf muscle stretching improves endothelium-dependent dilation of soleus muscle arterioles and increases soleus muscle blood flow during exercise. However, the effects of muscle stretching on the function of arteries supplying the legs of PAD patients is unknown. We hypothesized that daily calf muscle stretching improves vascular endothelial function and walking distance in PAD patients. To test our hypothesis, a randomized, non-blinded, crossover study was performed. Four weeks of muscle stretching (30 min/d, 5 days/wk) and 4 weeks of sedentary lifestyle (no stretching) were performed in random order. Thirteen patients with PAD participated in this study (71 ± 2 years old; 7 males and 6 females). During the stretching intervention both ankle joints were maintained at 15o of dorsiflexion using ankle dorsiflexion splints to stretch their calf muscles at home. Flow-mediated dilation (FMD; dilation to post-occlusion reactive hyperemia) and nitroglycerin-induced dilation (dilation to sublingual 0.4 mg nitroglycerin) of the popliteal artery were measured after 4 weeks of muscle stretching and after the no stretching period using ultrasound. A six-minute walk test was also performed to obtain walking distance. After 4 weeks of muscle stretching, FMD and 6-minute walking distance significantly improved as compared to the values measured after 4 weeks of no stretching (FMD: 5.2 ± 0.6 % vs. 3.7 ± 0.4 %, P=0.003 stretching vs. no stretching, 6-minute walking distance: 355 ± 32 m vs. 311 ± 31 m, P=0.007, stretching vs. no stretching; mean ± SE). No difference in nitroglycerin-induced dilation was found between groups (10.9 ± 1.4 vs. 9.9 ± 1.1 %, P=0.54, stretching vs. no stretching). Percentage change of walking distance (%change = [(stretching - no stretching) / no stretching] x 100) significantly correlated with the %change of FMD (R 2 =0.65, P=0.03). These results indicate that static calf muscle stretching enhances vascular endothelial function of the popliteal artery, contributing to improvement of walking tolerance in PAD patients.

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Daily Passive Muscle Stretching Improves Flow-Mediated Dilation of Popliteal Artery and 6-minute Walk Test in Elderly Patients with Stable Symptomatic Peripheral Artery Disease

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2019.05.003 ◽

2019 ◽

Vol 20 (8) ◽

pp. 642-648 ◽

Cited By ~ 10

Author(s):

Kazuki Hotta ◽

Wayne B. Batchelor ◽

James Graven ◽

Vishal Dahya ◽

Thomas E. Noel ◽

...

Keyword(s):

Elderly Patients ◽

Popliteal Artery ◽

Flow Mediated Dilation ◽

Walk Test ◽

Peripheral Artery ◽

Muscle Stretching ◽

Artery Disease ◽

6 Minute Walk Test ◽

Passive Muscle ◽

Minute Walk

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Acute mitochondrial antioxidant intake improves endothelial function, antioxidant enzyme activity, and exercise tolerance in patients with peripheral artery disease

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00235.2020 ◽

2020 ◽

Vol 319 (2) ◽

pp. H456-H467 ◽

Cited By ~ 1

Author(s):

Song-Young Park ◽

Elizabeth J. Pekas ◽

Ronald J. Headid ◽

Won-Mok Son ◽

TeSean K. Wooden ◽

...

Keyword(s):

Endothelial Function ◽

Peripheral Artery Disease ◽

Oral Intake ◽

Muscle Performance ◽

Vascular Endothelial ◽

Peripheral Artery ◽

Walking Capacity ◽

Antioxidant Intake ◽

Artery Disease ◽

First Time

The results of this study reveal for the first time that acute oral intake of mitochondrial-targeted antioxidant (MitoQ, 80 mg) is effective for improving vascular endothelial function and superoxide dismutase in patients with peripheral artery disease (PAD). Acute MitoQ intake is also effective for improving maximal walking capacity and delaying the onset of claudication in patients with PAD. These findings suggest that the acute oral intake of MitoQ-mediated improvements in vascular mitochondria play a pivotal role for improving endothelial function, the redox environment, and skeletal muscle performance in PAD.

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The effect of exercise training on vascular endothelial function and cardiac autonomic control in patients with coronary artery disease and diabetes

10.5353/th_991044057364203414 ◽

2018 ◽

Author(s):

Yuk-wang, Edward Tam

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Exercise Training ◽

Endothelial Function ◽

Autonomic Control ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Cardiac Autonomic Control ◽

Artery Disease

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Enclosed Zone Flow-mediated Dilation (ezFMD): Development of a Novel Method for Evaluating Vascular Endothelial Function through Medical and Engineering Collaboration

The Journal of Japanese College of Angiology ◽

10.7133/jca.19-00002 ◽

2019 ◽

Vol 59 (4) ◽

pp. 23-28

Author(s):

Toshio Tsuji ◽

Harutoyo Hirano ◽

Yukihito Higashi ◽

Masao Yoshizumi

Keyword(s):

Endothelial Function ◽

Flow Mediated Dilation ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Engineering Collaboration ◽

Novel Method

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Body mass-normalized moderate dose of dietary nitrate intake improves endothelial function and walking capacity in patients with peripheral artery disease

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00121.2021 ◽

2021 ◽

Author(s):

Elizabeth J. Pekas ◽

TeSean K. Wooden ◽

Saantosh Yadav ◽

Song-Young Park

Keyword(s):

Skeletal Muscle ◽

Endothelial Function ◽

Body Mass ◽

Walking Distance ◽

Moderate Dose ◽

Peripheral Artery ◽

Oxygen Utilization ◽

Muscle Oxygen ◽

Walking Capacity ◽

Artery Disease

Peripheral artery disease (PAD) is characterized by the accumulation of atherosclerotic plaques in the lower extremity conduit arteries, which impairs blood flow and walking capacity. Dietary nitrate has been used to reduce blood pressure (BP) and improve walking capacity in PAD. However, a standardized dose for PAD has not been determined. Therefore, we sought to determine the effects of a body mass-normalized moderate dose of nitrate (0.11 mmol nitrate/kg) as beetroot juice on serum nitrate/nitrite, vascular function, walking capacity, and tissue oxygen utilization capacity in patients with PAD. 11 patients with PAD received either nitrate supplement or placebo in a randomized crossover design. Total serum nitrate/nitrite, resting BP, brachial and popliteal artery endothelial function (flow-mediated dilation, FMD), arterial stiffness (pulse-wave velocity, PWV), augmentation index (AIx), maximal walking distance and time, claudication onset time, and skeletal muscle oxygen utilization were measured pre-and-post-nitrate and placebo intake. There were significant group x time interactions (p<0.05) for serum nitrate/nitrite, FMD, BP, walking distance and time, and skeletal muscle oxygen utilization. The nitrate group showed significantly increased serum nitrate/nitrite (Δ1.32μM), increased brachial and popliteal FMD (Δ1.3% and Δ1.7%, respectively), reduced peripheral and central systolic BP (Δ-4.7mmHg and Δ-8.2mmHg, respectively), increased maximal walking distance (Δ92.7m) and time (Δ56.3s), and reduced deoxygenated hemoglobin during walking. There were no changes in PWV, AIx, or claudication (p>0.05). These results indicate that a body-mass normalized moderate dose of nitrate may be effective and safe for reducing BP, improving endothelial function, and improving walking capacity in patients with PAD.

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Replacing carbohydrate during a glucose challenge with the egg white portion or whole eggs protects against postprandial impairments in vascular endothelial function in prediabetic men by limiting increases in glycaemia and lipid peroxidation

British Journal Of Nutrition ◽

10.1017/s0007114517003610 ◽

2018 ◽

Vol 119 (3) ◽

pp. 259-270 ◽

Cited By ~ 7

Author(s):

Joshua D. McDonald ◽

Chureeporn Chitchumroonchokchai ◽

Jinhui Li ◽

Eunice Mah ◽

Allison N. Labyk ◽

...

Keyword(s):

Lipid Peroxidation ◽

Endothelial Function ◽

Hdl Cholesterol ◽

Flow Mediated Dilation ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Glucose Challenge ◽

Egg Yolks ◽

Artery Flow ◽

Postprandial Lipids

AbstractEggs attenuate postprandial hyperglycaemia (PPH), which transiently impairs vascular endothelial function (VEF). We hypothesised that co-ingestion of a glucose challenge with egg-based meals would protect against glucose-induced impairments in VEF by attenuating PPH and oxidative stress. A randomised, cross-over study was conducted in prediabetic men (n20) who ingested isoenegertic meals (1674 kJ (400 kcal)) containing 100 g glucose (GLU), or 75 g glucose with 1·5 whole eggs (EGG), seven egg whites (WHITE) or two egg yolks (YOLK). At 30 min intervals for 3 h, brachial artery flow-mediated dilation (FMD), plasma glucose, insulin, cholecystokinin (CCK), lipids (total, LDL- and HDL-cholesterol; TAG), F2-isoprostanes normalised to arachidonic acid (F2-IsoPs/AA), and methylglyoxal were assessed. In GLU, FMD decreased at 30–60 min and returned to baseline levels by 90 min. GLU-mediated decreases in FMD were attenuated at 30–60 min in EGG and WHITE. Compared with GLU, FMDAUCwas higher in EGG and WHITE only. Relative to baseline, glucose increased at 30–120 min in GLU and YOLK but only at 30–90 min in EGG and WHITE. GlucoseAUCand insulinAUCwere also lower in EGG and WHITE only. However, CCKAUCwas higher in EGG and WHITE compared with GLU. Compared with GLU, F2-IsoPs/AAAUCwas lower in EGG and WHITE but unaffected by YOLK. Postprandial lipids and methylglyoxal did not differ between treatments. Thus, replacing a portion of a glucose challenge with whole eggs or egg whites, but not yolks, limits postprandial impairments in VEF by attenuating increases in glycaemia and lipid peroxidation.

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Switching to Aggressive Statin Improves Vascular Endothelial Function in Patients with Stable Coronary Artery Disease

Journal of Atherosclerosis and Thrombosis ◽

10.5551/jat.3848 ◽

2010 ◽

Vol 17 (7) ◽

pp. 705-711 ◽

Cited By ~ 6

Author(s):

Masaaki Hoshiga ◽

Kumiko Arishiro ◽

Takahiro Nakakoji ◽

Norihiko Miyazaki ◽

Nobuyuki Negoro ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Endothelial Function ◽

Stable Coronary Artery Disease ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Artery Disease

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Adaptation of external counterpulsation based on individual shear rate therapy improves endothelial function and claudication distance in peripheral artery disease

VASA ◽

10.1024/0301-1526/a000544 ◽

2016 ◽

Vol 45 (4) ◽

pp. 317-324 ◽

Cited By ~ 9

Author(s):

Eva-Elina Buschmann* ◽

Michele Brix* ◽

Lulu Li ◽

Janke Doreen ◽

Andreas Zietzer ◽

...

Keyword(s):

Shear Rate ◽

Endothelial Function ◽

Walking Distance ◽

Peripheral Perfusion ◽

Peripheral Artery ◽

Doppler Flow ◽

External Counterpulsation ◽

Non Invasive ◽

Artery Disease

Abstract. Background: External counterpulsation therapy enhances blood flow and was shown to improve endothelial function and quality of life in coronary artery disease patients. However, high pressures of up to 300 mmHg may lead to malperfusion of the ischaemic limb. To improve the clinical outcome of patients with peripheral artery disease (PAD), we adjusted external counterpulsation and developed a novel non-invasive approach termed individual shear rate therapy (ISRT). Patients and methods: In the present study, 14 patients with a Fontaine stage IIb and femoral-popliteal PAD underwent 30 hours of ISRT over 5 weeks. For ISRT, individual treatment pressures that do not exceed 160 mmHg were assessed by Doppler flow parameters during counterpulsation (individual shear rate diagnosis) in order to enhance and maximise peripheral perfusion. The study aimed to enhance peripheral perfusion and evaluate the primary clinical endpoint endothelial function, as well as to perform preliminary analysis of the ankle brachial index (ABI) and walking distance. Results: Doppler flow measurements in the lower limb (ankle) validated that maximum blood flow velocity during systole and acceleration doubled during ISRT. Study results demonstrated that long-term ISRT significantly increased flow-mediated dilation (FMD) in the brachial artery (0.13+/- 0.09 mm to 0.38+/- 0.05 mm; p < 0.05), while nitromediated dilation (0.36+/- 0.10 mm to 0.45+/- 0.08 mm) remained and common femoral artery FMD did not reach statistical significance (0.38+/- 0.08 mm to 0.67+/- 0.19 mm; p<0.05). Initial claudication distance considerably improved for all patients after 30 hours of ISRT (92.6 +/- 8.2 metres to 280+/- 101.3 metres, p<0.05), just like the absolute claudication distance, which showed a more than 2.5-fold increase (167.8+/- 18.1 metres to 446.7+/- 133.3 metres; p<0.05). The ABI did not improve (0.58+/- 0.03 to 0.65+/- 0.04). Conclusions: Our data demonstrate that long-term ISRT is a potential novel non-invasive treatment to improve endothelial function and absolute pain-free walking distance for PAD patients.

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