scholarly journals Exercise Training Increases Resting Calf Muscle Oxygen Metabolism in Patients with Peripheral Artery Disease

Metabolites ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 814
Author(s):  
Zhe Li ◽  
Erin K. Englund ◽  
Michael C. Langham ◽  
Jinchao Feng ◽  
Kebin Jia ◽  
...  
Keyword(s):  
Exercise Training ◽  
Peripheral Artery Disease ◽  
Oxygen Metabolism ◽  
Calf Muscle ◽  
Optical Measurements ◽  
Oxygen Extraction Fraction ◽  
Peripheral Artery ◽  
Muscle Oxygen ◽  
Supervised Exercise ◽  
Artery Disease

Exercise training can mitigate symptoms of claudication (walking-induced muscle pain) in patients with peripheral artery disease (PAD). One adaptive response enabling this improvement is enhanced muscle oxygen metabolism. To explore this issue, we used arterial-occlusion diffuse optical spectroscopy (AO-DOS) to measure the effects of exercise training on the metabolic rate of oxygen (MRO2) in resting calf muscle. Additionally, venous-occlusion DOS (VO-DOS) and frequency-domain DOS (FD-DOS) were used to measure muscle blood flow (F) and tissue oxygen saturation (StO2), and resting calf muscle oxygen extraction fraction (OEF) was calculated from MRO2, F, and blood hemoglobin. Lastly, the venous/arterial ratio (γ) of blood monitored by FD-DOS was calculated from OEF and StO2. PAD patients who experience claudication (n = 28) were randomly assigned to exercise and control groups. Patients in the exercise group received 3 months of supervised exercise training. Optical measurements were obtained at baseline and at 3 months in both groups. Resting MRO2, OEF, and F, respectively, increased by 30% (12%, 44%) (p < 0.001), 17% (6%, 45%) (p = 0.003), and 7% (0%, 16%) (p = 0.11), after exercise training (median (interquartile range)). The pre-exercise γ was 0.76 (0.61, 0.89); it decreased by 12% (35%, 6%) after exercise training (p = 0.011). Improvement in exercise performance was associated with a correlative increase in resting OEF (R = 0.45, p = 0.02).

scholarly journals Effects of exercise training on calf muscle oxygen extraction and blood flow in patients with peripheral artery disease

2017 ◽  
Vol 123 (6) ◽  
pp. 1599-1609 ◽  
Author(s):  
Wesley B. Baker ◽  
Zhe Li ◽  
Steven S. Schenkel ◽  
Malavika Chandra ◽  
David R. Busch ◽  
...  
Keyword(s):  
Blood Flow ◽  
Exercise Training ◽  
Peripheral Artery Disease ◽  
Near Infrared ◽  
Muscle Blood Flow ◽  
Calf Muscle ◽  
Oxygen Extraction ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Artery Disease

We employed near-infrared optical techniques, diffuse correlation spectroscopy (DCS), and frequency-domain near-infrared spectroscopy (FD-NIRS) to test the hypothesis that supervised exercise training increases skeletal muscle microvascular blood flow and oxygen extraction in patients with peripheral artery disease (PAD) who experience claudication. PAD patients ( n = 64) were randomly assigned to exercise and control groups. Patients in the exercise group received 3 mo of supervised exercise training. Calf muscle blood flow and oxygen extraction were optically monitored before, during, and after performance of a graded treadmill protocol at baseline and at 3 mo in both groups. Additionally, measurements of the ankle-brachial index (ABI) and peak walking time (PWT) to maximal claudication were made during each patient visit. Supervised exercise training was found to increase the maximal calf muscle blood flow and oxygen extraction levels during treadmill exercise by 29% (13%, 50%) and 8% (1%, 12%), respectively [ P < 0.001; median (25th percentile, 75th percentile)]. These improvements across the exercise group population were significantly higher than corresponding changes in the control group ( P < 0.004). Exercise training also increased PWT by 49% (18%, 101%) ( P = 0.01). However, within statistical error, the ABI, resting calf muscle blood flow and oxygen extraction, and the recovery half-time for hemoglobin\myoglobin desaturation following cessation of maximal exercise were not altered by exercise training. The concurrent monitoring of both blood flow and oxygen extraction with the hybrid DCS/FD-NIRS instrument revealed enhanced muscle oxidative metabolism during physical activity from exercise training, which could be an underlying mechanism for the observed improvement in PWT. NEW & NOTEWORTHY We report on noninvasive optical measurements of skeletal muscle blood flow and oxygen extraction dynamics before/during/after treadmill exercise in peripheral artery disease patients who experience claudication. The measurements tracked the effects of a 3-mo supervised exercise training protocol and revealed that supervised exercise training improved patient ability to increase microvascular calf muscle blood flow and oxygen extraction during physical activity.

Vascular Inflammation, Calf Muscle Oxygen Saturation, and Blood Glucose are Associated With Exercise Pressor Response in Symptomatic Peripheral Artery Disease

Angiology ◽  
2019 ◽  
Vol 70 (8) ◽  
pp. 747-755 ◽  
Author(s):  
Andrew W. Gardner ◽  
Polly S. Montgomery ◽  
Ming Wang ◽  
Chixiang Chen ◽  
Marcos Kuroki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Glucose ◽  
Oxygen Saturation ◽  
Peripheral Artery Disease ◽  
Pressor Response ◽  
Calf Muscle ◽  
Peripheral Artery ◽  
Muscle Oxygen ◽  
Artery Disease ◽  
Vascular Biomarkers

We determined whether calf muscle oxygen saturation (StO2) and vascular biomarkers of inflammation and oxidative stress were associated with an exercise pressor response during treadmill walking in 179 patients with symptomatic peripheral artery disease (PAD). The exercise pressor response was measured as the change in blood pressure from rest to the end of the first 2-minute treadmill stage (2 mph, 0% grade). There was a wide range in the change in systolic blood pressure (−46 to 50 mm Hg) and in diastolic blood pressure (−23 to 38 mm Hg), with mean increases of 4.3 and 1.4 mm Hg, respectively. In multiple regression analyses, significant predictors of systolic pressure included glucose ( P < .001) and insulin ( P = .039). Significant predictors of diastolic pressure included cultured endothelial cell apoptosis ( P = .019), the percentage drop in exercise calf muscle (StO2; P = .023), high-sensitivity C-reactive protein ( P = .032), and glucose ( P = .033). Higher levels in pro-inflammatory vascular biomarkers, impaired calf muscle StO2 during exercise, and elevated blood glucose were independently associated with greater exercise pressor response in patients with symptomatic PAD. The clinical implication is that exercise and nutritional interventions designed to improve inflammation, microcirculation, and glucose metabolism may also lower blood pressure during exercise in patients with symptomatic PAD.

Gait changes after supervised exercise training in patients with symptomatic lower extremity peripheral artery disease

2021 ◽  
pp. 1358863X2098483
Author(s):  
Stefano Lanzi ◽  
Joël Boichat ◽  
Luca Calanca ◽  
Pauline Aubertin ◽  
Davide Malatesta ◽  
...  
Keyword(s):  
Exercise Training ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Stride Frequency ◽  
Peripheral Artery ◽  
Phase Duration ◽  
Supervised Exercise ◽  
Gait Parameters ◽  
Artery Disease

This study aimed to investigate the effects of supervised exercise training (SET) on walking performance and spatiotemporal gait changes in patients with symptomatic lower extremity peripheral artery disease (PAD). In this single-arm prospective nonrandomized cohort study, patients with Fontaine stage II PAD following a 3-month SET program were included. Before and after SET, a constant-load treadmill test was performed to determine the pain-free and maximal walking distances (PFWD and MWD, respectively). During this test, spatiotemporal gait parameters were assessed. The ankle–brachial index (ABI) and toe–brachial index (TBI) were also measured. Twenty-seven patients with PAD (64.0 ± 1.9 y, 74% men) were included. Following SET, the PFWD (+68%; p = 0.001) and MWD (+79%; p ⩽ 0.001) significantly increased. The ABI and TBI did not change significantly. Following SET, the stride duration, stride frequency, stride length, and double support phase duration did not change significantly. In contrast, subphases of stance showed significant changes: the loading response (+8%; p = 0.03) and foot-flat (+2%; p = 0.01) phases were significantly longer, whereas the push-off phase (–7%; p = 0.002) was significantly shorter. A significant positive correlation was found between changes in the foot-flat phase and changes in PFWD ( r = 0.43, p = 0.03). A significant negative correlation was found between changes in the push-off phase and changes in PFWD ( r = −0.39, p = 0.05). No significant correlations were found between changes in relative durations of the subphases of stance and MWD. These results indicate that changes in temporal gait parameters during the foot contact phase potentially constitute an underlying mechanism of delayed claudication distance in patients with symptomatic PAD.

scholarly journals Improvement in 6-Minute Walking Distance after Supervised Exercise Training Is Related to Changes in Quality of Life in Patients with Lower Extremity Peripheral Artery Disease

2021 ◽  
Vol 10 (15) ◽  
pp. 3330
Author(s):  
Stefano Lanzi ◽  
Luca Calanca ◽  
André Berchtold ◽  
Lucia Mazzolai
Keyword(s):  
Quality Of Life ◽  
Exercise Training ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Sf 36 ◽  
Artery Disease

This study aimed to investigate the relationship between supervised exercise training (SET)-induced changes in treadmill performance and 6 min walking distance, and changes in general (physical and mental) self-perceived health-related quality of life (HRQoL) in symptomatic patients with lower extremity peripheral artery disease (PAD). This is an observational study investigating Fontaine stage II PAD patients participating in 3-month SET. Before and following SET, treadmill performance (pain-free (PFWD) and maximal (MWD)), and 6 min walking distance (6MWD) were assessed. Self-perceived HRQoL was assessed with the Medical Outcomes Study Short-Form 36 (SF-36). Ankle- and toe-brachial indexes were also measured. One-hundred forty-seven patients with PAD were included (64.9 ± 9.6 y, 70% men). After SET, PFWD (+102%, p ≤ 0.001), MWD (+87%, p ≤ 0.001), and 6MWD (+14%, p ≤ 0.001) significantly increased. All eight SF-36 subscale scores significantly improved following SET (p ≤ 0.04). SET significantly improved physical and mental component summaries of the SF-36 (p ≤ 0.001). Larger increases in 6MWD were associated with greater improvements in physical (β = 0.19; p = 0.02) and mental (β = 0.24; p = 0.005) component summaries of the SF-36. No significant relationship was observed between changes in treadmill performance and changes in physical and mental component summaries of the SF-36. These results show that improvements in 6MWD following SET are related to improvements in general self-perceived HRQoL in patients with symptomatic lower extremity PAD. On the contrary, changes in treadmill performance were not related to improvements in HRQoL. These results suggest that the 6 min walking test is an essential outcome measure to assess overall patient functional status following interventions in patients with PAD.

Calf Muscle Oxygen Saturation during 6-Minute Walk Test and Its Relationship with Walking Impairment in Symptomatic Peripheral Artery Disease

2018 ◽  
Vol 52 ◽  
pp. 147-152 ◽  
Author(s):  
Aluísio Andrade-Lima ◽  
Gabriel G. Cucato ◽  
Wagner J.R. Domingues ◽  
Antônio H. Germano-Soares ◽  
Bruno R. Cavalcante ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Peripheral Artery Disease ◽  
Calf Muscle ◽  
Walk Test ◽  
Peripheral Artery ◽  
Muscle Oxygen ◽  
Artery Disease ◽  
6 Minute Walk Test ◽  
Minute Walk

Supervised Exercise Training for Symptomatic Peripheral Artery Disease

2017 ◽  
Vol 6 (4) ◽  
pp. 78-83
Author(s):  
Jonathan K. Ehrman ◽  
Karen Lui ◽  
Diane Treat-Jacobson
Keyword(s):  
Exercise Training ◽  
Peripheral Artery Disease ◽  
Training Session ◽  
Rehabilitation Program ◽  
Background Information ◽  
Sufficient Evidence ◽  
Final Decision ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Artery Disease

In May 2017 the Centers for Medicare and Medicaid Services (CMS) published a final decision memo for supervised exercise therapy for symptomatic peripheral artery disease. This was because there was sufficient evidence demonstrating the benefit of exercise training for improving pain-free and peak walking time. This training can take place in a clinic setting or within a cardiac rehabilitation program. There were specific instructions for what must take place during supervised exercise training during each session day a patient was present. The goal of this review is to provide background information about the research that led to this decision from CMS. It will also review specifics of a supervised exercise training session and conclude with specifics about the CMS decision memo language as it relates to implementing a supervised exercise training session.

scholarly journals Multimodal Supervised Exercise Training is Effective in Improving Long Term Walking Performance in Patients with Symptomatic Lower Extremity Peripheral Artery Disease

2021 ◽  
Vol 10 (10) ◽  
pp. 2057
Author(s):  
Barbara Ney ◽  
Stefano Lanzi ◽  
Luca Calanca ◽  
Lucia Mazzolai
Keyword(s):  
Exercise Training ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Walking Performance ◽  
Artery Disease ◽  
Fontaine Stage

This study aimed to evaluate the effect of a multimodal supervised exercise training (SET) program on walking performance for 12 months in patients with symptomatic lower extremity peripheral artery disease (PAD). Consecutive patients with Fontaine stage II PAD participating in the SET program of our hospital were retrospectively investigated. Walking performance, assessed using a treadmill with measures of the pain-free and maximal walking distance (PFWD, MWD, respectively), and 6 min walking distance (6MWD), were tested before and following SET, as well as at 6 and 12 months after SET completion. Ninety-three symptomatic patients with PAD (65.0 ± 1.1 y) were included in the study. Following SET, the walking performance significantly improved (PFWD: +145%, p ≤ 0.001; MWD: +97%, p ≤ 0.001; 6MWD: +15%, p ≤ 0.001). At 6 months, PFWD (+257%, p ≤ 0.001), MWD (+132%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-SET condition. At 12 months, PFWD (+272%, p ≤ 0.001), MWD (+130%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-training condition. The walking performance remained significantly improved in both women and men for up to 12 months (p ≤ 0.001). Multimodal SET is effective at improving walking performance in symptomatic patients with PAD, with improvements lasting up to 12 months.

Sign in / Sign up

Export Citation Format

Share Document