Effects of physical training in intermittent claudication

Autrup, Herman; Harris, Cole; Stoner, Gary D.; Selkirk, James K.; Schafer, Paul W.; Trump, Benjamin F.

doi:10.3109/00365517809108414

Cited by 118 publications

(30 citation statements)

References 10 publications

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“…8,19 In contrast, training does not affect lower extremity large vessel hemodynamics. 8,30 Exercise training also improves lower extremity oxygen extraction in PAD, consistent with improved muscle metabolic status. 30 Taken together, these observations suggest that training has effects on skeletal muscle metabolism which are important in the beneficial response to the intervention.…”

Section: Accumulation Of Metabolic Intermediatesmentioning

confidence: 84%

“…Exercise rehabilitation improves functional performance in patients with PAD without affecting large vessel hemodynamics. 8,30 Exercise is a potent regulator of metabolic enzymes in normal individuals. 10,14 Supporting the concept that exercise rehabilitation modifies muscle metabolism in PAD, the carnitine pool is redistributed from acylcarnitine to carnitine (i.e.…”

Section: Implications Of Metabolic Abnormalities In Padmentioning

confidence: 99%

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Acquired skeletal muscle metabolic myopathy in atherosclerotic peripheral arterial disease

2000

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Peripheral arterial disease (PAD) is associated with an increased risk of overall cardiovascular mortality, and substantial morbidity resulting from claudication. While the initial disease process is clearly the result of atherosclerosis in the arterial circulation of the limb, altered hemodynamics do not completely explain the pathophysiology of claudication. Work from several laboratories has demonstrated secondary changes in the skeletal muscle of patients with PAD which are consistent with the presence of an acquired metabolic myopathy in these patients. Key findings include an alteration in the expression of mitochondrial enzymes, the accumulation of metabolic intermediates, altered regulation of mitochondrial respiration, increased oxidative stress, and the presence of somatic mutations in the mitochondrial genome. Understanding the metabolic changes associated with PAD is important in understanding the pathophysiology of claudication and in the development of novel therapeutic strategies.

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Section: Accumulation Of Metabolic Intermediatesmentioning

confidence: 84%

Section: Implications Of Metabolic Abnormalities In Padmentioning

confidence: 99%

Acquired skeletal muscle metabolic myopathy in atherosclerotic peripheral arterial disease

2000

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“…. 57 This increase in leg VO 2 occurred through increases in leg blood flow from 79 to 342 ml min À1 and the a-VO 2 from 0.09 to 0.171 ml min À1 blood. The increase in leg blood flow would, on the basis of calf perfusion measurements made during or after walking, 59,60 be no more than 40% of that seen in healthy controls; whereas the increase in a-VO 2 is the same as that observed in young, healthy subjects performing maximal calf exercise 61 or even greater than controls during cycling or walking.…”

Section: Walking Performance and Metabolismmentioning

confidence: 99%

“…Leg VO 2 and a-VO 2 The range of a-VO 2 data during maximal exercise in claudicants is $ 0.04 ml ml À1 blood, 63 and the standard error of the mean is usually very small (2À4% of the mean) compared with leg blood flow (15% of the mean). 57,62 At an average maximum leg blood flow of $ 400 ml min À1 , 57 a difference in a-VO 2 of 0.04 ml ml À1 would yield a range for calf muscle VO 2 of 16 ml min À1 for one leg and 32 ml min À1 for two legs. This latter value would explain no more than 3À6% of the range for peak VO 2 in claudicants.…”

mentioning

confidence: 99%

Skeletal muscle metabolic changes in peripheral arterial disease contribute to exercise intolerance: a point-counterpoint discussion

2004

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Patients with claudication have a marked impairment in exercise performance. Several factors contribute to this limitation, including reductions in large vessel blood flow and oxygen delivery as well as metabolic abnormalities in skeletal muscle. The relative contribution of these factors and their role in the pathophysiology of the exercise limitation is discussed using a point-counterpoint approach. Future directions for research conclude the discussion.

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“…Surgical revascularization does not completely normalize exercise performance (31), and exercise training, which does not modify hemodynamics, has been shown to improve walking capacity in patients with PAD (40). These observations have prompted investigations of a mechanism distal to the arterial occlusion to explain these phenomena.…”

mentioning

confidence: 99%

Relationship between leg muscle capillary density and peak hyperemic blood flow with endurance capacity in peripheral artery disease

Robbins

Jones

Duscha

et al. 2011

Journal of Applied Physiology

105

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WR, Annex BH. Relationship between leg muscle capillary density and peak hyperemic blood flow with endurance capacity in peripheral artery disease. J Appl Physiol 111: 81-86, 2011. First published April 21, 2011 doi:10.1152/japplphysiol.00141.2011.-The aim of this study was to determine if skeletal muscle capillary density is lower in patients with peripheral artery disease (PAD) and if capillary density relates to functional limitations. PAD patients with intermittent claudication (IC) have a decreased exercise tolerance due to exerciseinduced muscle ischemia. Despite the apparent role diminished arterial flow has in this population, the degree of walking pain and functional limitation is not entirely explained by altered hemodynamics of the affected limbs. We hypothesized that skeletal muscle capillary density is lower in PAD and is related to the functional impairment observed in this population. Sixty-four patients with PAD and 56 controls underwent cardiopulmonary exercise testing and a gastrocnemius muscle biopsy. A subset of these patients (48 PAD and 47 controls) underwent peak hyperemic flow testing via plethysmography. Capillary density in PAD patients was lower compared with controls (P Ͻ 0.001). After adjustment for several baseline demographic imbalances the model relating capillary density to peak oxygen consumption (V O2) remained significant (P Ͻ 0.001). In PAD subjects, capillary density correlated with peak V O2, peak walking time (PWT), and claudication onset time (COT). Peak hyperemic blood flow related to peak V O2 in both PAD and control subjects. PAD is associated with lower capillary density, and capillary density is related to the functional impairment as defined by a reduced peak V O2, PWT, and COT. These findings suggest that alterations in microcirculation may contribute to functional impairment capacity in PAD.claudication; skeletal muscle PERIPHERAL ARTERY DISEASE (PAD) is a major health problem that affects over eight million people in the United States (42). PAD is caused by atherosclerosis, which leads to arterial obstruction and decreased blood flow to the lower extremities. The most frequent clinical symptomatic manifestation of PAD is intermittent claudication (IC), which is defined as ischemic leg pain that occurs with walking and improves with rest (21). Patients with IC are known to have impaired exercise capacity and decreased ability to perform activities of daily living (31).Despite the role diminished arterial flow has in claudication, altered hemodynamics of the affected limbs do not entirely explain the degree of functional limitation in patients with IC (6,7,11,29,41). Surgical revascularization does not completely normalize exercise performance (31), and exercise training, which does not modify hemodynamics, has been shown to improve walking capacity in patients with PAD (40). These observations have prompted investigations of a mechanism distal to the arterial occlusion to explain these phenomena.A potential mechanistic target for study is the microcirculation as ...

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Effects of physical training in intermittent claudication

Cited by 118 publications

References 10 publications

Acquired skeletal muscle metabolic myopathy in atherosclerotic peripheral arterial disease

Acquired skeletal muscle metabolic myopathy in atherosclerotic peripheral arterial disease

Skeletal muscle metabolic changes in peripheral arterial disease contribute to exercise intolerance: a point-counterpoint discussion

Relationship between leg muscle capillary density and peak hyperemic blood flow with endurance capacity in peripheral artery disease

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