The effect of treadmill training on endothelial function and walking abilities in patients with peripheral arterial disease

Januszek, Rafał; Mika, Piotr; Konik, Anita; Petriczek, Tomasz; Nowobilski, Roman; Niżankowski, Rafał

doi:10.1016/j.jjcc.2013.12.002

Cited by 43 publications

(42 citation statements)

References 33 publications

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“…52 A recent study of patients undergoing a 12-week exercise training program demonstrated an improvement in flow-mediated dilation compared with baseline, suggesting that improvements in endothelial function may be one mechanism mediating reduced symptoms of claudication after exercise training. 53 In addition, in an animal model of chronic atherosclerosis that simulated some features of PAD, a pharmacological intervention that improved exercise-induced blood flow also improved the animals' functional status. 54 The impaired vasodilation in patients with PAD is likely a sequela of the obstruction, and improvement in physiological vasodilation with exercise offers a potential therapeutic target.…”

Section: Endothelial and Microcirculatory Dysfunctionmentioning

confidence: 99%

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Hiatt¹,

Armstrong²,

Larson³

et al. 2015

Circulation Research

137

118

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P eripheral artery disease (PAD) is initiated by atherogenic mechanisms common to all major vascular territories but encompasses several distinctly important clinical sequelae.1 The global burden of PAD is large and rising, with substantial morbidity and mortality found in high-, middle-, and low-income countries. 2 The atherosclerotic occlusive disease underlying PAD is associated with an exercise limitation in the majority of patients, whereas the classic symptoms of intermittent claudication, ischemic rest pain, and ischemic ulceration are less common manifestations. 3 Patients with PAD are also at increased risk of myocardial infarction, ischemic stroke, heart failure, renovascular hypertension, and vascular death reflecting the systemic atherosclerotic burden. [4][5][6] The epidemiology of Peripheral Artery Disease Compendium© 2015 American Heart Association, Inc. The diagnosis of PAD can be ascertained by simple hemodynamic measurements, in particular, the ankle-brachial index (ABI), a test performed by measuring the systolic blood pressure in each arm and the dorsalis pedis and posterior tibial arteries of each ankle. The highest of the dorsalis pedis or posterior tibial artery pressures is the numerator of the ABI specific to each leg, whereas the highest arm pressure on either side is the denominator. A ratio of <0.90 in either leg is considered hemodynamic evidence of PAD. 16 When imaged, PAD can be characterized as one or more arterial stenoses or occlusions involving the distal aorta, iliac, femoral, popliteal, or tibial arteries. 17The underlying mechanisms responsible for the functional limitations in PAD are hemodynamic in origin, which affects the supply of oxygen and substrates to metabolically active tissue: skeletal muscle in the case of intermittent claudication and skin and subcutaneous tissues in the case of critical leg ischemia. However, additional pathophysiologic mechanisms contribute to the limb manifestations, where a reduction in blood flow alone does not fully account for the exercise limitation. Recent research into the pathophysiology of this exercise limitation has identified several important sequelae resultant from the chronic hemodynamic deficit. These changes affecting the vasculature and skeletal muscle distal to the primary hemodynamic lesions likely contribute to the mechanisms of exercise limitation in PAD. These advances are reviewed here with an additional focus on identifying possible future therapeutic strategies. Symptomatic Manifestations and Exercise Limitations in PADIn the coronary circulation, plaque rupture leading to acute ischemic events is a common clinical presentation; in PAD, progressive atherosclerosis leading to chronic stenosis and occlusion, often in series, in the arteries supplying the lower extremities dominates the symptomatic manifestations.6 Limb SymptomsPatients with PAD may present with a range of limb symptoms. Most patients are either asymptomatic or have atypical limb symptoms during exercise, whereas only a third have typical symptoms of c...

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Section: Endothelial and Microcirculatory Dysfunctionmentioning

confidence: 99%

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Hiatt¹,

Armstrong²,

Larson³

et al. 2015

Circulation Research

137

118

View full text Add to dashboard Cite

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“…In this context, Januszek et al [64] showed that 12 weeks of supervised, intermittent treadmill walking until induce claudication, three times a week, prolonged the asymptomatic walking distance and improved brachial artery FMD in 43% after program. Another study that tested the hypothesis of potential effects of endothelial function in PAD patients that underwent to a supervised treadmill training program of 12 weeks found that brachial artery FMD values increased by 45% after program and the patients with better walking abilities at baseline derived greater clinical and metabolic benefits [65] .…”

Section: Exercise Arterial Function and Cardiac Rehabilitationmentioning

confidence: 99%

Exploring Vascular Function Biomarkers: Implications for Rehabilitation

Phillips¹,

Andaku²,

Mendes³

et al. 2017

Braz J Cardiovasc Surg

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The endothelium plays an important role in maintaining vascular homeostasis and regulating blood vessel function. Endothelial function is considered an independent predictor for risk of future cardiovascular events in cardiovascular and non-cardiovascular patients, as well as a predictor for postoperative complications in cardiovascular surgery patients. Brachial artery flow-mediated dilation by high-resolution ultrasound is widely used to evaluate endothelium-dependent vasodilation, which is mainly mediated by nitric oxide release. Physical exercise exerts beneficial effects on endothelial function and can be used in both primary and secondary prevention of cardiac and peripheral artery diseases, even in the postoperative period of cardiovascular surgery.

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“…The coexistence of vascular dysfunction both in conduit arteries and microvasculature in patients with PolyVD must be recognized. The achievement of functional improvement in the already sclerotic conduit arteries might be difficult, but the microvascular endothelial dysfunction might be modifiable and treatable by potential medical therapies and life-style intervention [32]; exercise training improved endothelial function in patients with PAD [33]. An effective therapeutic strategy may involve the development of treatment to improve microvascular endothelial dysfunction, as assessed by RHI, in patients with higher risks of cardiovascular events.…”

Section: Variablementioning

confidence: 99%

Advanced peripheral microvascular endothelial dysfunction and polyvascular disease in patients with high cardiovascular risk

Makino

Sugiyama

Jinnouchi³

et al. 2016

Journal of Cardiology

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The effect of treadmill training on endothelial function and walking abilities in patients with peripheral arterial disease

Cited by 43 publications

References 33 publications

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Exploring Vascular Function Biomarkers: Implications for Rehabilitation

Advanced peripheral microvascular endothelial dysfunction and polyvascular disease in patients with high cardiovascular risk

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