The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients

Abstract

BackgroundAerobic exercise in general and high-intensity interval training (HIIT) specifically is known to improve vascular function in a range of clinical conditions. HIIT in particular has demonstrated improvements in clinical outcomes, in conditions that have a strong macroangiopathic component. Nevertheless, the effect of HIIT on microcirculation in systemic sclerosis (SSc) patients is yet to be investigated. Therefore, the purpose of the study was to compare the effects of two HIIT protocols (cycle and arm cranking) on the microcirculation of the digital area in SSc patients.MethodsThirty-four limited cutaneous SSc patients (65.3 ± 11.6 years old) were randomly allocated in three groups (cycling, arm cranking and control group). The exercise groups underwent a 12- week exercise program twice per week. All patients performed the baseline and post-exercise intervention measurements where physical fitness, functional ability, transcutaneous oxygen tension (ΔTcpO2), body composition and quality of life were assessed. Endothelial-dependent as well as -independent vasodilation were assessed in the middle and index fingers using LDF and incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP). Cutaneous flux data were expressed as cutaneous vascular conductance (CVC).ResultsPeak oxygen uptake increased in both exercise groups (p < 0.01, d = 1.36). ΔTcpO2 demonstrated an increase in the arm-cranking group only, with a large effect, but not found statistically significant,(p = 0.59, d = 0.93). Endothelial-dependent vasodilation improvement was greater in the arm-cranking (p < 0.05, d = 1.07) in comparison to other groups. Both exercise groups improved life satisfaction (p < 0.001) as well as reduced discomfort and pain due to Raynaud’s phenomenon (p < 0.05). Arm cranking seems to be the preferred mode of exercise for study participants as compared to cycling (p < 0.05). No changes were observed in the body composition or the functional ability in both exercise groups.ConclusionsOur results suggest that arm cranking has the potential to improve the microvascular endothelial function in SSc patients. Also notably, our recommended training dose (e.g., a 12-week HIIT program, twice per week), appeared to be sufficient and tolerable for this population. Future research should focus on exploring the feasibility of a combined exercise such as aerobic and resistance training by assessing individual’s experience and the quality of life in SSc patients.Trial registrationClinicalTrials.gov (NCT number): NCT03058887, February 23, 2017.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1605-0) contains supplementary material, which is available to authorized users.

Experiences of physical activity and exercise in individuals with systemic sclerosis: A qualitative study

“…Our participants experienced how PA/exercises improved blood circulation and that they could have the potential to reduce the risk of digital ulcers and even the need of amputation. This is in line with a recent study that demonstrated the improved function of microvascular endothelial after exercises in SSc (Mitropoulos, Gumber, Crank, Akil, & Klonizakis, ). Whether exercise could have the potential to improve blood circulation in SSc‐individuals needs to be studied further in a randomized controlled trial, preferably including a patient‐reported outcome measure assessing perceived circulation as well as objective measurements.…”

Exploring the microcirculatory effects of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis

“…This is the first study to explore the microcirculatory effects of an exercise intervention, combining HIIT and RT, being used as an adjunct therapy to standard pharmacotherapy in people with lcSSc. The current study builds upon our previous work in this population (Mitropoulos et al, 2018a), aiming to provide important evidence, which would ultimately lead to a change in the therapeutic pathway for this clinical population.…”

“…The exercise group undertook twice-weekly supervised exercise sessions at three different Sheffield sport venues: a) Centre of Sport and Exercise Science of Sheffield Hallam University, b) Graves sport centre and c) Concord sport centre. The HIIT protocol has been presented previously (Mitropoulos et al, 2018a). With respect to the RT, patients performed five upper body exercises in a circuit row for three circles interspersed by 2-3 minutes.…”

“…A recent study from our research team (Mitropoulos et al, 2018a), revealed that exercise and more specifically high intensity interval training (HIIT) is able to improve the endothelial-dependent microvascular function is people with SSc. The study explored the effects of a HIIT protocol (30s 100 peak power output (PPO)/ 30s passive recovery) using two different modes of exercise, arm-cranking and cycling, on the digital microvascular function in SS patients.…”

Physikalische Therapie bei systemischer Sklerose (Sklerodermie)

“…Dass dies auch bei der Sklerodermie möglich ist, zeigen verschiedene, allerdings nicht randomisiert-kontrollierte Studien [35].EingeschränktgiltdieswohlauchfürPatientenmiteinerpul-monalenBeteiligung,LungenfibrosemitpulmonalerHypertonie, wobei mehr noch als bei Sklerodermie-Patienten ohne Lungenbeteiligung auf die reduzierte kardiopulmonale Belastbarkeit zu achtenist,diebeischwererAusprägungeineTrainingseignungauch ausschließenkann. AerobesTrainingistbeidersystemischenSkleroseabernoch auseinemanderenGrundinteressant.AusUntersuchungenmit PatientenmitperiphererAVKweißmanseitlangem,dasseinAusdauertraining auf dem Ergometer oder Laufband die periphere Mikrozirkulation in den Beinen verbessern und die schmerzfreie Gehstreckeverlängernkann [36].Einerandomisiert-kontrollierteStudie zeigte nun, dass auch bei Sklerodermie-Patienten ein gezieltes 12-wöchigesAusdauertraininginsbesonderemitHandergometern, wenigermitFahrradergometern,indenHändenzueinerverbesser-tenperipherenSauerstoffaufnahmeundvermindertenSchmerzen imRahmenderRaynaud-Symptomatikführte [37].Angabenzuobjektivierbaren Parametern der körperlichen Leistung wurden allerdingsnichtgeliefert.DieUntersuchungdeutetdaraufhin,dassein gezieltesAusdauertrainingderbetroffenenExtremitätenalternativ oder im Wechsel mit CO 2 -BädernzurnachhaltigenVerbesserung der Mikrozirkulation eingesetzt werden kann.…”