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Post-revascularisation exercise training for peripheral arterial disease
Abstract   Peer reviewed

Post-revascularisation exercise training for peripheral arterial disease

Christopher D Askew, Brad Stefanovic, Fraser D Russell, S Green and P J Walker
17th Annual Congress of the European College of Sports Science Book of Abstracts, p.261
Annual Congress of the European College of Sports Science (ECSS), 17th (Bruges, Belgium, 04-Jul-2012–07-Jul-2012)
2012
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Abstract

Human Movement and Sports Science
Introduction Peripheral arterial disease (PAD) is an atherosclerotic disease characterised by blockages in the arteries of the lower limbs. Although supervised exercise training is recommended for patients with early stage PAD and claudication, the effects of exercise training in patients who have undergone revascularisation are not clear. This study aimed to determine the effect of postrevascularisation exercise training on walking tolerance, muscle fatigue and lower limb blood flow in patients with PAD. Methods Fifteen patients who had recently (less than 6 weeks) undergone surgical or percutaneous revascularisation for PAD were randomised to either supervised exercise training (SET: n = 8, age = 61+/-6 y) or standard care (CON: n=7, age = 65+/-10 y). Patients in SET attended three training sessions per week for six weeks, and completed interval treadmill walking and progressive plantar flexion resistance exercises. Before and after the intervention period, walking capacity was determined with a six-minute walk test. Maximum voluntary contraction (MVC) force, muscle endurance, and fatigue of the calf muscles were assessed using an isometric plantar flexion dynamometer in both the revascularised and non-revascularised legs. Blood flow was assessed at rest and during exercise using strain gauge plethysmography. Results Six-minute walk distance increased with SET (pre 405 +/- 89; post 452 +/- 94 m) compared with CON (pre 412 +/- 67; post 413 +/- 79 m). Plantar flexion MVC force tended to increase with SET in both the revascularised (~11%) and non-revascularised legs (~15%), although this was only significant compared with CON in the non-revascularised leg. Plantar flexion endurance increased with SET in both the revascularised (pre 541 +/- 318; post 1108 +/- 909 s) and non-revascularised legs (pre 623 +/- 319; post 1143 +/- 556 s) compared with CON. The calf fatigue profile included an initial rapid exponential decay phase followed by slower linear phase, and there tended to be a shift in fatigue kinetics whereby there was a delay in the onset of the later phase following SET. There were no changes in resting or exercise blood flow in either group. Discussion This study demonstrates that supervised exercise improves walking capacity and calf muscle function in patients with PAD who have recently undergone revascularisation. These changes occurred in the absence of any change in blood flow, which supports notion that exercise tolerance is limited by both haemodynamic and non-haemodynamic factors in PAD.

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