Calf muscle hemoglobin oxygen saturation characteristics and exercise performance in patients with intermittent claudication

Gardner, Andrew W.; Parker, Donald E.; Webb, Nykita; Montgomery, Polly S.; Scott, Kristy J.; Blevins, Steve M.

doi:10.1016/j.jvs.2008.04.005

Cited by 49 publications

(97 citation statements)

References 22 publications

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“…(17;25) The current study supports our previous findings that women have shorter time to minimum calf muscle StO 2 and PWT during treadmill exercise. (17) The shorter time to reach minimum calf muscle StO 2 in women suggests that they have greater impairment in the increase in capillary blood volume during exercise.…”

Section: Discussionsupporting

confidence: 89%

“…(25) Briefly, myoglobin may partially contribute to the calf muscle StO 2 measurement, capillary and venular blood have different oxygen saturations and may mix in the local tissue, and the subcutaneous fat thickness directly under the probe may interfere with the measure of calf muscle StO 2 . However, we believe these limitations have minimal influence on calf muscle StO 2 as discussed earlier.…”

Section: Discussionmentioning

confidence: 99%

“…(25) The probe was attached to the skin over the medial gastrocnemius muscle of the more severely affected leg using a double-sided adhesive light-excluding patch. (26) A baseline measure of calf muscle StO 2 was obtained at rest as patients stood on the treadmill for two minutes to allow for equilibration.…”

Section: Methodsmentioning

confidence: 99%

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Gender differences in daily ambulatory activity patterns in patients with intermittent claudication

Gardner

Parker

Montgomery

et al. 2010

Journal of Vascular Surgery

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Purposes To compare the pattern of daily ambulatory activity in men and women with intermittent claudication, and to determine whether calf muscle hemoglobin oxygen saturation (StO2) is associated with daily ambulatory activity. Methods Forty men and 41women with peripheral arterial disease limited by intermittent claudication were assessed on their community-based ambulatory activity patterns for one week with an ankle-mounted step activity monitor, and on calf muscle StO2 during a treadmill test. Results Women had lower adjusted daily maximal cadence (mean ± SE) for five continuous minutes of ambulation (26.2 ± 1.2 strides/min vs. 31.0 ± 1.2 strides/min; p = 0.009), for one minute of ambulation (43.1 ± 0.9 strides/min vs. 47.2 ± 0.9 strides/min; p=0.004), and for intermittent ambulation determined by the peak activity index (26.3 ± 1.2 strides/min vs. 31.0 ± 1.2 strides/min; p = 0.009). Women also had lower adjusted time to minimum calf muscle StO2 during exercise (p = 0.048), which was positively associated with maximal cadence for five continuous minutes (r = 0.51; p < 0.01), maximal cadence for 1 minute (r = 0.42; p < 0.05), and peak activity index (r = 0.44; p < 0.05). These associations were not significant in men. Conclusion Women with intermittent claudication ambulate slower in the community setting than men, particularly for short continuous durations of up to five minutes and during intermittent ambulation at peak cadences. Furthermore, the daily ambulatory cadences of women are correlated with their calf muscle StO2 during exercise, as women who walk slower in the community setting reach their minimum calf muscle StO2 sooner than those who walk at faster paces. Women with intermittent claudication should be encouraged to not only walk more on a daily basis, but to do so at a pace that is faster than their preferred speed.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Gender differences in daily ambulatory activity patterns in patients with intermittent claudication

Gardner

Parker

Montgomery

et al. 2010

Journal of Vascular Surgery

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“…Calf muscle Sto 2 reflects the balance between O 2 delivery and O 2 utilization and time to minimum Sto 2 and submaximal Sto 2 measures are positively associated with walking performance in patients with intermittent claudication [21,22]. The Sto 2 findings suggest that, after training, patients had a better matching of O 2 delivery to O 2 utilization in the early stages of the incremental walking test, which probably facilitated improved walking distances by delaying the accumulation of metabolites that cause claudication pain.…”

Section: Discussionmentioning

confidence: 96%

“…As the exact contribution from intracellular myoglobin is unclear [20], changes in calf muscle Sto 2 were used as an index of the balance between O 2 delivery and O 2 utilization; a mismatch being reflected by a fall in Sto 2 relative to baseline. Time-tominimum Sto 2 is thought of as a key measure of calf muscle Sto 2 in patients with intermittent claudication because it is strongly correlated with treadmill-walking performance in these patients [21,22]. This suggests that patients with faster deoxygenation of the active musculature (probably because of an inadequate blood supply) have greater impairment in exercise performance.…”

Section: Incremental Treadmill-walking Assessmentmentioning

confidence: 99%

Limb-specific and cross-transfer effects of arm-crank exercise training in patients with symptomatic peripheral arterial disease

et al. 2009

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Arm cranking is a useful alternative exercise modality for improving walking performance in patients with intermittent claudication; however, the mechanisms of such an improvement are poorly understood. The main aim of the present study was to investigate the effects of arm-crank exercise training on lower-limb O2 delivery in patients with intermittent claudication. A total of 57 patients with intermittent claudication (age, 70+/-8 years; mean+/-S.D.) were randomized to an arm-crank exercise group or a non-exercise control group. The exercise group trained twice weekly for 12 weeks. At baseline and 12 weeks, patients completed incremental tests to maximum exercise tolerance on both an arm-crank ergometer and a treadmill. Respiratory variables were measured breath-by-breath to determine peak VO2 (O2 uptake) and ventilatory threshold. Near-IR spectroscopy was used in the treadmill test to determine changes in calf muscle StO2 (tissue O2 saturation). Patients also completed a square-wave treadmill-walking protocol to determine VO2 kinetics. A total of 51 patients completed the study. In the exercise group, higher maximum walking distances (from 496+/-250 to 661+/-324 m) and peak VO2 values (from 17.2+/-2.7 to 18.2+/-3.4 ml.kg-1 of body mass.min-1) were recorded in the incremental treadmill test (P<0.05). After training, there was also an increase in time to minimum StO2 (from 268+/-305 s to 410+/-366 s), a speeding of VO2 kinetics (from 44.7+/-10.4 to 41.3+/-14.4 s) and an increase in submaximal StO2 during treadmill walking (P<0.05). There were no significant changes in the control group. The results suggest that the improvement in walking performance after arm-crank exercise training in patients with intermittent claudication is attributable, at least in part, to improved lower-limb O2 delivery.

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Exercise Training and Peripheral Arterial Disease

Haas

Lloyd

Yang

et al. 2012

Comprehensive Physiology

119

108

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Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12–15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50–1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking ~5 times/wk, at a significant intensity that requires frequent rest periods, are most significant. Pre-clinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including: improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a life style pattern, that includes enhanced physical activity prior to the advance of PAD limitations, is the most desirable and beneficial.

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Calf muscle hemoglobin oxygen saturation characteristics and exercise performance in patients with intermittent claudication

Abstract: In patients limited by intermittent claudication, shorter ICD and ACD values are associated with reaching a minimum value in calf muscle StO(2) sooner during treadmill exercise and with having a delayed recovery in calf muscle StO(2) after exercise.

Cited by 49 publications

References 22 publications

Gender differences in daily ambulatory activity patterns in patients with intermittent claudication

Gender differences in daily ambulatory activity patterns in patients with intermittent claudication

Limb-specific and cross-transfer effects of arm-crank exercise training in patients with symptomatic peripheral arterial disease

Exercise Training and Peripheral Arterial Disease

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