Effect of Intensive Walking Exercise on Skeletal Muscle Blood Flow in Intermittent Claudication

Abstract

Walking exercise is generally accepted as a valid therapeutic regimen in the treatment of peripheral arterial occlusive disease (PAOD) of Fontaine stage II. In order to quantify the effect of walking exercise and/or drug therapy on regional muscular blood flow, PAOD Fontaine stage II was induced by multiple ligations of the femoral artery and of all side branches in one hindlimb of mongrel dogs; the contralateral extremity served as control. The animals underwent walking exercise with increasing intensities on a treadmill five days per week over one year; one group received 600 mg buflomedil (BF) per day orally in addition. At the end of the training period, the regional blood flow in all skeletal muscles of both hindlimbs was quantified by means of 15 microns radioactively labeled microspheres at resting conditions, after treadmill exercise (ten minutes) with or without preinjection of BF (3 mg/kg body weight) into the abdominal aorta. At resting condition and at the end of treadmill exercise the regional muscular blood flow did not differ significantly between the diseased and control extremity. Supplementary oral treatment with BF over one year had no significant effect; the increase in muscular blood flow during treadmill exercise was not enhanced after intra-aortic injection of BF. Consequently walking exercise has the potential to increase the functional capacity of collaterals in intermittent claudication and to restore blood supply to skeletal muscle.

The Effects of Peripheral Vascular Disease on Gait

“…Exercise training has been shown to produce improvements in walking distance of up to 100% in PVD subjects (11). Whereas the mechanism for this improvement is unclear, previous studies have suggested that total limb blood flow does not improve, although there maybe a redistribution of blood flow to the lower limb to active muscles from inactive tissues (4,6,12). One of the possible mechanisms for improvement in walking distance would be alterations in gait (6).…”

“…P ERIPHERAL vasculardisease(PVD) is a relatively common, debilitating diseasein the elderlypopulation (1)(2)(3)(4). It is caused by the atheroscleroticblockage of arteriesin the lower abdomen and legs.The blockageusuallyoccurs at one or more points along the lower aortic, iliac, femoral, or popliteal arteries, and leads to decreased blood flow distal to the point where it occurs.…”

Exercise-induced calf muscle hyperemia: quantitative mapping with low-dose dynamic contrast enhanced magnetic resonance imaging

“…With lower extremity peripheral artery disease (PAD), patients often develop intermittent claudication during walking activities, thereby decreasing their mobility (57). PAD is caused by atherosclerosis that results in arterial narrowing in one or more segments of the peripheral vasculature.…”

Review of the adaptation of skeletal muscle in intermittent claudication

“…Adherence with the class was associated with improved walking distances. Maximal walking distances correlated with faster clearance rates (r = 0.64, p < 0.0025) [38], time to achieve maximal blood flow post exercise (r = −0.45, p < 0.0025) [37] and the duration of hyperaemia (r = −0.77, p < 0.0005) [37,39] Whilst total limb blood flow remains constant during exercise, flow to ischaemic areas increases when compared with baseline [40].…”

“…In rats with femoral artery ligation, the rate of vessel enlargement was 2%/day over 25 days [45], with no change occurring in the controls. Exercise has been foundto increase collateral blood flow by 43%, in both young [40,45,46] and old models of ischaemia, compared to their sedentary counterparts; 67 +/− 10 ml/min/100g and 30 +/− 4.9 ml/min/100g respectively [47].…”