Walking Training Improves Systemic and Local Pathophysiological Processes in Intermittent Claudication

Andrade-Lima, Aluísio; Silva, Natan; Chehuen, Marcel da Rocha; Miyasato, Roberto; Souza, Rodrigo Wagner Alves de; Leicht, Anthony S.; Brum, Patrícia Chakur; Oliveira, Edilamar Menezes de; Wolosker, Nelson; Forjaz, C. L. M.

doi:10.1016/j.ejvs.2021.02.022

Cited by 13 publications

(16 citation statements)

References 57 publications

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“…Again, a significant drop in systolic pressure is observed after the first 5 weeks, in the early, slow-speed phase. Such response of the systolic pressure to exercise training was previously reported [38] in particular in hypertensive subjects (5)(6)(7)(8)(9)(10)(11)(12). This benefit in some cases, especially but non-exclusively in animal models, was associated to low-moderate-intensity exercise [39].…”

Section: Discussionsupporting

confidence: 58%

“…Notably, this approach differs completely from the training recommended based on faster walking speed, longer bouts of exercise, rest according to patients' sensation after tolerating ischemic pain [4,6,19]. A dose-response effect of exercise on vessels has also been reported [29], with a favorable effect on the endothelial function deriving from low-to moderate-intensity exercise in murine models and in humans [29][30][31] and recently specifically in PAD patients after submaximal training [9]. Lower inflammation and oxidative stress induced by moderate intensity may contribute, unlike high-intensity exercise [29,31], also followed by a decrease in vascular function immediately post-exercise [32], by an increase of all blood inflammatory markers in PAD patients and of reactive oxygen species production [9,33].…”

Section: Discussionmentioning

confidence: 99%

“…Various factors related to the hemodynamic picture have been hypothesized to explain this missed outcome [7]. However, vascular adaptations might theoretically occur in PAD patients engaged in exercise programs [7] in the light of the well-described effects of exercise training on vasculature [9][10][11][12]. Interestingly, hemodynamic improvements have been observed following pain-free home-based exercise program [13][14][15][16][17][18] based on the FITT (frequency, intensity, time, type) principles which are differently combined with respect to the recommended programs [4,19].…”

Section: Introductionmentioning

confidence: 99%

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Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study

et al. 2021

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In patients with peripheral artery disease (PAD), supervised exercise at near-moderate pain improves walking ability but not ankle-brachial index (ABI) values. In a retrospective observational study, we determined vascular and functional effects of a 6-month structured pain-free exercise program in patients with claudication and compressible vessels. Four-hundred and fifty-nine consecutive patients were studied. Segmental limb pressures were measured and ABI calculated during circa-monthly hospital visits. The 6-min (6MWD) and the pain-free walking distance (PFWD) during the 6-min walking test were determined. Two daily 8-min sessions of slow–moderate in-home walking at increasing metronome-paced speed were prescribed. After excluding patients with unmeasurable ABI or incompletion of the program, 239 patients were studied. Safe and satisfactory (88%) execution of the prescribed training sessions was reported. During the visits, bilateral ABI improved (+ 0.07; p < 0.001) as well as the segmental pressures in the more impaired limb, with changes already significant after 5 weeks of slow walking. Both systolic and diastolic blood pressure decreased overtime (F = 46.52; p < 0.001; F = 5.52; p < 0.001, respectively). 6MWD and PFWD improved (41[0‒73]m p < 0.001 and 107[42‒190]m p < 0.001, respectively) with associated decrease of walking heart rate (F = 15.91; p < 0.001) and Physiological Cost Index (F = 235.93; p < 0.001). The variations of most parameters at different visits correlated to the training load calculated. In a regression model, the PFWD variations directly correlated with rate sessions completed, training load and ABI change and inversely with the baseline value (R2 = 0.27; p < 0.001). In the PAD population studied, moderate pain-free exercise improved ABI with associated progressive functional and cardiovascular changes occurring regardless of subjects characteristics.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study

et al. 2021

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“…Moreover, training inhibits inflammation and pro-inflammatory macrophage polarization in the lower limb ischemic muscle [ 235 ]. The positive effects of physical activity on inflammation have also been widely demonstrated in various human populations [ 236 , 237 , 238 ]. In patients with PAD, higher levels of physical activity were independently associated with lower levels of inflammatory markers [ 239 , 240 ], whereas several trials have shown beneficial effects of exercise programs in terms of systemic inflammation [ 241 , 242 ].…”

Section: Novel Fields Worth Exploringmentioning

confidence: 99%

The Role of Neutrophils in Lower Limb Peripheral Artery Disease: State of the Art and Future Perspectives

Buso

Faggin

Rosenblatt‐Velin

et al. 2023

IJMS

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In recent years, increasing attention has been paid to the role of neutrophils in cardiovascular (CV) disease (CVD) with evidence supporting their role in the initiation, progression, and rupture of atherosclerotic plaque. Although these cells have long been considered as terminally differentiated cells with a relatively limited spectrum of action, recent research has revealed intriguing novel cellular functions, including neutrophil extracellular trap (NET) generation and inflammasome activation, which have been linked to several human diseases, including CVD. While most research to date has focused on the role of neutrophils in coronary artery and cerebrovascular diseases, much less information is available on lower limb peripheral artery disease (PAD). PAD is a widespread condition associated with great morbidity and mortality, though physician and patient awareness of the disease remains low. To date, several studies have produced some evidence on the role of certain biomarkers of neutrophil activation in this clinical setting. However, the etiopathogenetic role of neutrophils, and in particular of some of the newly discovered mechanisms, has yet to be fully elucidated. In the future, complementary assessment of neutrophil activity should improve CV risk stratification and provide personalized treatments to patients with PAD. This review aims to summarize the basic principles and recent advances in the understanding of neutrophil biology, current knowledge about the role of neutrophils in atherosclerosis, as well as available evidence on their role of PAD.

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“…Muscle stretch has been widely performed in subjects who undergo physical therapy ( Kay and Blazevich, 2012 ; Afonso et al, 2021 ; Gomez-Cuaresma et al, 2021 ). In the past, muscle stretch has been positioned as a control treatment against exercise training groups in many studies ( Chubak et al, 2006 ; Iyalomhe et al, 2015 ; Best et al, 2018 ; Cho et al, 2018 ; Lopes et al, 2019 ; Thomas et al, 2020 ; Andrade-Lima et al, 2021 ; de Carvalho et al, 2021 ; Ngwa et al, 2021 ; Qi et al, 2021 ). It is worth noting; however, that stretch has a significant effect on blood vessels, and rather surprisingly, induces more favorable effects on large arteries than regular resistance training ( Cortez-Cooper et al, 2008 ).…”

Section: Introductionmentioning

confidence: 99%

Microvascular Adaptations to Muscle Stretch: Findings From Animals and the Elderly

Hotta

Muller‐Delp

2022

Front. Physiol.

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Microcirculation in skeletal muscle is disturbed with advancing aging, causing limited capillary blood flow and exercise incapacity. Muscle stretch has been widely performed in physical therapy, sports medicine, and health promotion. However, the effect of stretch on microvascular reactivity and muscle blood flow remains unknown. This review focuses on stretch-induced microvascular adaptations based on evidence from cultured cells, small animals, and human studies. Vascular endothelium senses and responds to mechanical stimuli including stretch. This endothelial mechanotransduction potentially plays a vital role in the stretch-induced microvascular adaptation alongside hypoxia. Aging impairs microvascular endothelial function, but muscle stretch has the potential to restore it. Muscle stretch may be an alternative to improve vascular function and enhance exercising blood flow, especially for those who have difficulties in participating in exercise due to medical, functional, or psychological reasons.

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Walking Training Improves Systemic and Local Pathophysiological Processes in Intermittent Claudication

Cited by 13 publications

References 57 publications

Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study

Structured pain-free exercise progressively improves ankle-brachial index and walking ability in patients with claudication and compressible arteries: an observational study

The Role of Neutrophils in Lower Limb Peripheral Artery Disease: State of the Art and Future Perspectives

Microvascular Adaptations to Muscle Stretch: Findings From Animals and the Elderly

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