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Xu Z, Zheng X, Ding H, Zhang D, Cheung PMH, Yang Z, Tam KW, Zhou W, Chan DCC, Wang W, Wong SYS. The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e48355. [PMID: 39045858 PMCID: PMC11287235 DOI: 10.2196/48355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 07/25/2024] Open
Abstract
Background Previous literature lacks summative information on the mental health benefits achieved from different forms of walking. Objective The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety. Methods This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool. Results This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69). Conclusions Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.
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Affiliation(s)
- Zijun Xu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Xiaoxiang Zheng
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Hanyue Ding
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Dexing Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Peter Man-Hin Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zuyao Yang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - King Wa Tam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Weiju Zhou
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Dicken Cheong-Chun Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wenyue Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Samuel Yeung-Shan Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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2
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Speichinger F, Gratl A, Raude B, Schawe L, Carstens J, Hering NA, Greiner A, Pesta D, Frese JP. Mitochondrial respiration in peripheral arterial disease depends on stage severity. J Cell Mol Med 2024; 28:e18126. [PMID: 38534092 DOI: 10.1111/jcmm.18126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/17/2023] [Accepted: 01/05/2024] [Indexed: 03/28/2024] Open
Abstract
Peripheral arterial disease (PAD) is an increasing cause of morbidity and its severity is graded based on clinical manifestation. To investigate the influence of the different stages on myopathy of ischemic muscle we analysed severity-dependent effects of mitochondrial respiration in PAD. Eighteen patients with severe PAD, defined as chronic limb-threatening ischemia, 47 patients with intermittent claudication (IC) and 22 non-ischemic controls were analysed. High-resolution respirometry (HRR) was performed on muscle biopsies of gastrocnemius and vastus lateralis muscle of patients in different PAD stages to investigate different respiratory states. Results from HRR are given as median and interquartile range and were normalized to citrate synthase activity (CSA), a marker for mitochondrial content. In order to account for inter-individual differences between patients and controls, we calculated the ratio of O₂-flux in gastrocnemius muscle over vastus muscle ('GV ratio'). CSA of the gastrocnemius muscle as a proxy for mitochondrial content was significantly lower in critical ischemia compared to controls. Mitochondrial respiration normalized to CSA was higher in IC compared to controls. Likewise, the GV ratio was significantly higher in IC compared to control. Mitochondrial respiration and CSA of PAD patients showed stage-dependent modifications with greater changes in the mild PAD stage group (IC).
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Affiliation(s)
- Fiona Speichinger
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Gratl
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ben Raude
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Larissa Schawe
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Carstens
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nina A Hering
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Pesta
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Centre for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Jan Paul Frese
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
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3
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The Effects of Exercise Training on Mitochondrial Function in Cardiovascular Diseases: A Systematic Review and Meta-Analysis. Int J Mol Sci 2022; 23:ijms232012559. [PMID: 36293409 PMCID: PMC9603958 DOI: 10.3390/ijms232012559] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022] Open
Abstract
Mitochondria dysfunction is implicated in the pathogenesis of cardiovascular diseases (CVD). Exercise training is potentially an effective non-pharmacological strategy to restore mitochondrial health in CVD. However, how exercise modifies mitochondrial functionality is inconclusive. We conducted a systematic review using the PubMed; Scopus and Web of Science databases to investigate the effect of exercise training on mitochondrial function in CVD patients. Search terms included “mitochondria”, “exercise”, “aerobic capacity”, and “cardiovascular disease” in varied combination. The search yielded 821 records for abstract screening, of which 20 articles met the inclusion criteria. We summarized the effect of exercise training on mitochondrial morphology, biogenesis, dynamics, oxidative capacity, antioxidant capacity, and quality. Amongst these parameters, only oxidative capacity was suitable for a meta-analysis, which demonstrated a significant effect size of exercise in improving mitochondrial oxidative capacity in CVD patients (SMD = 4.78; CI = 2.99 to 6.57; p < 0.01), but with high heterogeneity among the studies (I2 = 75%, p = 0.003). Notably, aerobic exercise enhanced succinate-involved oxidative phosphorylation. The majority of the results suggested that exercise improves morphology and biogenesis, whereas findings on dynamic, antioxidant capacity, and quality, were inadequate or inconclusive. A further randomized controlled trial is clearly required to explain how exercise modifies the pathway of mitochondrial quantity and quality in CVD patients.
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Cornelis N, Chatzinikolaou PN, Buys R, De Wilde C, Fourneau I, Claes J, Goetschalckx K, Cornelissen V. Near infrared spectroscopy to evaluate the effect of a hybrid exercise programme on peripheral muscle metabolism in patients with intermittent claudication: an exploratory PROSECO-IC sub study. J Sports Sci 2022; 40:1031-1041. [PMID: 35271414 DOI: 10.1080/02640414.2022.2045062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Intermittent claudication (IC) is characterized by decreased blood flow and oxygen delivery to the lower-limb muscles, resulting in pain and impaired functional capacity. This study evaluated the effects of a 12-week hybrid walking intervention on muscle oxygenation and functional capacity in 38 patients with IC (Rutherford I-III). Functional capacity was evaluated by means of two different treadmill test protocols and a six-minute walk test (6MWT). Muscle oxygenation was assessed during the treadmill tests using near-infrared spectroscopy. After the intervention, maximal walking distance was significantly increased (p < 0.001) during the progressive maximal treadmill test (mean (SD): +155 (SD 177) metres) and 6MWT (+18 (SD 29) metres) metres, with concomitant improvements in muscle oxygenation measures. Deoxygenation was slower during the progressive maximal test (p < 0.001) and reoxygenation was faster during recovery (p = 0.045). During the more submaximal test, oxygenated haemoglobin was better preserved (p = 0.040). Slower deoxygenation was more pronounced in the high responders of the progressive maximal treadmill test (p = 0.002). The findings suggest that preserved oxygen availability and slower deoxygenation during exercise could partly explain the improvements in functional capacity.
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Affiliation(s)
- Nils Cornelis
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | - Panagiotis N Chatzinikolaou
- Department of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roselien Buys
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | - Camille De Wilde
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Cardiovascular sciences, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
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5
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Ibeggazene S, Pymer S, Birkett ST, Caldow E, Harwood AE. A systematic review of exercise intervention reporting quality and dose in studies of intermittent claudication. Vascular 2022; 31:477-488. [PMID: 35130092 DOI: 10.1177/17085381211070700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Exercise therapy is an important treatment option for people with intermittent claudication (IC). Appropriate reporting of exercise interventions in populations with IC within randomised controlled trials (RCTs) is important to ensure that research can be translated into clinical practice. Therefore, the purpose of our review is to evaluate the reporting of exercise interventions in RCTs of exercise therapy in patients with IC. METHODS A systematic search was performed to identify relevant trials in patients with IC published until May 2020. Studies including only participants with critical limb ischaemia or asymptomatic peripheral artery disease were excluded. Each trial was scored using the recently developed 'Consensus on Exercise Reporting Template' (CERT) which has a maximum obtainable score of 19. RESULTS Of 1489 unique records identified from the search, 73 trials were included, reporting 107 exercise interventions. Overall, the average CERT score was 10/19. The exercise equipment used, the use of supervision and a description of whether the exercise prescription was tailored or generic were the most frequently reported intervention components. The motivational strategies used, intervention adherence and intervention fidelity were the most underreported CERT components. There was no trend indicating that CERT scores were higher in more recent publications. CONCLUSIONS We have identified that important details about exercise interventions are frequently missing from the published literature. These missing data hinder replication of research findings and limit the translation of evidence into clinical practice.
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Affiliation(s)
- Saïd Ibeggazene
- College of Health, Wellbeing and Life Sciences, 7314Sheffield Hallam University, Sheffield, UK
| | - Sean Pymer
- Academic Vascular Surgical Unit, 12195Hull York Medical School, Hull, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, 6723University of Central Lancashire, Preston, UK
| | - Edward Caldow
- School of Health and Society, 7046University of Salford, Salford, UK
| | - Amy E Harwood
- Centre for Sports, Exercise and Life Sciences, 120958Coventry University, Coventry, UK
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6
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Waddell A, Seed S, Broom DR, McGregor G, Birkett ST, Harwood AE. Safety of home-based exercise for people with intermittent claudication: A systematic review. Vasc Med 2021; 27:186-192. [PMID: 34930062 PMCID: PMC8996308 DOI: 10.1177/1358863x211060388] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intermittent claudication (IC) is a classic symptom of peripheral artery disease,
with first line treatment being supervised exercise therapy (SET). Despite this,
SET is frequently underutilised, and adherence is often poor. An alternative
option are home-based exercise programmes (HBEP). Although HBEPs are well
tolerated, to the authors’ knowledge, no research has assessed their safety. The
aim of this review was to assess the safety of HBEPs in people living with IC.
We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library
databases. The main parameter of interest was complication rate, calculated as
the number of related adverse events per patient-hours. Subanalysis was
undertaken to determine differences in safety for studies that did and did not
include pre-exercise cardiac screening, and for studies with exercise at low,
moderate, and high levels of claudication pain. Our search strategy identified
8693 results, of which 27 studies were included for full review. Studies
included 1642 participants completing 147,810 patient-hours of home-based
exercise. Four related adverse events were reported, three of which were cardiac
in origin, giving an all-cause complication rate of one event per 36,953
patient-hours. Three of these events occurred following exercise to high levels
of claudication pain, and one occurred with pain-free exercise. One event
occured in a study without cardiac screening. Based on the low number of related
adverse events, HBEPs appear to be a safe method of exercise prescription for
people with IC. Our results strengthen the rationale for providing alternative
exercise options for this population. PROSPERO Registration No.:
CRD42021254581
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Affiliation(s)
- Alexander Waddell
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Sally Seed
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - David R Broom
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
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7
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McDermott MM, Dayanidhi S, Kosmac K, Saini S, Slysz J, Leeuwenburgh C, Hartnell L, Sufit R, Ferrucci L. Walking Exercise Therapy Effects on Lower Extremity Skeletal Muscle in Peripheral Artery Disease. Circ Res 2021; 128:1851-1867. [PMID: 34110902 DOI: 10.1161/circresaha.121.318242] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Walking exercise is the most effective noninvasive therapy that improves walking ability in peripheral artery disease (PAD). Biologic mechanisms by which exercise improves walking in PAD are unclear. This review summarizes evidence regarding effects of walking exercise on lower extremity skeletal muscle in PAD. In older people without PAD, aerobic exercise improves mitochondrial activity, muscle mass, capillary density, and insulin sensitivity in skeletal muscle. However, walking exercise increases lower extremity ischemia in people with PAD, and therefore, mechanisms by which this exercise improves walking may differ between people with and without PAD. Compared with people without PAD, gastrocnemius muscle in people with PAD has greater mitochondrial impairment, increased reactive oxygen species, and increased fibrosis. In multiple small trials, walking exercise therapy did not consistently improve mitochondrial activity in people with PAD. In one 12-week randomized trial of people with PAD randomized to supervised exercise or control, supervised treadmill exercise increased treadmill walking time from 9.3 to 15.1 minutes, but simultaneously increased the proportion of angular muscle fibers, consistent with muscle denervation (from 7.6% to 15.6%), while angular myofibers did not change in the control group (from 9.1% to 9.1%). These findings suggest an adaptive response to exercise in PAD that includes denervation and reinnervation, an adaptive process observed in skeletal muscle of people without PAD during aging. Small studies have not shown significant effects of exercise on increased capillary density in lower extremity skeletal muscle of participants with PAD, and there are no data showing that exercise improves microcirculatory delivery of oxygen and nutrients in patients with PAD. However, the effects of supervised exercise on increased plasma nitrite abundance after a treadmill walking test in people with PAD may be associated with improved lower extremity skeletal muscle perfusion and may contribute to improved walking performance in response to exercise in people with PAD. Randomized trials with serial, comprehensive measures of muscle biology, and physiology are needed to clarify mechanisms by which walking exercise interventions improve mobility in PAD.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine and Preventive Medicine (M.M.M., J.S.), Northwestern University Feinberg School of Medicine
| | - Sudarshan Dayanidhi
- Shirley Ryan Ability Laboratory (S.D.), Northwestern University Feinberg School of Medicine
| | - Kate Kosmac
- Center for Muscle Biology, University of Kentucky (K.K.)
| | - Sunil Saini
- Jawaharlal Nehru University, School of Biotechnology, New Delhi, India (S.S.)
| | - Joshua Slysz
- Department of Medicine and Preventive Medicine (M.M.M., J.S.), Northwestern University Feinberg School of Medicine
| | | | - Lisa Hartnell
- Division of Intramural Research, National Institute on Aging (L.H., L.F.)
| | - Robert Sufit
- Department of Neurology (R.S.), Northwestern University Feinberg School of Medicine
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging (L.H., L.F.)
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8
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Birkett ST, Harwood AE, Caldow E, Ibeggazene S, Ingle L, Pymer S. A systematic review of exercise testing in patients with intermittent claudication: A focus on test standardisation and reporting quality in randomised controlled trials of exercise interventions. PLoS One 2021; 16:e0249277. [PMID: 33939704 PMCID: PMC8092776 DOI: 10.1371/journal.pone.0249277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
A systematic review was conducted to identify the range of terminology used in studies to describe maximum walking distance and the exercise testing protocols, and testing modalities used to measure it in patients with intermittent claudication. A secondary aim was to assess the implementation and reporting of the exercise testing protocols. CINAHL, Medline, EMBASE and Cochrane CENTRAL databases were searched. Randomised controlled trials whereby patients with intermittent claudication were randomised to an exercise intervention were included. The terminology used to describe maximal walking distance was recorded, as was the modality and protocol used to measure it. The implementation and reporting quality was also assessed using pre-specified criteria. Sixty-four trials were included in this review. Maximal walking distance was reported using fourteen different terminologies. Twenty-two different treadmill protocols and three different corridor tests were employed to assess maximal walking distance. No single trial satisfied all the implementation and reporting criteria for an exercise testing protocol. Evidence shows that between-study interpretation is difficult given the heterogenous nature of the exercise testing protocols, test endpoints and terminology used to describe maximal walking distance. This is further compounded by poor test reporting and implementation across studies. Comprehensive guidelines need to be provided to enable a standardised approach to exercise testing in patients with intermittent claudication.
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Affiliation(s)
- Stefan T. Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston, United Kingdom
| | - Amy E. Harwood
- Centre for Sports, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Edward Caldow
- School of Health and Society, University of Salford, Salford, United Kingdom
| | - Saïd Ibeggazene
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, United Kingdom
| | - Sean Pymer
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, United Kingdom
- * E-mail:
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9
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Impact of aerobic exercise type on blood flow, muscle energy metabolism, and mitochondrial biogenesis in experimental lower extremity artery disease. Sci Rep 2020; 10:14048. [PMID: 32820213 PMCID: PMC7441153 DOI: 10.1038/s41598-020-70961-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Exercise training (ET) is recommended for lower extremity artery disease (LEAD) management. However, there is still little information on the hemodynamic and metabolic adaptations by skeletal muscle with ET. We examined whether hindlimb perfusion/vascularization and muscle energy metabolism are altered differently by three types of aerobic ET. ApoE−/− mice with LEAD were assigned to one of four groups for 4 weeks: sedentary (SED), forced treadmill running (FTR), voluntary wheel running (VWR), or forced swimming (FS). Voluntary exercise capacity was improved and equally as efficient with FTR and VWR, but remained unchanged with FS. Neither ischemic hindlimb perfusion and oxygenation, nor arteriolar density and mRNA expression of arteriogenic-related genes differed between groups. 18FDG PET imaging revealed no difference in the steady-state levels of phosphorylated 18FDG in ischemic and non-ischemic hindlimb muscle between groups, nor was glycogen content or mRNA and protein expression of glucose metabolism-related genes in ischemic muscle modified. mRNA (but not protein) expression of lipid metabolism-related genes was upregulated across all exercise groups, particularly by non-ischemic muscle. Markers of mitochondrial content (mitochondrial DNA content and citrate synthase activity) as well as mRNA expression of mitochondrial biogenesis-related genes in muscle were not increased with ET. Contrary to FTR and VWR, swimming was ineffective in improving voluntary exercise capacity. The underlying hindlimb hemodynamics or muscle energy metabolism are unable to explain the benefits of running exercise.
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