Local and Systemic Inflammation and Oxidative Stress After a Single Bout of Maximal Walking in Patients With Symptomatic Peripheral Artery Disease

Walking training decreases cardiovascular load after walking to maximal intermittent claudication in patients with peripheral artery disease

PURPOSE

This study investigated whether: 1) walking training (WT) changes cardiovascular load after walking until maximal intermittent claudication (IC) in patients with peripheral artery disease (PAD); and 2) acute and chronic cardiovascular responses to walking were related to each other.

METHODS

A randomized, controlled, parallel-group design was employed. Thirty-two men with PAD and IC were randomly assigned to one of two groups: WT (n=16) or control (CO, n=16) twice a week for 12 weeks. The WT group completed 15, 2-min bouts of walking at moderate intensity interspersed with 2-min upright resting intervals per session. The CO group completed 30 minutes of stretching per session. At Baseline and after 12 weeks, both groups underwent a progressive walking session to maximal IC (3.2 km/h, 2% increase in grade every 2 min). Systolic blood pressure (BP), diastolic BP, heart rate (HR), and rate pressure product (RPP) were measured pre- and post-walking. Data were analyzed by three-way mixed ANOVAs. Pearson correlations were used to explore the association between the acute and chronic responses.

RESULTS

WT significantly reduced pre- and post-walking systolic BP (p<0.001), diastolic BP (p<0.001), and RPP (p<0.001). No significant correlations were found between the acute and chronic changes observed for all variables (all p>0.05).

CONCLUSION

In patients with PAD, WT decreased cardiovascular load assessed before and after walking to maximal IC. Furthermore, the acute and chronic cardiovascular responses to walking were not associated. Thus, WT may reduce the risk of immediate post-walking cardiac events in susceptible patients.

Oxidative stress and vascular dysfunction: Potential therapeutic targets and therapies in peripheral artery disease

Peripheral artery disease (PAD) is the manifestation of atherosclerosis characterized by the accumulation of plaques in the arteries of the lower limbs. Interestingly, growing evidence suggests that the pathology of PAD is multifaceted and encompasses both vascular and skeletal muscle dysfunctions, which contributes to blunted physical capabilities and diminished quality of life. Importantly, it has been suggested that many of these pathological impairments may stem from blunted reduction-oxidation (redox) handling. Of note, in those with PAD, excessive production of reactive oxygen species (ROS) outweighs antioxidant capabilities resulting in oxidative damage, which may have systemic consequences. It has been suggested that antioxidant supplementation may be able to assist in handling ROS. However, the activation of various ROS production sites makes it difficult to determine the efficacy of these antioxidant supplements. Therefore, this review focuses on the common cellular mechanisms that facilitate ROS production and discusses how excessive ROS may impair vascular and skeletal muscle function in PAD. Furthermore, we provide insight for current and potential antioxidant therapies, specifically highlighting activation of the Kelch-like ECH-associated protein 1 (Keap1) - Nuclear Factor Erythroid 2-related factor 2 (Nrf2) pathway as a potential pharmacological therapy to combat ROS accumulation and aid in vascular function, and physical performance in patients with PAD. Altogether, this review provides a better understanding of excessive ROS in the pathophysiology of PAD and enhances our perception of potential therapeutic targets that may improve vascular function, skeletal muscle function, walking capacity, and quality of life in patients with PAD.

Research trends and hotspots of exercise therapy in Panvascular disease: A bibliometric analysis

Panvascular diseases are a group of vascular system diseases, mainly including the heart, brain, neck, and other parts of the vascular lesions. As a non-pharmacological intervention, exercise therapy could prevent and treat Panvascular diseases. However, few bibliometric analyses of exercise therapy in Panvascular disease exist. This study aimed to analyze the trends and hotspots over the past decade and provide insights into the latest state of the art in global research, thereby contributing to further research in the field. We systematically searched the Web of Science Core Collection (WOSCC) for articles on exercise therapy and Panvascular disease. The acquired information from the reports was analyzed using CiteSpace and VOSviewer software to assess and forecast this field hottest areas and trends. The final analysis included 294 articles by our specified inclusion criteria. The number of publications has gradually increased over the past decade. Stroke was one of the most studied Panvascular diseases. China and the University of Sao Paulo were the country es and institutions that contributed the most to the field. Mary M. McDermott was the most prolific researcher, and the Journal of Vascular Surgery published the most articles. The 6-minute walk test, skeletal muscle, oxidative stress, and supervised exercise therapy were hot topics from 2019 to 2023. In conclusion, exploring exercise therapy programs and exercise mechanisms for Panvascular diseases has been ongoing. This study revealed the current status and trends of research in the field and identified hot topics. It was helpful for scholars to understand exercise therapy critical role in treating and preventing Panvascular diseases and provided a reference for clinical decision-making and further research.

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

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.

Effects of Exercise Mode on Arterial Stiffness in Symptomatic Peripheral Artery Disease Patients: A Randomized Crossover Clinical Trial

BACKGROUND

Exercise program has been recommended for the treatment of symptomatic peripheral artery disease (PAD) patients. However, whether exercise promotes reduction in arterial stiffness in these patients, who exhibit high arterial stiffness, is poor known.

AIM

To analyze the effects of a single session of resistance, walking, and combined exercises on arterial stiffness in symptomatic PAD patients and to describe individual responses and identify clinical predictors of arterial stiffness responses after exercises.

METHODS

Twelve patients with symptomatic PAD underwent four experimental sessions in random order: walking exercise (W - 10 bouts of 2-min walking at the speed corresponding to the onset of claudication pain with 2-min interval among sets), resistance exercise (R - 2 sets of 10 reps in eight resistance exercises), combined exercise (CO - 1 set of 10 reps in eight resistance exercises + 5 bouts of 2-min walking with 2-min interval between) and control session (C - resting in exercise room). Ambulatory arterial stiffness index (AASI) was obtained during ambulatory period after each session. Body mass index, ankle brachial index, sex and age also were evaluated.

RESULTS

AASI was lower in R compared to other sessions (R - 0.52 ± 0.05; W - 0.59 ± 0.05; CO - 0.64 ± 0.05; C - 0.60 ± 0.05, P < 0.001), with 75% of patients presenting lower AASI after R session. No difference was found between W, CO and C sessions (P> 0.05). Ankle brachial index was negatively correlated with R and W sessions net effect (r = -0.618 and -0.750, respectively; P< 0.05 for both), no correlation was found with CO.

CONCLUSION

A single bout of resistance exercise acutely reduces arterial stiffness in symptomatic PAD, while walking and combined exercise did not alter this variable. This response is more likely to occur in individuals with less severe disease.