Exercise training for intermittent claudication: does it adversely affect biochemical markers of the exercise-induced inflammatory response?
OBJECTIVE
To identify a stable biochemical marker of disease severity in patients with intermittent claudication and to use these findings to assess the effect of therapeutic exercise training.


METHODS
Case-control study: prospective randomised-controlled trial of exercise training.


METHODS
Plasma fibrinogen, serum amyloid A protein (SAA), C-reactive protein (CRP) and urinary albumin-creatinine ratio (ACR) were measured in 67 claudicants and 15 controls. Twenty-two patients were randomised to supervised exercise training and 17 randomised to observation. Subjects were reviewed at 3, 6 and 12 months.


RESULTS
The median (interquartile range) baseline fibrinogen was 3.7 g/l (3.3-4.25) in claudicants and 3.5 g/l (2.9-3.95) in controls (p = 0.045); CRP was 4.7 mg/l (2.2-9.0) and 2.1 mg/l (1.0-2.8), respectively (p < 0.0001); SAA was 72 mg/l (35-132) and 30 mg/l (20-89) (p = 0.0009). Claudicants showed an increased urinary ACR following treadmill exercise (Wilcoxon, p < 0.0001) with no change in controls. Exercise training reduced SAA at 6 months, CRP at 3 months and progressively attenuated the post-exercise increase in ACR. No similar changes were found in controls.


CONCLUSIONS
Repetitive low-grade inflammatory events in claudicants lead to elevation of serum acute-phase proteins. Exercise training is associated with symptomatic improvement and reduction inflammatory markers. The concern that exercise has adverse systemic effects therefore seems to be unjustified.
Tisi
P V
PV
Department of Vascular Surgery, Royal South Hants Hospital, U.K.
Hulse
M
M
Chulakadabba
A
A
Gosling
P
P
Shearman
C P
CP
D000368:Aged; D000419:Albuminuria; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003404:Creatinine / Q000652:urine; D005081:Exercise Therapy; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D007249:Inflammation; D007383:Intermittent Claudication / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D000685:Serum Amyloid A Protein / Q000032:analysis
D015415:Biomarkers; D000685:Serum Amyloid A Protein; D005340:Fibrinogen; D002097:C-Reactive Protein; D003404:Creatinine