title: Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication.
abstract: OBJECTIVE
  The effects of upper-limb (arm cranking) and lower-limb (leg cranking) exercise training on walking distances in patients with intermittent claudication was assessed.
  
  
  METHODS
  Sixty-seven patients (33 to 82 years old) with moderate to severe intermittent claudication were recruited, and the maximum power generated during incremental upper- and lower-limb ergometry tests was determined, as were pain-free and maximum walking distances (by using a shuttle walk test). Patients were randomly assigned to an upper-limb training group (n = 26) or a lower-limb training group (n = 26). An additional untrained group (n = 15) was recruited on an ad hoc basis in parallel with the main trial by using identical inclusion criteria. This group was subsequently shown to possess a similar demographic distribution to the two exercise groups. Supervised training sessions were held twice weekly for 6 weeks.
  
  
  RESULTS
  Both training programs significantly improved the maximum power generated during the incremental upper- and lower-limb ergometry tests (P <. 001), which may reflect an increase in central cardiovascular function that was independent of the training mode. More importantly, pain-free and maximum walking distances also improved in both training groups (P <.001). The improvements in the training groups were similar; there were no changes in the untrained control group. These findings suggest that the symptomatic improvement after upper-limb exercise training may result, in part, from systemic cardiovascular effects rather than localized metabolic or hemodynamic changes.
  
  
  CONCLUSIONS
  Carefully prescribed upper-limb exercise training can evoke a rapid symptomatic improvement in patients with claudication, while avoiding the physical discomfort experienced when performing lower-limb weight-bearing exercise.
authors.affiliation: Division of Clinical Sciences, Northern General Hospital and the Sheffield Institute of Sports Medicine and Exercise Science, UK.
authors.forename: R D
authors.initials: RD
authors.lastname: Walker
authors.forename: S
authors.initials: S
authors.lastname: Nawaz
authors.forename: C H
authors.initials: CH
authors.lastname: Wilkinson
authors.forename: J M
authors.initials: JM
authors.lastname: Saxton
authors.forename: A G
authors.initials: AG
authors.lastname: Pockley
authors.forename: R F
authors.initials: RF
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D002320:Cardiovascular Physiological Phenomena; D016552:Ergometry; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology / Q000628:therapy*; D007866:Leg / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D010809:Physical Fitness / Q000502:physiology; D011788:Quality of Life; D012119:Respiration; D016138:Walking / Q000502:physiology*