title: Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheral arterial disease.
abstract: Peripheral arterial disease (PAD) is a major cause of morbidity and mortality. Endothelial function, which is a measure of vascular health, is impaired in patients with PAD. We examined the effects of 6 months of aerobic exercise rehabilitation on brachial artery endothelial function, assessed using high-frequency ultrasonography, and calf blood flow in 19 older PAD patients (age 69 +/- 1 years, mean +/- SEM) with intermittent claudication (ankle to brachial artery index of 0.73 +/- 0.04). After exercise, the time to onset of claudication pain increased by 94%, from 271 +/- 49 to 525 +/- 80 seconds (p <0.01), and the time to maximal claudication pain increased by 43%, from 623 +/- 77 to 889 +/- 75 seconds (p <0.05). Exercise rehabilitation increased the flow-mediated brachial arterial diameter by 61%, from 0.18 +/- 0.03 to 0.29 +/- 0.04 mm (p <0.005), as well as the relative change in brachial arterial diameter from the resting state by 60%, from 4.81 +/- 0.82% to 7.97 +/- 1.03% (p <0.005). Maximal calf blood flow (14.2 +/- 1.0 vs 19.2 +/- 2.0 ml/100 ml/min; p = 0.04), and postocclusive reactive hyperemic blood flow (9.8 +/- 0.8 vs 11.3 +/- 0.7 ml/100 ml/min; p = 0.1) increased 35% and 15%, respectively. In conclusion, exercise rehabilitation improved ambulatory function, endothelial-dependent dilation, and calf blood flow in older PAD patients with intermittent claudication.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine and Baltimore Veteran Affairs Medical Center, 21201, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Brendle
authors.forename: L J
authors.initials: LJ
authors.lastname: Joseph
authors.forename: M C
authors.initials: MC
authors.lastname: Corretti
authors.forename: A W
authors.initials: AW
authors.lastname: Gardner
authors.forename: L I
authors.initials: LI
authors.lastname: Katzel
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology / Q000534:rehabilitation; D007511:Ischemia / Q000503:physiopathology / Q000534:rehabilitation*; D007866:Leg / Q000098:blood supply*; D008297:Male; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000502:physiology*; D014664:Vasodilation / Q000502:physiology