title: Limb-specific and cross-transfer effects of arm-crank exercise training in patients with symptomatic peripheral arterial disease.
abstract: Arm cranking is a useful alternative exercise modality for improving walking performance in patients with intermittent claudication; however, the mechanisms of such an improvement are poorly understood. The main aim of the present study was to investigate the effects of arm-crank exercise training on lower-limb O2 delivery in patients with intermittent claudication. A total of 57 patients with intermittent claudication (age, 70+/-8 years; mean+/-S.D.) were randomized to an arm-crank exercise group or a non-exercise control group. The exercise group trained twice weekly for 12 weeks. At baseline and 12 weeks, patients completed incremental tests to maximum exercise tolerance on both an arm-crank ergometer and a treadmill. Respiratory variables were measured breath-by-breath to determine peak VO2 (O2 uptake) and ventilatory threshold. Near-IR spectroscopy was used in the treadmill test to determine changes in calf muscle StO2 (tissue O2 saturation). Patients also completed a square-wave treadmill-walking protocol to determine VO2 kinetics. A total of 51 patients completed the study. In the exercise group, higher maximum walking distances (from 496+/-250 to 661+/-324 m) and peak VO2 values (from 17.2+/-2.7 to 18.2+/-3.4 ml.kg-1 of body mass.min-1) were recorded in the incremental treadmill test (P<0.05). After training, there was also an increase in time to minimum StO2 (from 268+/-305 s to 410+/-366 s), a speeding of VO2 kinetics (from 44.7+/-10.4 to 41.3+/-14.4 s) and an increase in submaximal StO2 during treadmill walking (P<0.05). There were no significant changes in the control group. The results suggest that the improvement in walking performance after arm-crank exercise training in patients with intermittent claudication is attributable, at least in part, to improved lower-limb O2 delivery.
authors.affiliation: Centre for Sport and Exercise Science, Sheffield Hallam University, UK.
authors.forename: Garry
authors.initials: G
authors.lastname: Tew
authors.forename: Shah
authors.initials: S
authors.lastname: Nawaz
authors.forename: Irena
authors.initials: I
authors.lastname: Zwierska
authors.forename: John M
authors.initials: JM
authors.lastname: Saxton
mesh_terms: D000368:Aged; D001132:Arm / Q000503:physiopathology*; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology / Q000534:rehabilitation*; D035002:Lower Extremity / Q000098:blood supply; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply; D010101:Oxygen Consumption / Q000502:physiology; D011659:Pulmonary Gas Exchange / Q000502:physiology; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology