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Cited by 186Peripheral Artery Disease ManagementCardiovascular and exercise physiologyPhysical Activity and Health

Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial

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Zwierska, Irena, Walker, Richard D., Choksy, Sohail A., Male, Jonathan S., Pockley, A. Graham, Saxton, John M.·2005·Journal of Vascular Surgery
DOI 10.1016/j.jvs.2005.08.021
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Abstract

Objectives To investigate the effects of a 24-week program of upper- and lower-limb aerobic exercise training on walking performance in patients with symptomatic peripheral arterial disease (PAD) and to study the mechanisms that could influence symptomatic improvement.Methods After approval from the North Sheffield Local Research Ethics Committee, 104 patients (median age, 69 years; range, 50 to 85 years) with stable PAD were randomized into an upper- or lower-limb aerobic exercise training group (UL-Ex or LL-Ex), or to a nonexercise training control group. Training was performed twice weekly for 24 weeks at equivalent relative exercise intensities. An incremental arm- and leg-crank test (ACT and LCT) to maximum exercise tolerance was performed before and at 6, 12, 18, and 24 weeks of the intervention to determine peak oxygen consumption (VO(2)). Walking performance, defined as the claudicating distance (CD) and maximum walking distance (MWD) achieved before intolerable claudication pain, was assessed at the same time points by using a shuttle-walk protocol. Peak blood lactate concentration, Borg ratings of perceived exertion (RPE) and pain category ratio (CR-10) were recorded during all assessments.Results CD and MWD increased over time (P < .001) in both training groups. At 24 weeks, CD had improved by 51% and 57%, and MWD had improved by 29% and 31% (all P < .001) in the UL-Ex and LL-Ex groups, respectively. An increase in peak heart rate at MWD in the UL-Ex group (109 +/- 4 vs 115 +/- 4 beats/min; P < .01) and LL-Ex group (107 +/- 3 vs 118 +/- 3 beats/min; P = .01) was accompanied by an increase in the amount of pain experienced in both groups (P < .05), suggesting that exercising patients could tolerate a higher level of cardiovascular stress and an increased intensity of claudication pain before test termination after training. Patients assigned to exercise training also showed an increase in LCT peak VO2 at the 24-week time point in relation to baseline (P < .01) and control patients (P < .01), whereas ACT peak VO2 was only improved in the UL-Ex group (P < .05).Conclusions Our results suggest that a combination of physiologic adaptations and improved exercise pain tolerance account for the improvement in walking performance achieved through upper-limb aerobic exercise training in patients with PAD. Furthermore, that both arm- and leg-crank training could be useful exercise training modalities for improving cardiovascular function, walking performance, and exercise pain tolerance in patients with symptomatic PAD.

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  • For individuals with PAD, with and without intermittent claudication and pain in the extremities during PA, low-to-moderate walking, arm-crank, and cycling exercise have all been shown to enhance mobility, functional capacity, exercise pain tolerance, and QOL.

    “For individuals with PAD, with and without intermittent claudication and pain in the extremities during PA, low-to-moderate walking, arm-crank, and cycling exercise have all been shown to enhance mobility, functional capacity, exercise pain tolerance, and QOL ( 214 , 295 ).”

    From Exercise and Type 2 Diabetes (2010) · cites this paper as [295]

    The Abstract and Conclusion report improved walking performance and exercise-pain tolerance after arm- and leg-crank training in patients with symptomatic PAD. The study did not test walking as a training intervention or establish benefits for patients without claudication, and the passages found do not report a quality-of-life outcome. The Supervised exercise training section describes training at 85%–90% of limb-specific peak oxygen uptake, rather than low-to-moderate intensity. Page numbers are unavailable in our copy. (LLM, conf=0.91)

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Research works printed but not linked: 1

  1. [19]19. Alpert JS, Larsen OA, Lassen NA. Exercise and intermittent claudica- tion. Blood flow in the calf muscle during walking studied by the xenon-133 clearance method. Circulation 1969;39:353-9.

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Authors
Zwierska, I., Walker, R. D., Choksy, S. A., Male, J. S., Pockley, A. G., & Saxton, J. M.
Affiliations
  • Sheffield Hallam University (GB)
  • Northern General Hospital (GB)
Corresponding author
Saxton, John M.
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2005-12
Volume
42
Issue
6
Pages
1122-1130
ISSN
0741-5214 (ISSN-L)
DOI
10.1016/j.jvs.2005.08.021
OpenAlex
W1999404058
Cited by
186
References
30
Citations by year
2026: 7 · 2025: 9 · 2024: 10 · 2023: 3 · 2022: 8 · 2021: 11 · 2020: 5 · 2019: 15 · 2018: 9 · 2017: 6 · 2016: 9 · 2015: 8 · 2014: 8 · 2013: 9 · 2012: 10
FWCI
8.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Vascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Northumbria Research Link (Northumbria University) (submittedVersion)
  • SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (submittedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders
British Heart Foundation
Topics
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
peripheral arterial disease, aerobic exercise training, upper limb exercise, leg exercise, walking performance, claudication distance, peak oxygen uptake, exercise rehabilitation, Borg rating of perceived exertion, blood lactate, maximum walking distance, older adults
MeSH terms
Aged, Aged, 80 and over, Arm, Arterial Occlusive Diseases, Exercise Therapy, Female, Humans, Leg, Male, Middle Aged, Biomarkers, Walking, Treatment Outcome, Exercise Tolerance, Lactic Acid

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