Putting your heart into walking further

Background: Leg exercise training improves maximum walking distance (MWD) in claudicants, but it also causes neutrophil activation and may, as a consequence, elicit damage to the coronary circulation. It was hypothesized that symptomatic improvements induced by exercise programmes result from systemic cardiovascular effects rather than localized changes in the lower limb. The aim of this study was to develop an upper body training programme that would enhance cardiovascular fitness while avoiding potentially damaging inflammatory responses. Methods: Sixty‐three stable claudicants were recruited; all underwent arm and leg ergometry exercise assessments. Peripheral blood was obtained before and 1 h after exercise. The intensity (median channel of fluorescence; MCF) of neutrophil CD11b expression (as a measure of neutrophil activation) was determined using whole blood flow cytometry. Patients were randomized to an arm ( n = 24) or leg ( n = 24) training programme structured to achieve identical heart rate changes. Training involved two supervised sessions per week for 6 weeks. Controls undertook no exercise ( n = 15). The MWD was determined at the beginning and end of training. Results: Arm exercise had no effect on neutrophil expression of CD11b, whereas expression was significantly increased by leg exercise ( Table ). Arm and leg training increased the maximum work rate from 75 to 100 W ( P = 0·004; Wilcoxon test) and there was a concomitant decrease in the submaximal heart rate (arm group 150 to 131 beats min −1 ; leg group 155 to 136 beats min −1 ; P = 0·002). These cardiovascular changes were accompanied by an increased MWD ( Table ). There were no changes in the control group.CD11b (MCF) MWD (m) Before exercise After exercise Before training After trainingArm 43 (34–71) 37 (31–68) 261 (188–340) 393 (335–450) * Leg 41 (35–62) 71 (51–98) † 231 (200–341) 357 (275–430) *Values are median (interquartile range). * P = 0·001 † P = 0·01 versus before training or exercise (Wilcoxon signed rank test)Conclusion: Upper body training can increase walking distance in claudicants without neutrophil activation and maximizing cardiovascular fitness appears to be the key to improving symptoms in these patients. © 2000 British Journal of Surgery Society Ltd