Exercise Training Reduces the Acute Inflammatory ResponseAssociated with Claudication

Background: recent research has shown that episodes of claudication may be associated with a systemic inflammatory response that causes injury to the vascular endothelium. As claudicants are often directed to undertake regular walking exercises there has been a concern that this may accelerate endothelial injury. Aims: the aim of our study was to assess the baseline markers of ischaemia-reperfusion injury (IRI) in claudicants and controls after acute treadmill exercise and to then examine the effect of a 3 month supervised exercise-training programme, on these markers, in the claudicant group. Methods: forty-six claudicants and 22 age-matched controls undertook acute treadmill exercise. Neutrophil activation, degranulation, free radical damage and antioxidants were measured (by flow cytometry, ELISA, and chemiluminescence) at rest and at 5, 30 and 60 min post-exercise. Claudicants were then recruited into an intensive 3 month supervised exercise programme (SEP) after which the same parameters of IRI were reassessed at different time points, at 3 and 6 months. Results: resting markers of IRI were similar in both groups. Exercise had no effect on the control group. Immediately after exercise, claudicants developed significant neutrophil activation and degranulation with free radical damage. This effect decreased sequentially after 3 months of exercise training. Conclusion: this study for the first time demonstrates that the exercise training of claudicants is beneficial, not only in terms of improving their walking distance, but also by decreasing the injurious effects of IRI that occur during claudication. Exercise training should be an essential part of the medical management of the majority of claudicants.