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Patients with atherosclerotic peripheral arterial disease (PAD) of the lower extremities haveimpaired walking ability due to exercise-induced muscle ischemia and the resultant pain ofintermittent claudication. To evaluate the benefit of exercise training as a treatment for patientswith PAD, as well as possible mechanisms associated with improvement, we randomly assigned19 men with disabling claudication to treated and control groups. Treatment consisted ofsupervised treadmill walking (1 hr/day, 3 days/wk, for 12 weeks) with progressive increases inspeed and grade as tolerated. Graded treadmill testing was performed to maximal toleration ofclaudication pain on entry and after 12 weeks of training to define changes in peak exerciseperformance. After 12 weeks, treated subjects had increased their peak walking time 123%,peak oxygen consumption 30%, and pain-free walking time 165% (all p<0.05). Control subjectshad no change in peak oxygen consumption, but after 12 weeks, peak walking time increased20% (p<0.05). In treated subjects, maximal calf blood flow (measured by a plethysmograph)increased 38+45% (p<0.05), but the change in flow was not correlated to the increase in peakwalking time. Elevated plasma concentrations of acylcarnitines have been associated with thefunctional impairment of PAD and may reflect the metabolic state of ischemic skeletal muscle.In treated subjects, a 26% decrease in resting plasma short-chain acylcarnitine concentrationwas correlated with improvement in peak walking time (r= -0.78, p <0.05). Thus, 12 weeks ofexercise training for patients with PAD improved peak exercise performance and claudicationpain severity, which in part may be due to an improvement in skeletal muscle oxidativemetabolism. (Circulation 1990;81:602-609)
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