An increase in
peripheral blood flow through changes in the collateral
circulation, reduced blood viscosity, or
regression of disease would decrease the amount of
muscle ischemia during exercise, resulting in an
Downloaded from http://circ.ahajournals.org/ by guest on August 2, 2014
Hiatt et al Exercise Training and Peripheral Arterial Disease 603
increase in peak exercise capacity. Finally, despite
the limited blood flow, improvements in skeletal
muscle metabolism would facilitate the extraction of
oxygen and substrate and, thus, allow for a
greater peak exercise capacity