Influence of upper- and lower-limb exercise training on cardiovascular function and walking distances in patients with intermittent claudication

Purpose: The effects of upper-limb (arm cranking) and lower-limb (leg crank ing) exercise training on walking distances in patients with intermittent c laudication was assessed. Methods: Sixty-seven patients (33 to 82 years old) with moderate to severe intermittent claudication were recruited, and the maximum power generated d uring incremental upper- and lower-limb ergometry tests was determined, as were pain-free and maximum walking distances (by using a shuttle walk test) . Patients were randomly assigned to an upper-limb training group (n = 26) or a lower-limb training group (n = 26), An additional untrained group (n = 15) was recruited on an ad hoc basis in parallel with the main trial by us ing identical inclusion criteria. This group was subsequently shown to poss ess a similar demographic distribution to the two exercise groups. Supervis ed training sessions were held twice weekly for 6 weeks. Results: Both training programs significantly improved the maximum power ge nerated during the incremental upper- and lower-limb ergometry tests (P < . 001), which may reflect an increase in central cardiovascular function that was independent of the training mode. More importantly, pain-free and maxi mum walking distances also improved in both training groups (P < .001). The improvements in the training groups were similar; there were no changes in the untrained control group. These findings suggest that the symptomatic i mprovement after upper-limb exercise training may result, in part, from sys temic cardiovascular effects rather than localized metabolic or hemodynamic changes. Conclusion: Carefully prescribed upper-limb exercise training can evoke a r apid symptomatic improvement in patients with claudication, while avoiding the physical discomfort experienced when performing lower-limb weight-beari ng exercise.