The inflammatory response to upper and lower limb exercise and the effectsof exercise training in patients with claudication

Purpose: We have previously shown that a program of upper limb exercise tra ining can induce significant improvements in walking distance in patients w ith claudication. This study assessed whether upper limb exercise avoids th e systemic inflammatory responses associated with lower limb exercise and a lso whether the inflammatory response to acute lower limb exertion is modif ied by a program of supervised exercise training. Methods: Fifty-two patients with stable intermittent claudication were rand omized into two groups who underwent 6 weeks of supervised upper (n = 26) o r lower (n = 26) Limb cardiorespiratory exercise training. A parallel contr ol group (n = 15) was provided with lifestyle advice only. Neutrophil activ ation markers (CD11b and CD66b) and plasma levels of von Willebrand factor (marker of endothelial damage) in response to an acute bout of sustained up per and lower limb exercise were assessed before and after the period of tr aining. Plasma levels of soluble E-selectin (marker of endothelial activati on) were also determined before and after the training period. Results: An acute bout of sustained lower limb exercise significantly incre ased the intensity of CD11b and CD66b expression by peripheral blood neutro phils in all groups, whereas upper limb exercise had no effect. Resting neu trophil expression of CD11b and CD66b and circulating von Willebrand factor levels were unaffected by the training program, as were the inflammatory r esponses to an acute bout of sustained upper and lower limb muscular work, despite the fact that both training programs significantly increased walkin g distances. Conclusions These findings indicate that upper limb exercise training progr ams may offer certain advantages over currently prescribed lower limb progr ams. Our results show that exercising nonischemic muscles in a way that pro motes improved cardiorespiratory function and walking capacity can avoid th e potentially deleterious systemic inflammatory responses associated with l ower limb exertion in patients with stable intermittent claudication.