Mechanisms responsible for reducing intermittent claudication as a result of treadmill training

Abstract

Intermittent claudication, according to the Fontaine classification, is a classical symptom of stage II peripheral arterial occlusive disease (PAOD) of the lower limbs. It results from the progression of atherosclerosis leading to the narrowing and complete occlusion of arteries. It manifests with pain in the muscles of the lower limbs which forces the patients to interrupt their current activity. Supervised treadmill training is believed to lead to the most favourable outcomes in the form of improved pain-free walking distance and maximum walking distance. The improvement in pain related to intermittent claudication and in functional performance are probably the combined effect of various mechanisms in response to the exercise training. The most important mechanisms include: improved skeletal muscle metabolism, favourable haemorheologic changes, delayed progression of atherosclerosis, peripheral blood flow adaptation, improved economics of walking, and changed perception of pain. The role of these mechanisms and their contribution to the improved functional performance in this group of patients are not unequivocally established and continue to be disputable. In this paper we review and discuss the mechanisms responsible for improving walking distance observed during walking exercises in patients with intermittent claudication.
Acta Angiol 2010; 16, 2: 49-66