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Clinical and mitochondrial adaptations after near infrared spectroscopy-guided exercise training for claudication in peripheral arterial disease

Session Poster session 4

Speaker Jonathan Murrow

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : J Murrow (Athens,US), J Brizendine (Athens,US), B Djire (Athens,US), H Young (Birmingham,US), S Rathbun (Athens,US), K Mccully (Athens,US)

Authors:
J. Murrow1 , J. Brizendine2 , B. Djire2 , H. Young3 , S. Rathbun4 , K. McCully4 , 1Augusta University - University of Georgia Medical Partnership - Athens - United States of America , 2University of Georgia, Kinesiology - Athens - United States of America , 3University of Alabama Birmingham - Birmingham - United States of America , 4University of Georgia - Athens - United States of America ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 713

Background: Supervised treadmill exercise for claudication in peripheral arterial disease is effective but poorly tolerated because of ischemic leg pain. The mechanism of benefit of exercise training and the role of skeletal muscle mitochondrial adaptations is not well understood. Near-infrared spectroscopy (NIRS) allows for real-time assessment of skeletal muscle blood flow and tissue hypoxia in claudication. NIRS-derived post-exercise recovery of oxygen consumption fit to a mono-exponential curve also yields a time constant (Tc) that is an index of mitochondrial oxidative capacity.

Methods: We devised a novel treadmill exercise training program wherein subjects with claudication trained thrice weekly in hour-long sessions for 12 weeks, randomized to NIRS-guided training (n=8, age 72±9.7y, 25% female) vs. traditional pain-based training (n=10, age 71.6±8.8y, 20% female). NIRS-guided training was determined by 15% reduction in skeletal muscle oxygenation by NIRS rather than by symptoms of pain. We also characterized mitochondrial capacity (Tc) at baseline and after 12 weeks of training.

Results: Baseline pain-free walking time on a Gardner treadmill test was similar in both cohorts (2.5±0.9 vs 3.6±1.0 min, p=0.5). After 36 training sessions, NIRS-guided cohorts improved similar to pain-guided cohorts (pain-free walking time 6.7±0.9 vs. 6.9±1.1 min, p<0.01 for change from baseline and p=0.97 between cohorts) while ABI did not change (0.8±0.1, p=0.5). Improvements in mitochondrial oxidative capacity (Tc) was greater in the pain-guided cohort than in the NIRS-guided cohort (38.8±8.3 vs. 14.0±9.3, p=0.018).

Conclusions: NIRS-guided exercise training improves claudication comparable to traditional pain-based training regimens. Adaptations in mitochondrial function rather than increases in limb perfusion may account for functional improvement. Increases in mitochondrial oxidative capacity may be proportional to the degree of tissue hypoxia during exercise.

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