Advertisement

European Journal of Applied Physiology

, Volume 104, Issue 4, pp 749–756 | Cite as

Plantar flexion: an effective training for peripheral arterial disease

  • Eivind WangEmail author
  • Jan Hoff
  • Henrik Loe
  • Nils Kaehler
  • Jan Helgerud
Original Article

Abstract

This study examined whether a training intervention likely to elicit adaptations in the leg could result in reduced leg pain and increased whole body physical capacity. Twenty-seven peripheral arterial disease (PAD) patients were randomized to either an individual leg plantar flexion training group (TG) training 4 × 4 min intervals at 80% of maximal work rate three times per week for 8 weeks or a control group. The TG significantly increased plantar flexion peak oxygen uptake and power output by 23.5 and 43.9%, respectively. Treadmill peak oxygen uptake (VO2peak) significantly increased 12.3% in the TG and was associated with a significant increased time to exhaustion of 20.0% when treadmill walking. Eleven of 14 patients no longer reported leg pain limitations at VO2peak. No differences in cardiac output measured at VO2peak, or walking economy were observed. Plantar flexion training was effective in increasing VO2peak and walking performance, and may be a useful strategy in treatment of PAD.

Keywords

Cardiac output Claudication Exercise Oxygen uptake 

References

  1. Andersen P, Saltin B (1985) Maximal perfusion of skeletal muscle in man. J Physiol 366:233–249PubMedGoogle Scholar
  2. Bauer TA, Brass EP, Nehler M, Barstow TJ, Hiatt WR (2004) Pulmonary Vo2 dynamics during treadmill and arm exercise in peripheral arterial disease. J Appl Physiol 97:627–634. doi: 10.1152/japplphysiol.00612.2003 PubMedCrossRefGoogle Scholar
  3. Bergh U, Sjodin B, Forsberg A, Svedenhag J (1991) The relationship between body mass and oxygen uptake during running in humans. Med Sci Sports Exerc 23:205–211. doi: 10.1249/00005768-199102000-00010 PubMedGoogle Scholar
  4. Dibski DW, Smith DJ, Jensen R, Norris SR, Ford GT (2005) Comparison and reliability of two non-invasive acetylene uptake techniques for the measurement of cardiac output. Eur J Appl Physiol 94:670–680. doi: 10.1007/s00421-005-1343-2 PubMedCrossRefGoogle Scholar
  5. Gardner AW, Poehlman ET (1995) Exercise rehabilitation programs for the treatment of claudication pain: a meta analysis. JAMA 274:975–980. doi: 10.1001/jama.274.12.975 PubMedCrossRefGoogle Scholar
  6. Gardner AW, Montgomery PS, Flinn WR, Katzel LI (2005) The effect of exercise intensity on the response to exercise rehabilitation in patients with intermittent claudication. J Vasc Surg 42:702–709. doi: 10.1016/j.jvs.2005.05.049 PubMedCrossRefGoogle Scholar
  7. Haseler LJ, Lin A, Hoff J, Richardson RS (2007) Oxygen availability and PCr recovery rate in untrained human calf muscle: evidence of metabolic limitation in normoxia. Am J Physiol Regul Integr Comp Physiol 293:2046–2051. doi: 10.1152/ajpregu.00039.2007 Google Scholar
  8. Helgerud J (1994) Maximal oxygen uptake, anaerobic threshold and running economy in women and men with similar performances level in marathons. Eur J Appl Physiol 68:155–161. doi: 10.1007/BF00244029 CrossRefGoogle Scholar
  9. Helgerud J, Høydal KL, Wang E, Karlsen T, Berg PR, Bjerkaas M et al (2007) Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 39:665–671. doi: 10.1249/mss.0b013e3180304570 PubMedCrossRefGoogle Scholar
  10. Hiatt WR, Regensteiner JG, Hargarten ME, Wolfel EE, Brass EP (1990) Benefit of exercise conditioning for patients with peripheral arterial disease. Circulation 81:602–609PubMedGoogle Scholar
  11. Hiatt WR, Wolfel EE, Meier RH, Regensteiner JG (1994) Superiority of treadmill walking exercise versus strength training for patients with peripheral arterial disease. Circulation 90:1866–1874PubMedGoogle Scholar
  12. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. (2006) ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 113:463–454. doi: 10.1161/CIRCULATIONAHA.106.174526 Google Scholar
  13. Klausen K, Secher NH, Clausen JP, Hartling O, Jensen JT (1982) Central and regional circulatory adaptations to one- leg training. J Appl Physiol 52:976–983PubMedGoogle Scholar
  14. Mayers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE (2002) Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346:793–801. doi: 10.1056/NEJMoa011858 CrossRefGoogle Scholar
  15. Richardson RS, Grassi B, Gavin TP, Haseler LJ, Tagore K, Roca J et al (1999) Evidence of O2 supply- dependent VO2max in the exercise- trained human quadriceps. J Appl Physiol 86:1048–1053PubMedGoogle Scholar
  16. Rognmo Ø, Hetland E, Helgerud J, Hoff J, Slørdahl SA (2004) High intensity aerobic interval training is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary arterial disease. Eur J Cardiovasc Prev Rehabil 11:216–222. doi: 10.1097/01.hjr.0000131677.96762.0c PubMedCrossRefGoogle Scholar
  17. Shephard RJ, Bouhlel E, Vandevalle H, Monod H (1988) Muscle mass as a factor limiting physical work. J Appl Physiol 64:1472–1479. doi: 10.1063/1.341820 PubMedCrossRefGoogle Scholar
  18. Slordahl SA, Wang E, Hoff J, Kemi OJ, Amundsen BH, Helgerud J (2005) Effective training for patients with intermittent claudication. Scand Cardiovasc J 39:244–249. doi: 10.1080/14017430510035844 PubMedCrossRefGoogle Scholar
  19. Stewart KJ, Hiatt WR, Regensteiner JG, Hirsch AT (2002) Exercise training for claudication. N Engl J Med 347:1941–1951. doi: 10.1056/NEJMra021135 PubMedCrossRefGoogle Scholar
  20. Tan KH, Cossart L, Edwards PR (2000) Exercise training and peripheral vascular disease. Br J Surg 87:553–562. doi: 10.1046/j.1365-2168.2000.01445.x PubMedCrossRefGoogle Scholar
  21. Wagner PD (2000) New ideas on limitations to VO2max. Exerc Sport Sci Rev 28:10–14PubMedGoogle Scholar
  22. Weitz JI, Byrne J, Clagett GP, Farkouh ME, Porter JM, Sackett DL et al (1996) Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation 94:3026–3049PubMedGoogle Scholar
  23. Wisløff U, Støylen A, Loennechen JP, Bruvold M, Rognmo Ø, Haram PM et al (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients. Circulation 115:3086–3094. doi: 10.1161/CIRCULATIONAHA.106.675041 PubMedCrossRefGoogle Scholar
  24. Zhou B, Conlee RK, Jensen R, Fellingham GW, George JD, Fisher AG (2001) Stroke volume does not plateau during exercise in elite male distance runners. Med Sci Sports Exerc 33:1849–1854. doi: 10.1097/00005768-200111000-00008 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Eivind Wang
    • 1
    Email author
  • Jan Hoff
    • 1
    • 2
  • Henrik Loe
    • 1
  • Nils Kaehler
    • 1
  • Jan Helgerud
    • 1
    • 3
  1. 1.Department of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.Department of Physical Medicine and RehabilitationSt Olav University HospitalTrondheimNorway
  3. 3.Hokksund Rehabilitation CentreHokksundNorway

Personalised recommendations