| Summary: | Background: In patients with intermittent claudication (IC), supervised exercise programmes (SEP) improve walking distance and quality of life (QoL); however the mechanisms by which these benefits are achieved remain unclear. Endothelial dysfunction is recognised as a trigger of the atheroinflammatory cascade and subsequent cardiovascular disease. In health, training improves cardiorespiratory physiology, inflammation and endothelial function. Changes in cardiorespiratory physiology, inflammatory markers and endothelial function are contradictory in IC. Objectives: This thesis aimed to assess the impact of SEP on cardiopulmonary physiology, endothelial function and athero-inflammatory markers in patients with IC. Methods: Following local research ethics committee and R & D approval, patients with IC were recruited from outpatient clinic. After providing informed written consent, patients underwent baseline assessment on two separate days. Session 1: participants completed a constant load treadmill test with pre and post exercise ankle brachial pressure indices. Session 2: measured QoL, endothelial function (EndoPAT2000, Itamar, Israel), venepuncture and a cardiopulmonary exercise test (CPET) using cycle ergometry. Participants then underwent a 12 week period of SEP which consisted of circuit training, with re-assessments at six and twelve weeks. The primary outcome measure was a 1.5ml/kg/min improvement in peak VO₂ after six weeks of exercise. Secondary outcomes included changes in endothelial function, quality of life, walking distance and inflammatory markers at both six and twelve weeks. Results: No significant improvements in CPET measurements, endothelial function or inflammation were demonstrated at any time point. Traditional markers of walking ability and QoL demonstrated an improvement by 12 weeks. Conclusions: The underlying mechanism through which exercise improves walking distance remains un-identified. Further work regarding the changes at the cellular level within the muscle is of importance.
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