Daily Passive Muscle Stretching Improves Flow-Mediated Dilation of Popliteal Artery and 6-minute Walk Test in Elderly Patients with Stable Symptomatic Peripheral Artery Disease
Daily Passive Muscle Stretching Improves Flow-Mediated Dilation of Popliteal Artery and 6-minute Walk Test in Elderly Patients with Stable Symptomatic Peripheral Artery Disease
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DOI：
10.1016/j.carrev.2019.05.003
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发表时间：
2019-08-01
影响因子：
1.7
通讯作者：
Muller-Delp, Judy
中科院分区：
文献类型：
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作者：
Hotta, Kazuki;Batchelor, Wayne B.;Muller-Delp, Judy
背景：外周动脉疾病(PAD)患者常因骨骼肌供氧不足而导致行走障碍。在老年大鼠中，我们已经证明，每天伸展小腿肌肉可以改善比目鱼肌小动脉的内皮依赖性扩张，并在运动过程中增加毛细血管和肌肉血流量。因此，我们假设每天小腿肌肉拉伸可以改善PAD患者的月国动脉内皮依赖性血管扩张和步行功能。方法：我们进行了一项随机、非盲法、交叉研究，13名有稳定症状PAD的患者被随机分为被动小腿肌肉拉伸4周(踝关节背屈30min/d，5天/周)和4周不进行肌肉拉伸4周。结果：伸肌4周后，牵张组的内皮依赖性血流介导的血管舒张率和6MWT较对照组明显改善(FMD：5.1+/-0.5%vs.3.7+/-0.3%，P=0.005：6MWT：340+/-43mvs.182+/-34m：P=0.0006)。硝酸甘油引起的血管扩张在两组间差异无统计学意义(10.9+/-1.2对9.9+/-0.4%，P=0.48)。伸展后6MWT总步行距离与FMD值呈正相关(R=0.645.0 5，P=0.0 2)。结论：被动伸展小腿肌能增强血管内皮功能，改善步行功能。这些发现值得在前瞻性随机试验中进一步研究。(C)2019 Elsevier Inc.保留所有权利。
Background: Patients with peripheral arterial disease (PAD) often have walking impairment due to insufficient oxygen supply to skeletal muscle. In aged rats, we have shown that daily stretching of calf muscles improves endothelium-dependent dilation of arterioles from the soleus muscle and increases capillarity and muscle blood flow during exercise. Therefore, we hypothesized that daily muscle stretching of calf muscles would improve endothelium-dependent vasodilation of the popliteal artery and walking function in PAD patients.Methods: We performed a randomized, non-blinded, crossover study whereby 13 patients with stable symptomatic PAD were randomized to undergo either 4 weeks of passive calf muscle stretching (ankle dorsiflexion applied 30 min/d, 5 days/wk) followed by 4 weeks of no muscle stretching and vice versa. Endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin-induced dilation of the popliteal artery and 6 minute walk test (6MWT) were evaluated at baseline and after each 4 week interval.Results: After 4 weeks of muscle stretching, FMD and 6MWT improved significantly in the muscle stretching group vs. the control (FMD: 5.1 +/- 0.5% vs. 3.7 +/- 0.3%, P = 0.005: 6MWT continuous walking distance: 304 +/- 43 m vs. 182 +/- 34 m: P = 0.0006). No difference in nitroglycerin-induced dilation was found between groups (10.9 +/- 1.2 vs. 9.9 +/- 0.4%, P = 0.48). Post-stretching, 6MWT total walking distance was positively correlated with normalized FMD (R = 0.645, P = 0.02).Conclusions: Passive calf muscle stretching enhanced vascular endothelial function and improved walking function in elderly patients with stable symptomatic PAD. These findings merit further investigation in a prospective randomized trial. (C) 2019 Elsevier Inc. All rights reserved.