THE UTILITY OF UPPER EXTREMITY AEROBIC TRAINING FOR CRITICAL LIMB ISCHEMIA

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。严重肢体缺血（CLI）每年影响约500- 1000 /百万人，并与衰老显著相关，它会导致显著的发病率和死亡率，降低生活质量和功能状态，增加卫生保健资源的使用。CLI是由严重的进行性动脉粥样硬化引起的，当下肢的血流量不足以充分供应组织时，即使在休息时也会发生。这项随机对照研究将评估对严重肢体缺血（最严重的外周动脉疾病（PAD））患者进行为期12周的上肢有氧训练的可行性、耐受性和初步疗效。由于严重的缺血性疼痛，CLI患者通常无法进行下肢运动。有证据表明，上肢有氧训练（几何术）对跛行患者的治疗效果与下肢运动相当。上肢运动的全身反应可能对CLI患者的下肢有显著影响，可能导致疼痛症状的改善。本研究的具体目的是：(1)确定在随机分组的CLI缺血性休息痛患者中进行为期12周的上肢有氧训练的可行性和耐受性，(2)与常规护理组相比，评估上肢有氧训练对缺血性休息痛和经皮氧合变化的主要结果以及功能状态和生活质量变化的次要结果的影响。(3)通过监测心血管调节、止血和血栓形成标志物，探讨运动诱导CLI患者症状改善的潜在机制。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Critical Limb Ischemia (CLI) affects approximately 500-1,000/million individuals per year and is significantly associated with aging, it produces significant morbidity and mortality, decreased quality of life and functional status, and increased use of health care resources. CLI is caused by severe progressive atherosclerosis, occurring when blood flow to the lower extremity is insufficient to adequately supply tissue, even at rest. This randomized control study will asses the feasibility, tolerability, and preliminary efficacy of a supervised 12-week program of upper extremity aerobic training for individuals with critical limb ischemia, the most severe form of peripheral arterial disease (PAD). Patients with CLI are often unable to perform lower extremity exercise because of severe ischemic pain. There is evidence that upper extremity aerobic training (ergometry) provides therapeutic benefits comparable to lower extremity exercise in patients with claudication. Systemic response to upper extremity exercise may have a significant effect on the lower extremities of CLI patients, which may result in improvement of pain symptoms. Specific aims of this study are to (1) determine the feasibility and tolerability of a supervised 12-week program of upper extremity aerobic training in a randomized group of subjects with ischemic rest pain due to CLI, (2) evaluate the impact of upper extremity aerobic training on primary outcomes of change in ischemic rest pain and transcutaneous oxygenation and secondary outcomes of changes in functional status and quality of life compared to a usual care group, and (3) examine potential mechanisms of exercise-induced symptomatic improvement in patients with CLI by monitoring indicators of cardiovascular conditioning hemostatis and thrombotic markers of CLI.