ANGIOGENESIS AND THE MECHANISMS OF EXERCISE TRAINING IN PAD

这个子项目是许多利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 外周动脉疾病（PAD）损害流向腿部的动脉血流，是全身动脉粥样硬化的主要指标。 大约1/3的PAD患者有跛行，定义为行走时单腿或双腿疼痛，休息后缓解。 跛行患者的运动能力明显受损。 PAD患者的治疗目标包括风险因素调整和抗血小板药物治疗，以解决心血管死亡风险增加的问题。 在许多随机试验中证明，有监督的运动训练是提高步行能力的最有效治疗方法。 无论是跛行的生理学还是运动训练改善跛行患者行走的机制都不清楚，因此迫切需要进行旨在确定PAD患者运动训练变化基础的临床研究。 在这项研究中，将从杜克大学医学中心和科罗拉多大学健康科学中心招募年龄超过40岁、有跛行且静息时ABI <0.90的男性和女性。 患者将被随机分配到一个监督或家庭为基础的锻炼计划。 评估将在基线、3周（对于受监督的锻炼者）和3个月时进行。 将在基线时检测性别匹配的健康对照。 核心假设是，运动训练的有益效果主要是通过血管生成效应或新血管的形成来介导的。

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. Peripheral arterial disease (PAD) impairs arterial blood flow to the legs and is a major indicator of systemic atherosclerosis. Approximately 1/3 of patients with PAD have claudication, defined as pain in one or both legs during walking, that is relieved by rest. Patients with claudication have a marked impairment in exercise performance. Goals of treatment for PAD patients include risk-factor modification and antiplatelet drug therapy to address increased cardiovascular mortality risk. Supervised exercise training is the most efficacious treatment to improve walking capacity, demonstrated in many randomized trials. Neither the physiology of claudication nor the mechanisms by which exercise training improves walking in people with claudication are understood and therefore there is an urgent need for clinical research directed towards defining the basis of the exercise training changes induced in PAD patients. In this stud7, men and women over 40 years, with claudication and an ABI of < .90 at rest will be recruited from Duke University Medical Center and the University of Colorado Health Sciences Center. Patients will be randomized to a supervised or home-based exercise program. Evaluations will be at baseline, 3 weeks (for the supervised exercisers), and at 3 months. Age-gender matched healthy controls will be tested at baseline. The central hypothesis is that the beneficial effects of exercise training are primarily mediated through an angiogenic effect, or the formation of new blood vessels.