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Oligonucleotide microarray expression profiling: human skeletal muscle phenotype and aerobic exercise training.

Regular aerobic exercise reduces risk of cardiovascular disease far more effectively than any pharmaceutical agent. The precise mechanisms contributing to these health benefits are unknown. Currently, much of our knowledge regarding the molecular regulators of skeletal muscle phenotype remodeling in response to muscle activity is derived from rodent models. Over the past five years large scale gene analysis has emerged as a promising research strategy for studying complex processes in human tissue. This review will principally discuss the application of large scale gene expression profiling to study the molecular responses to longitudinal aerobic exercise training studies in humans. The focus is largely on the Affymetrix technology platform, as this can be most easily compared, in a quantitative manner, across laboratories. Indeed, there are compelling reasons to adopt a common standard to obtain maximum synergy across complex, expensive and invasive human studies. Direct comparisons between array data sets can be made, and these should be considered novel 'experiments', often providing great insight into disease mechanisms. Weaknesses in existing human studies are identified and future objectives are discussed.

Exercise↗

Effect of exercise training on glucose tolerance, in vivo insulin sensitivity, lipid and lipoprotein concentrations in middle-aged men with mild hypertriglyceridemia.

The effects of 9 weeks of aerobic exercise training with maintenance of stable body weight upon insulin sensitivity and upon glucose, lipid, and lipoprotein concentrations were studied in 10 middle-aged men with mild hypertriglyceridemia. Following training, mean maximum oxygen consumption improved from 33.5 +/- 1.9 to 39.3 +/- 1.9 mL/kg/min (means +/- SEM), (P less than 0.01). Glucose concentrations, both fasting and during oral glucose tolerance testing, remained stable but both fasting insulin concentrations and insulin responses to oral glucose decreased (P less than 0.1 and less than 0.01, respectively). In vivo insulin sensitivity improved 25 +/- 6.1% (P less than 0.01) following training. Exercise training resulted in decreases in fasting serum triglyceride concentrations from 203 +/- 12.6 to 126 +/- 9.0 mg/dL (P less than 0.01), primarily as a result of the reduction in VLDL-triglycerides (P less than 0.01). The magnitude in percentage decrease of VLDL-triglycerides was found to be significantly correlated (r = 0.71, P less than 0.05) with the magnitude in percent increase in max VO2. Serum cholesterol levels declined from 211 +/- 8.9 to 193 +/- 11.9 mg/dL (P less than 0.01), and the ratio of HDL-cholesterol to total cholesterol was improved. This study demonstrates that exercise training at a level of intensity feasible for many middle-aged men has beneficial effects on several factors that have been associated with an increased risk of cardiovascular disease.

Adult↗

Knee-joint proprioception during 30-day 6 degrees head-down bed rest with isotonic and isokinetic exercise training.

To determine if daily isotonic exercise or isokinetic exercise training coupled with daily leg proprioceptive training, would influence leg proprioceptive tracking responses during bed rest (BR), 19 men (36 +/- SD 4 years, 178 +/- 7 cm, 76.8 +/- 7.8 kg) were allocated into a no-exercise (NOE) training control group (n = 5), and isotonic exercise (ITE, n = 7) and isokinetic exercise (IKE, n = 7) training groups. Exercise training was conducted during BR for two 30-min periods.d-1, 5 d.week-1. Only the IKE group performed proprioceptive training using a new isokinetic procedure with each lower extremity for 2.5 min before and after the daily exercise training sessions; proprioceptive testing occurred weekly for all groups. There were no significant differences in proprioceptive tracking scores, expressed as a percentage of the perfect score of 100, in the pre-BR ambulatory control period between the three groups. Knee extension and flexion tracking responses were unchanged with NOE during BR, but were significantly greater (*p < 0.05) at the end of BR in both exercise groups when compared with NOE responses (extension: NOE 80.7 +/- 0.7%, ITE 82.9* +/- 0.6%, IKE 86.5* +/- 0.7%; flexion: NOE 77.6 +/- 1.5%, ITE 80.0 +/- 0.8% (NS), IKE 83.6* +/- 0.8%). Although proprioceptive tracking was unchanged during BR with NOE, both isotonic exercise training (without additional proprioceptive training) and especially isokinetic exercise training when combined with daily proprioceptive training, significantly improved knee proprioceptive tracking responses after 30 d of BR.

Adult↗

Feasibility and efficacy of home exercise training before lung volume reduction.

BACKGROUND: Exercise training is recommended before lung volume reduction surgery (LVRS) in patients with emphysema. Unfortunately, many of these patients are referred from remote areas where there is no available rehabilitation program. The authors evaluated the feasibility and efficacy of a minimally supervised home-based exercise training program. METHODS: Twenty-three emphysematous patients (age 61 +/- 6, forced expiratory volume in 1 second = 29 +/- 7% predicted [mean +/- SD]) were recruited from our LVRS program. Measurements of pulmonary function, maximal and submaximal exercise capacity, 6-minute walking distance (6-MWD), muscle strength, and quality of life with the Chronic Respiratory Questionnaire were obtained before and after training. Home-based exercise training program included muscle exercises and aerobic training, and started with detailed teaching while the follow-up was ensured through weekly phone calls and a diary filled by each patient. RESULTS: Significant increases in 6-MWD (P < 0.001), quality of life (P < 0.005), peak work rate (P < 0.05), peak oxygen consumption (P < 0.05), endurance time (P < 0.005), and muscle strength were observed in the home-based exercise training program. CONCLUSIONS: Home-based exercise training for patients in preparation for LVRS was feasible, and induced significant improvement in exercise tolerance and quality of life.

Exercise↗

Putative role of the NTS in alterations in neural control of the circulation following exercise training in rats.

Exercise training (ExTr) has been associated with alterations in neural control of the circulation, including effects on arterial baroreflex function. The nucleus tractus solitarius (NTS) is the primary termination site of cardiovascular afferents and critical in the regulation of baroreflex-mediated changes in heart rate (HR) and sympathetic nervous system outflow. The purpose of the present study was to determine whether ExTr is associated with alterations in neurotransmitter regulation of neurons involved in control of cardiovascular function at the level of the NTS. We hypothesized that ExTr would increase glutamatergic and reduce GABAergic transmission in the NTS and that, collectively, these changes would result in a greater overall sympathoinhibitory drive from the NTS in ExTr animals. To test these hypotheses, male Sprague-Dawley rats were treadmill trained or maintained under sedentary conditions for 8-10 wk. NTS microinjections were performed in Inactin-anesthetized animals instrumented to record mean arterial pressure (MAP), HR, and lumbar sympathetic nerve activity (LSNA). Generalized activation of the NTS with unilateral microinjections of glutamate (1-10 mM, 30 nl) produced dose-dependent decreases in MAP, HR, and LSNA that were unaffected by ExTr. Bilateral inhibition of NTS with the GABAA agonist muscimol (1 mM, 90 nl) produced increases in MAP and LSNA that were blunted by ExTr. In contrast, pressor and sympathoexcitatory responses to bilateral microinjections of the ionotropic glutamate receptor antagonist, kynurenate (40 mM, 90 nl), were similar between groups. Bradycardic responses to bilateral microinjections of the GABAA antagonist bicuculline (0.1 mM, 90 nl) were attenuated by ExTr. These data indicate that alterations in neurotransmission at the level of the NTS contribute importantly to regulation of HR and LSNA in ExTr animals. In addition to alterations at NTS, these experiments suggest indirectly that changes in other cardiovascular nuclei contribute to the observed alterations in neural control of the circulation following ExTr.

Animals↗

Elevated skeletal muscle glucose transporter levels in exercise-trained middle-aged men.

Exercise training has been proposed to improve whole body insulin sensitivity through a postreceptor adaptation in skeletal muscle. This study examined if levels of the insulin-responsive muscle glucose transporter protein (GLUT-4) were associated with improved insulin sensitivity in trained vs. sedentary middle-aged individuals. Muscle GLUT-4 levels and oral glucose tolerance test (OGTT) responses were obtained in age-matched trained and sedentary men (n = 11). Plasma insulin levels during the OGTT were significantly lower (P less than 0.01) in the trained men, whereas no differences were seen in plasma glucose responses. GLUT-4 protein content was approximately twofold higher in the trained men (2.41 +/- 0.17 vs. 1.36 +/- 0.11 micrograms standard, P less than 0.001). OGTT responses and GLUT-4 levels were not altered 15-18 h after a standard exercise bout in six representative sedentary subjects. These data suggest that GLUT-4 levels are increased in conjunction with insulin sensitivity in chronically exercise-trained middle-aged men. This finding suggests a possible mechanism for the improved insulin sensitivity observed with exercise training in humans.

Adult↗

Selection criteria for exercise training in pulmonary rehabilitation.

While exercise training appears to have no effect on resting respiratory function, and its effect on ventilation/perfusion relationships is uncertain, it can significantly reduce the rate of lactic acid production, carbon dioxide generated from buffering of acid and the hydrogen ion stimulus to breathe during exercise. We had two objectives in this study: 1) to determine if patients who might benefit from exercise training could be selected based on resting respiratory function measurements; 2) to determine if the work rate at which the metabolic acidosis starts to develop could be reliably determined, non-invasively, by a simple modification of the recently described V-slope method of Beaver et al. Patients with severe obstructive lung disease, all of whom experienced exertional dyspnoea, underwent incremental exercise testing to determine if they could exercise to a level causing metabolic acidosis. About two thirds of the patients with severe airflow obstruction developed a significant metabolic acidosis (arterial standard HCO3- decrease of more than 2 mEq.l-1 after two minutes recovery following an incremental exercise test to maximum). The oxygen uptake (VO2) at which the metabolic acidosis (directly measured) and that of which the increase in CO2 in the expired air attributable to buffering (V-slope method), were in close agreement. There was no significant correlation between the magnitude of the exercise metabolic acidosis and the forced expiratory volume in one second (FEV1) or the diffusing capacity for carbon monoxide (DLCO). Thus, it is necessary to perform exercise testing in order to select patients for exercise training, based on the benefits accrued from reducing the exercise metabolic acidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis, Respiratory↗

Augmentation of catecholamine-stimulated [3H]GDP release in adipocyte membranes from exercise-trained rats.

The effects of exercise training on the catecholamine-stimulated [3H]GDP release in rat adipocyte membranes prelabeled with [3H]GTP and the adenylate cyclase activity were investigated. Exercise training significantly increased the release of [3H]GDP in response to (-)isoproterenol. The adenylate cyclase activity induced by a nonhydrolyzable guanine nucleotide analogue, Gpp(NH)p, was significantly greater in exercise-trained rats.

Adenylyl Cyclases↗

Regular moderate exercise training prevents decrease of CD4+ T-lymphocytes induced by a single bout of strenuous exercise in mice.

The biphasic effects of exercise training on the immune system have been studied extensively and represented by the well-known J-shaped curve with respect to training intensity. However, the relationship and interactions between "beneficial" exercise training and "harmful" strenuous exercise have not been researched. This study was designed to determine whether regular moderate exercise training could affect the changes of percentage of T-lymphocytes induced by a single bout of strenuous exercise. A protocol to run uphill on a 10 degrees tilted treadmill for 4 weeks was employed as moderate exercise training in mice, while a sedentary control group of mice was exposed to the same handling stress without training. The trained and untrained mice were then exposed to a single bout of strenuous exercise until exhaustion. Total leukocytes were collected from spleen and peripheral blood at 0 hr, 3 hrs, and 24 hrs postexhaustion, as well as from the control groups. Flow cytometric analyses were conducted to determine the percentages of selected leukocyte populations. It was demonstrated that moderate exercise training prevented the decrease of CD4+ but stimulated the increase of CD25+ CD8+ T-lymphocytes induced by a single bout of strenuous exercise, indicating an adaptive response that can affect changes of leukocyte subpopulations.

Animals↗

Effects of exercise training on chronotropic incompetence in patients with heart failure.

OBJECTIVE: To describe the effects of exercise training on chronotropic incompetence in patients with stable heart failure, as measured by their inability to achieve a peak exercise heart rate greater than 85% of maximum. BACKGROUND: Exercise intolerance and chronotropic incompetence are characteristic of patients with heart failure. Exercise training improves exercise capacity in these patients; however, to what extent reversal of chronotropic incompetence contributes to such a response remains uncertain. METHODS: Fifty-one patients undergoing standard medical therapy were randomly assigned to a 24-week exercise training program or a no exercise control group. Twenty-one of 26 patients assigned to the exercise group and 22 of 25 control patients completed the study. Peak oxygen consumption, resting and exercise plasma norepinephrine level, and quality of life (Living With Heart Failure Questionnaire) were assessed. RESULTS: A significant (P <.05) increase in peak heart rate was observed in the exercise group (9 +/- 3 beats/min) when compared with the control group (1 +/- 3 beats/min). Among exercise-trained patients with chronotropic incompetence at baseline (n = 14), the increase in peak heart rate at week 24 was 12 +/- 3 beats/min. Peak oxygen consumption was significantly (P <.05) increased in the exercise group (204 +/- 57 mL/min) versus the control group (72 +/- 33 mL/min). Health-related quality of life was not significantly changed with exercise training. Twenty-four weeks of exercise training induced a greater (P <.05) reduction in plasma norepinephrine at rest and during exercise in patients with a nonischemic cardiomyopathy versus those with ischemic cardiomyopathy. CONCLUSIONS: Exercise training results in an increase in peak heart rate and partial reversal of chronotropic incompetence among patients with stable heart failure. These responses contribute, in part, to the exercise training-induced increase in exercise capacity that occurs in these patients.

Cardiac Output↗

Exercise training in heart failure improves quality of life and exercise capacity.

AIMS: Benefit from exercise training in heart failure has mainly been shown in men with ischaemic disease. We aimed to examine the effects of exercise training in heart failure patients < or = 75 years old of both sexes and with various aetiology. METHODS AND RESULTS: Fifty-four patients with stable mild-to-moderate heart failure were randomized to exercise or control, and 49 completed the study (49% > or = 65 years; 29% women; 24% non-ischaemic aetiology; training, n = 22; controls, n = 27). The exercise programme consisted of bicycle training at 80% of maximal intensity over a period of 4 months. Improvements vs controls were found regarding maximal exercise capacity (6 +/- 12 vs -4 +/- 12% [mean +/- SD], P < 0.01) and global quality-of-life (2 [1] vs 0 [1] units [median ¿inter-quartile range¿], P < 0.01), but not regarding maximal oxygen consumption or the dyspnoea-fatigue index. All of these four variables significantly improved in men with ischaemic aetiology compared with controls (n = 11). However, none of these variables improved in women with ischaemic aetiology (n = 5), or in patients with non-ischaemic aetiology (n = 6). The training response was independent of age, left ventricular systolic function, and maximal oxygen consumption. No training-related adverse effects were reported. CONCLUSION: Supervised exercise training was safe and beneficial in heart failure patients < or = 75 years, especially in men with ischaemic aetiology. The effects of exercise training in women and patients with non-ischaemic aetiology should be further examined.

Activities of Daily Living↗

Effects of eight weeks of exercise training and orlistat therapy on body composition and maximal exercise capacity in obese females.

A comparative assessment was made of the short-term effects of orlistat therapy and exercise training on body composition and aerobic fitness in obese females. A total of 24 obese patients were enrolled in to the study; 12 received orlistat therapy (DO) and 12 participated in a regular aerobic exercise-training programme (DE). All patients were on hypocaloric diets. Each patient performed three incremental ramp exercise tests (one at Week 0, one at the end of Week 4 and one at the end of Week 8) to exhaustion using an electromagnetically braked cycle ergometer to determine their anaerobic threshold and maximal exercise (Wmax) capacity. Patients in the DE group performed continuous exercise at a work rate that corresponded to the anaerobic threshold. Weight loss and loss of fat mass after 8 weeks were -6.4% (P=0.002) and -13.4% (DE) vs -5.8% (P=0.002) and -6.4% (P=0.008) (DO), respectively. Wmax capacity was 90.8+/-5 W (basal) vs 92.9+/-5 W (Week 4, P=0.1) and 100.4+/-6 W (Week 8, 10.5%, P=0.04) in the DO group, and 96.2+/-6 W (basal) vs 129.1+/-4 W (Week 4, 34.1%, P=0.002) and 137.5+/-5 W(Week 8, 42.9%, P=0.002) in the DE group. Despite similar decreases in body weight in both groups, patients in the DE group achieved a markedly higher level of Wmax, reflecting a better improvement in cardiopulmonary fitness, compared with patients in the DO group. Considering the improvement of aerobic fitness in the short term, an aerobic exercise-training programme should be considered for sedentary obese patients to improve their aerobic fitness and thereby reduce the negative outcomes of obesity.

Anaerobic Threshold↗

Interactions of exercise training and ACE inhibition on insulin action in obese Zucker rats.

Exercise training or chronic treatment with angiotensin-converting enzyme (ACE) inhibitors can ameliorate glucose intolerance, insulin resistance of muscle glucose metabolism, and dyslipidemia associated with the obese Zucker rat. The purpose of the present study was to determine the interactions of exercise training and ACE inhibition (trandolapril) on these parameters in the obese Zucker rat. Animals were assigned to a sedentary control, a trandolapril-treated (1 mg. kg-1. day-1 for 6 wk), an exercise-trained (treadmill running for 6 wk), or a combined trandolapril-treated and exercise-trained group. Exercise training, alone or with trandolapril, significantly (P < 0. 05) increased peak O2 consumption by 31-34%. Similar decreases in fasting plasma insulin (34%) and free fatty acids (31%) occurred with exercise training alone or in combination with trandolapril. Compared with control, exercise training or trandolapril alone caused smaller areas under the curve (AUC) for glucose (12-14%) and insulin (28-33%) during an oral glucose tolerance test. The largest decreases in the glucose AUC (40%) and insulin AUC (53%) were observed in the combined group. Similarly, whereas exercise training or trandolapril alone improved maximally activated insulin-stimulated glucose transport in isolated epitrochlearis (26-34%) or soleus (39-41%) muscles, the greatest improvements in insulin action (67 and 107%, respectively) were seen in the combined group and were associated with similarly enhanced muscle GLUT-4 protein and total hexokinase levels. In conclusion, these results indicate combined exercise training and ACE inhibition improve oral glucose tolerance and insulin-stimulated muscle glucose transport to a greater extent than does either intervention alone.

Angiotensin-Converting Enzyme Inhibitors↗

Assessing the effect of exercise training in men with heart failure; comparison of maximal, submaximal and endurance exercise protocols.

AIMS: No consensus exists regarding the most appropriate exercise testing protocol for patients with congestive heart failure. This study describes the effect of exercise training on performance using three different protocols (maximal, submaximal and endurance testing) in patients with heart failure. METHODS AND RESULTS: Thirty men (mean age 67+/-8 years) with congestive heart failure in NYHA class III (mean ejection fraction 32+/-5%) were evaluated prior to and following exercise training. A maximal exercise cycle test with gas exchange measurements, a submaximal 6 min walk test and an endurance treadmill test with blood lactate sampling were used to evaluate exercise capacity after 12 weeks of exercise training. There was a 44.6% (P<0.001) increase in work performed during the maximal cycle test, with no significant increase in peak VO(2). The distance covered by the submaximal 6 min walk test increased by 8.1% (P<0.001). Lactate measured as area under the curve during the matched work intensity treadmill endurance test was reduced by 19.5% (P<0.005). CONCLUSION: We demonstrated a significant improvement in maximal, submaximal and endurance exercise capacity following 12 weeks of exercise training in patients with congestive heart failure. Endurance tests may be more sensitive and appropriate when assessing the efficacy of intervention in this population. Specifically, demonstration of reduced lactate production at matched work intensities suggests more efficient work and decreased dependence on anaerobic metabolism following training. Although maximal cycle tests are commonly used in clinical work, submaximal and endurance testing might be preferable for evaluating new treatment regimens in this population as they are easy to perform, are reproducible, and reflect daily tasks better than the maximal cycle test in this population.

Aged↗

Heterotopic renal transplantation in the rat: an advanced microsurgical training exercise.

Microsurgical training programs have instructed trainees from many surgical specialties with the expansion of these techniques into all areas of clinical surgery and experimental research. Most programs employ the rat femoral vessel model in microsurgical training. A more complex and less frequently used model, the rat renal transplantation procedure, can be used for advanced training in microsurgical and microurological techniques and offers several advantages over other microsurgical models. In the heterotopic renal transplant model, the left kidney from a donor rat is transferred to the inguinofemoral region of a syngeneic recipient. The method of revascularization can be varied from end-to-end repairs of vessels of equal diameter to those of unequal diameter. In addition to the variety of possible vascular repairs, an advantage of this model over others is that the kidney graft can be harvested by a technician, thus reducing the time commitments of the trainee. This model is ideal for microsurgeons, immunologists, and urologists, since it affords the opportunity for developing technical skills while preparing an experimental model that can be used for further research. We describe the model, the operative techniques, and the variations one can employ in performing the vascular repairs.

Anastomosis, Surgical↗

Heart rate and ratings of perceived exertion during treadmill and elliptical exercise training.

Elliptical exercise has recently increased in popularity. However, little is known regarding heart rate and perceptual responses during this exercise mode even though such information is important with respect to prescribing and regulating exercise intensity. In the current study, heart rate and perceived exertion were compared between treadmill and elliptical exercise. During treadmill exercise (TM(EST)) participants estimated RPE-Overall as well as RPE-Legs and RPE-Chest. Two elliptical sessions followed: (1) RPE estimation during elliptical exercise (EL(EST)): HR (b/ min.) from TM(EST) was achieved during elliptical exercise, with participants estimating RPE-Overall, RPE-Legs, and RPE-Chest. (2) RPE production during elliptical exercise (EL(PROD)): RPE-Overall from TM(EST) was produced during elliptical exercise. There were no significant differences between modes for RPE-Overall (TM(EST): 11.2 +/- 2.2 vs EL(EST): 11.9 +/- 3.2) or RPE-Chest (TM(EST): 11.0 +/- 2.4 vs EL(EST): 11.7+/- 3.2). Mean RPE-Legs was significantly different (TM(EST): 11.2 +/- 2.4 vs EL(EST): 12.5 +/- 3.1). Heart rate was not significantly different between TM(EST) (163 +/- 16.6) and EL(PROD) (159 +/- 20.0). Analysis indicated elliptical exercise is perceived as more intense with respect to leg (RPE-Legs) exertion. Further, RPE-Overall appears effective for regulating heart rate during elliptical exercise.

Adult↗

Effects of exercise training after open heart surgery on quality of life and exercise tolerance in patients with mitral regurgitation or aortic regurgitation.

We conducted a questionnaire survey regarding quality of life (QOL) to evaluate the effects of exercise training on the QOL in patients with valvular heart disease after surgery. This study included 64 consecutive patients who underwent heart surgery. They were divided into two groups: exercise training could (EX(+) group, n = 31) and could not be performed (EX(-) group, n = 33) until 6 months after surgery. To evaluate the QOL and exercise tolerance, we employed "a questionnaire regarding disease and quality of life" developed for Japanese people and cardiopulmonary exercise testing. In our questionnaire survey, the improvement rating (Delta subjective/social index), which was calculated from the difference between the pre-and postoperative values, was greater in the EX(+) group than that in the EX(-) group (4.9 +/- 3.1 versus 1.1 +/- 4.0, P < 0.05). In the changes in exercise tolerance, Delta anaerobic threshold was greater in the EX(+) group (0.79 +/- 0.17 versus -0.02 +/- 0.28, P < 0.01). Moreover, there was a positive correlation between Delta subjective/social index and Delta peak VO(2) (r = 0.62, P < 0.05). We concluded that exercise training for patients after cardiac surgery improves the QOL and exercise tolerance. It is suggested that changes in subjective and social parameters contribute to an exercise training-related improvement in the QOL.

Aged↗

Exercise training for intermittent claudication: does it adversely affect biochemical markers of the exercise-induced inflammatory response?

OBJECTIVES: To identify a stable biochemical marker of disease severity in patients with intermittent claudication and to use these findings to assess the effect of therapeutic exercise training. DESIGN: Case-control study: prospective randomised-controlled trial of exercise training. MATERIALS AND METHODS: Plasma fibrinogen, serum amyloid A protein (SAA), C-reactive protein (CRP) and urinary albumin-creatinine ratio (ACR) were measured in 67 claudicants and 15 controls. Twenty-two patients were randomised to supervised exercise training and 17 randomised to observation. Subjects were reviewed at 3, 6 and 12 months. RESULTS: The median (interquartile range) baseline fibrinogen was 3.7 g/l (3.3-4.25) in claudicants and 3.5 g/l (2.9-3.95) in controls (p = 0.045); CRP was 4.7 mg/l (2.2-9.0) and 2.1 mg/l (1.0-2.8), respectively (p < 0.0001); SAA was 72 mg/l (35-132) and 30 mg/l (20-89) (p = 0.0009). Claudicants showed an increased urinary ACR following treadmill exercise (Wilcoxon, p < 0.0001) with no change in controls. Exercise training reduced SAA at 6 months, CRP at 3 months and progressively attenuated the post-exercise increase in ACR. No similar changes were found in controls. CONCLUSIONS: Repetitive low-grade inflammatory events in claudicants lead to elevation of serum acute-phase proteins. Exercise training is associated with symptomatic improvement and reduction inflammatory markers. The concern that exercise has adverse systemic effects therefore seems to be unjustified.

Aged↗