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. Intermittent claudication has been considered the most classical symptom of lower extremity peripheral arterial disease (PAD). Our previous work shows that most men and women with PAD do not have classical symptoms of intermittent claudication. Our work also shows that persons with PAD who do not have intermittent claudication have significantly impaired lower extremity functioning compared to individuals without PAD. However, minimal data exist regarding the ability of exercise to improve impaired functioning in PAD persons without intermittent claudication. In addition, the ability of strength training to improve functioning in persons with PAD has been insufficiently studied. This study is a randomized controlled clinical trial to evaluate the effects of two specific exercise interventions on lower extremity functioning in 150 PAD patients with and without classical symptoms of intermittent claudication. Because of anticipated drop-outs, 195 individuals will be randomized into one of three study arms: a) supervised treadmill exercise training; b) supervised progressive resistance training; c) nutrition control group. After six-months of on-site exercise training, subjects will be transitioned to six-month home exercise programs to determine whether gains made during supervised training can be maintained in a home environment. Our primary outcome measures are the six-minute walk and the summary performance score- measures shown to be applicable to functioning during daily life. To determine mechanisms by which the exercise interventions improve lower extremity functioning, our secondary outcomes will include measurement of oxygen consumption, endothelial function, calf blood flow, viscosity, levels of inflammatory factors, and depressive symptoms.
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