This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor 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.
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