“Walking through atherosclerosis” Il training fisico intensivo nel paziente claudicante: effetti a breve e a lungo termine di due diversi protocolli su autonomia di marcia, performance emodinamica, funziona piastrinica e stress ossidativo.

Physical training is a validated treatment of peripheral arteria disease, leading to a clinical and prognostic improvement for the patient. It acts through several mechanisms, not yet fully elucidated, and despite its proven effectiveness it has not yet clearly defined criteria for the prescription, and in particular it is not yet clear what will be the frequency that ensures the greatest results in terms of improving the quality of life and contrast of disease progression. Based on these assumptions, we have developed an open-label clinical trial with two parallel arms (ratio 1:1) with 26 months of follow-up: we enrolled patients with arterial occlusive disease stage II (according to the classification of Leriche -Fontaine), who performed a cycle of 15 days of training, with measurement before and after the cycle of maximum walking capacity (via Treadmill test), indices of inflammation and oxidative stress (HsPCR, malondialdehyde), platelet activation (PFA -100, expression on platelets surface of activated GpIIbIIIa and P-selectin), and hemodynamic parameters such as the femoral artery flow and cardiac performance. The patients were then consecutively allocated to two groups: one has performed a cycle of physical training every 4 months (total 6 rehabilitative cycles in 20 months, including the first cycle), the other one cycle every 10 months (3 cycles rehabilitative cycles in 20 months, including the first cycle ). At 6 months after the end of the last cycle of rehabilitation, in both groups, we measured again walking capacity, platelet function, oxidative stress, and hemodynamic parameters measured at enrollment. The primary end point was to evaluate the efficacy of a protocol of training more intense compared to a less intense protocol in improving the maximum walking distance 26 months after enrollment, in order to define the best frequency of training cycle that provides the best clinical, instrumental and laboratory results. The training cycle has led to an increase in maximum walking distance and a reduction of oxidative stress, inflammatory status and platelet activation, and also an improvement in cardiac performance and peripheral perfusion (ABI and femoral artery flow ). By analyzing two different protocols of frequency of training cycle, the more intensive protocol is more effective in the maintenance of clinical results, and of effect on hemodynamic, oxidative stress and inflammatory state. It could therefore be assumed a threshold effect of the frequency of administration of the training in patient with peripheral arterial disease, below which it would be lost in part the effects of previous training. It would be useful to analyze these issues on a larger scale in order to assess the optimal frequency of administration of training, and to validate univocal protocols of intervention in PAD patients.