A randomised controlled trial of two supervised exercise regimens and their impact on inflammatory burden in patients with intermittent claudication

Objective: This study assesses the impact of treadmill-based SET alone or in combination with resistance training on systemic inflammatory response, in patients with intermittent claudication (IC). Methods: Thirty-five patients with IC were randomised to 12 weeks of treadmill-only SET (Group 1) or a combination of treadmill and lower-limb resistance SET (Group 2). A panel of pro- and anti-inflammatory markers were assessed before, during and after the SET. Results: Over the duration of SET, homocysteine increased within Group 1 (12.0–15.5 µmol/L, p = 0.003) but not Group 2, (13.7–14.7 µmol/) while neutrophil elastase (NE) increased within Group 2 (174.5–238.2 ng/mL, p = 0.007) but not Group 1 (300.8–312.0 ng/mL). In both groups NE increased following acute exercise at the start of the SET. Differences in cytokine expression was evident between the two groups (in Group 1, pro-inflammatory cytokines interleukin-12 and interferon-gamma decreased following an acute bout of exercise at the end of SET, where as in Group 2 pro-inflammatory cytokines interleukin-6 and 8 were seen to increase after an acute bout of exercise at the end of SET). Conclusion: SET in patients with IC influences the complex immune-modulatory state of atherosclerosis through inflammatory pathways that induce both pro-inflammatory and immunosuppressive responses.