Effects of supervised exercise on reticulated reactive platelets and erythrocyte fragments in patients with peripheral atherosclerosis.

Training is a effective treatment in patients with peripheral arterial disease (PAD). Platelet activation plays an important role in atherosclerosis progression. Reticulated platelets (IPF) are young platelets highly reactive and have been associated to cardiovascular complications with unstable conditions. Furthermore presence of a width blood red cell distribution, depends greatly on presence of red blood cells fragmentation and is considered as a negative prognostic factor for coronary artery disease. FRC may be related to inflammation and high oxidative stress. Few data can be found for patients with peripheral arterial disease on training. We aimed to evaluate the effects of aerobic training on IPF and FRC at rest and after maximal walking exercise before and after training. We enrolled 12 patients with intermittent claudication at stage II of Leriche-FOntaine Classification. They were submitted to a 15 days aerobic training period (cycling and treadmill exercise under maximal walking capacity - with pain elicited to moderate level - at least 70% of maximal capacity ). IPF, PLT count, PLT volume (MPV) and FRC were analyzed at rest, 1 hour after maximal treadmill test and after 24 hours, these exams were performed at the beginning and at the end of the training period. The Lab parameters were analyzed with impedentiometry, fluorimetry (oxazyne) and optical methods (Sysmex Xn-1000, Sysmex Corporation, Kobe, Japan). Walking distance was measured with treadmill (3,2 km/h, 2-10% slope), maximal test was prolonged to the maximal tolerated claudication pain. Platelets count was within normal range (216,9 ± 40 109/l ) and did not changed throughout the study; also MPV was unchanged (11,6±1,9 vs 11.45±0,8 fl ) ; plateletcrit was slightly reduced (0,246±0,061 vs 0,282 ±0,018 %). IPF count (figure) slightly changed during maximal stress at the beginning of training with increase after 24 hours; after training the count decreased significantly (*p<0,05) at rest and 1 hour after, while it increased significantly after 24 hours (** p<0,05 vs rest ad vs 24 h-pre) but less than before training. FRC decreased after triaining (0,381±0,121 vs 0,542±0,220 %; p<0,05), maximal test slightly increased FRC after 1 hour , no significant change after 24 hours.At the end of training, absolute walking distance increased (450±180 vs 250±108 m; p<0,05).Training reduces IPF in PAD patients, IPF increase after maximal test and this fact is attenuated by training. FRC are recused by training too; high FRC in these patients may be caused by mechanical forces throughout a large surface of atherosclerotic plaques, other mechanismstraining in PAD patients reduces IPF and FRC with potential improvement in risk involved are ischemia-reperfusion and oxidative stress. IPF are associated with an increase platelets activity and a higher turnover; in PAD both these conditions can be found associated with oxidative stress, inflammation and endothelial dysfunction. In conclusion we can hypotesize that training improving oxidation, inflammation and endothelium function, may cause favorable effects on platelets activation (IPF) and on FRC count.