Exercise training as modulator of oxidation, platelet activation and inflammation in patients with peripheral arterial disease.

Recent evidences suggest that exercise training may ameliorate oxidative stress in patients with Peripheral Arterial Disease (PAD) and reduces inflammation; fewer data are available on platelets activation during strenuous exercise and ischemia-reperfusion damage in this clinical setting; no data regarding red cells fragments are described, even if these are markers of increased cardiovascular risk. So we aimed to focus our investigation on these aspects analyzing how supervised training with daily repeated bouts of ischemia reperfusion phenomena may improve these parameters. We analyzed in particular: Nuclear related factor 2 (Nrf2), monocytes (CD16+), Platelets function (with PAF 100 with ADP and epinephrine, P selectin), count of reticulated platelets (IPF), red blood cells fragments (FRC) and oxidative stress (malondyaldehyde). These parameters were analyzed at rest and after maximal treadmill test, defined as the maximal walking capacity on a standardized treadmill eliciting maximal ischemic pain. These evaluations were also repeated at the end of a supervised training period of 3 weeks. The training included a 30 minutes walking on treadmill reaching 70% of maximal walking distance repeated, so eliciting a moderate ischemia/reperfusion phenomena. Our experience shows that training in PAD patients reduces oxidative stress (decrease of MDA) and increases anti-oxidative defensive system enhancing Nrf2-gene expression. Platelet function analysis shows a decrease of ADP aggregation (with an acute increase after treadmill maximal test and reduced increase at the end of the period), P selectin and oxidative stress (malondyaldehyde) were analyzed at rest and after maximal treadmill test, at the beginning and at the end of the period. The shift of monocytes subtype from an inflammatory to a classic subtype suggests a deep change in inflammation profile of these patients with training. Training reduces IPF in PAD patients, IPF increase after maximal test and this fact is attenuated by training. FRC are reduced by training too. These data may improve the knowledge about the effects of training on mechanisms involving inflammation, platelets activation and red cells fragmentation probably also through an increase of antioxidant natural defense system mediated by ischemic conditioning.