Abstract
BackgroundAerobic exercise in general and high-intensity interval training (HIIT) specifically is known to improve vascular function in a range of clinical conditions. HIIT in particular has demonstrated improvements in clinical outcomes, in conditions that have a strong macroangiopathic component. Nevertheless, the effect of HIIT on microcirculation in systemic sclerosis (SSc) patients is yet to be investigated. Therefore, the purpose of the study was to compare the effects of two HIIT protocols (cycle and arm cranking) on the microcirculation of the digital area in SSc patients.MethodsThirty-four limited cutaneous SSc patients (65.3 ± 11.6 years old) were randomly allocated in three groups (cycling, arm cranking and control group). The exercise groups underwent a 12- week exercise program twice per week. All patients performed the baseline and post-exercise intervention measurements where physical fitness, functional ability, transcutaneous oxygen tension (ΔTcpO2), body composition and quality of life were assessed. Endothelial-dependent as well as -independent vasodilation were assessed in the middle and index fingers using LDF and incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP). Cutaneous flux data were expressed as cutaneous vascular conductance (CVC).ResultsPeak oxygen uptake increased in both exercise groups (p < 0.01, d = 1.36). ΔTcpO2 demonstrated an increase in the arm-cranking group only, with a large effect, but not found statistically significant,(p = 0.59, d = 0.93). Endothelial-dependent vasodilation improvement was greater in the arm-cranking (p < 0.05, d = 1.07) in comparison to other groups. Both exercise groups improved life satisfaction (p < 0.001) as well as reduced discomfort and pain due to Raynaud’s phenomenon (p < 0.05). Arm cranking seems to be the preferred mode of exercise for study participants as compared to cycling (p < 0.05). No changes were observed in the body composition or the functional ability in both exercise groups.ConclusionsOur results suggest that arm cranking has the potential to improve the microvascular endothelial function in SSc patients. Also notably, our recommended training dose (e.g., a 12-week HIIT program, twice per week), appeared to be sufficient and tolerable for this population. Future research should focus on exploring the feasibility of a combined exercise such as aerobic and resistance training by assessing individual’s experience and the quality of life in SSc patients.Trial registrationClinicalTrials.gov (NCT number): NCT03058887, February 23, 2017.
Highlights
Aerobic exercise in general and high-intensity interval training (HIIT) is known to improve vascular function in a range of clinical conditions
ACh showed that is not correlated with Arm crank ergometer (ACE) V O2peak, which does not confirm to previous findings that have shown association of endothelial-dependent function with the improvement in aerobic capacity in patients with rheumatoid arthritis [30]
HIIT (30 s 100% Peak power output (PPO)/30 s passive recovery) involving the upper limbs may improve the microvascular reactivity through an enhancement of the endothelial-dependent function
Summary
Aerobic exercise in general and high-intensity interval training (HIIT) is known to improve vascular function in a range of clinical conditions. The effect of HIIT on microcirculation in systemic sclerosis (SSc) patients is yet to be investigated. Blood vessels are directly affected by SSc, as manifested by the diverse clinical complications that take place from the initiation to the propagation of the disease, and have important ramifications on the quality of life (QoL) of patients. The blood vessels are unable to compensate for the impairment of blood flow during severe RP attacks and this leads to the so-called ischaemia-reperfusion reactions. These vascular complications may progress to gangrene and digital amputation [8]. SSc has the highest case-specific mortality of any rheumatic disease being associated with substantial morbidity [9]
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