Exercise training can mitigate symptoms of claudication (walking-induced muscle pain) in patients with peripheral artery disease (PAD). One adaptive response enabling this improvement is enhanced muscle oxygen metabolism. To explore this issue, we used arterial-occlusion diffuse optical spectroscopy (AO-DOS) to measure the effects of exercise training on the metabolic rate of oxygen (MRO2) in resting calf muscle. Additionally, venous-occlusion DOS (VO-DOS) and frequency-domain DOS (FD-DOS) were used to measure muscle blood flow (F) and tissue oxygen saturation (StO2), and resting calf muscle oxygen extraction fraction (OEF) was calculated from MRO2, F, and blood hemoglobin. Lastly, the venous/arterial ratio (gamma) of blood monitored by FD-DOS was calculated from OEF and StO2. PAD patients who experience claudication (n = 28) were randomly assigned to exercise and control groups. Patients in the exercise group received 3 months of supervised exercise training. Optical measurements were obtained at baseline and at 3 months in both groups. Resting MRO2, OEF, and F, respectively, increased by 30% (95%CI 12% to 44%, p < 0.001), 17% (95%CI 6% to 45%, p = 0.003), and 7% (95%CI 0% to 16%, p = 0.11), after exercise training (median (interquartile range)). The pre-exercise gamma was 0.76 (95%CI 0.61 to 0.89); it decreased by 12% (95%CI 35% to 6%, p = 0.011) after exercise training. Improvement in exercise performance was associated with a correlative increase in resting OEF (R = 0.45, p = 0.02).

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