Ny behandling av røykerbein
Five plus’ an exercise study of patients with peripheral arterial disease
Periferal arterial disease presents as limb discomfort during exercise. Exercise treatment has proven to increase maximal walking distance. The aim of the present study is to evaluate calf-raises exercise training(five +), in patients with PAD compared to current recommendations of daily walking and the effect on mitochondrial oxidative capacity.
5+ training consists of standing in front of a wall, which is used for hand support and balance. The body will be lifted with the calf musculature to the maximal height that the subject can achieve. This will be repeated until pain is felt in the musculature. Following the initiation of pain the subject will perform five extra repetitions. Since this training only utilizes the body weight, the training can be performed at home without additional equipment or costs.
The five extra raises secure induction of ischemia and reperfusion. This is equal to preconditioning. Preconditioning is known to increase the number and function of mitochondria. The mitochondria is the energy factory in all cells and the overall question in the project is if improved efficiency in energyproduction can compensate for bad circulation (Røykerbein). The project has all characteristics to be brought from the university level to the general practioneer (Samhandling)
The logistics in the project is fully established, which includes the installation and education of a new pletysmograph from USA, working relations to collaborators such as "forskningsposten", Department of Surgery St Olavs Hospital(where the patients are recruited), the CERG-group and a new method to measure mitochondrial function in the muscles. The latter method has partly been learned in Austria.
We have tested patients in the first project in the Phd and the findings are very promising. The aim of the first study was to see how big the influence is after only one training session with 5+. We see a 33% increase in mitochondrial function already after 3 hours. The results will be the base for the first publication with this totally new training method, which has biological and logistical advantages to previous conservative managements of patients with claudication (Røykerbein).
We are currently organising the next study which will be a prospective randomised trial comparing home based 5+ training with conventional training. It is a step with many persons involved but the detailed time schedule aiming at disputation late 2016 is followed and there is no delay. We do think that this project will contribute not only to academic training but also to form a new method which can be beneficial to the biggest patient group in the field of Cardio-Vascular disease.
New Training method - Claudication
Claudicatio intermittens (røykerbein) is very common. The project wants to test if improved mitochondrial function, which is the "energy factory" can compensate for reduced circulation
The study describes a clinical trial designed to test if "Five plus training"(5+) induces changes in qualitative and quantitative response in the mitochondria. The idea is that improved energy production from mitochondria will compensate for reduced circulation to the legs in patients with claudication intermittent (røykerbein). Furthermore the method should be used by the patients at home. 5+ training consists of standing in front of a wall which is used for hand support and balance. The body will be lifted with the calf musculature to the maximal height that the subject can achieve. This will be repeated until pain is felt in the musculature. Following the initiation of pain the subject will perform five extra repetitions(5+). Since this training only utilizes the body weight, the training can be performed at home without additional equipment or cost. There is a natural progression of training dose as muscular adaptation occurs. The presence of pain = ischemia to be followed with reperfusion is the same as preconditioning which is known to improve mitochondrial function.
The project has established a pletysmograph for evaluation of blood flow with international support. The study has reached ethical approval. The involved people have been in a special laboratory abroad(Austria) to learn new and precise mitochondrial tests. A new laboratory set to study mitochondria is established. All tests have been performed on healthy subjects on which in addition muscle biopsies have been taken to measure mitochondrial function. All doctors and nurses are repeatedly informed. In summary all outlined methods in the application is now established and the recruitment of patients can begin. We will have clinical results at the next report.