Effects of warm-up on exercise capacity, platelet activation and platelet-leucocyte aggregation in patients with claudication.

Abstract

The effects of exercise and warm-up were investigated in patients with claudication. This case-control crossover study involved two treadmill exercise tests, one preceded by a warm-up. Exercise continued until maximal leg pain (patients with claudication) or exhaustion (controls). Blood was taken before, and 5 and 60 min after exercise for flow cytometric analysis of platelet activation and platelet-leucocyte aggregation. Both cohorts (eight patients with claudication of median age 63 years and eight healthy controls of median age 63.5 years) demonstrated improvement in exercise capacity after warm-up (13.1 per cent, P = 0.012 and 15.6 per cent, P = 0.008 respectively). Platelet activation increased after exercise in patients with claudication (fibrinogen binding: 1.11 per cent before exercise versus 2.63 per cent after exercise, P = 0.008; P-selectin: 0.68 versus 1.11 per cent, P = 0.028). Neither agonist stimulation nor warm-up altered this trend. Platelet-leucocyte (PLA) and platelet-neutrophil (PNA) aggregation were similarly increased immediately after exercise in patients with claudication (PLA: 7.6 versus 13.0 per cent, P = 0.004; PNA: 6.8 versus 10.2 per cent, P = 0.012). These remained high 60 min after exercise only in patients with claudication, but recovered to baseline levels when preceded by warm-up. Warm-up significantly desensitized PNA after stimulation with 10 micromol/l adenosine 5'-diphosphate at all time points. Warm-up increased the exercise capacity of patients with claudication. Exercise induced a thromboinflammatory response, with PLA and PNA persistently increased after 60 min in patients with claudication, an effect diminished after warm-up.