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- Title
Exercise, angiogenesis and critical limb ischemia.
- Authors
Ioana Constantinescu, Mihaela; Petru Constantinescu, Dan; Andercou, Aurel; Mironiuc, Aurel
- Abstract
Angiogenesis is formation of new blood vessels. This growth process is a complex process that involves multiple factors. Angiogenesis-related factors are: endogenous stimulators of angiogenesis (vascular endothelial growth factor VEGF; placental growth factor; angiopoietins; nitric oxide; basic fibroblast growth factor; angiotensin II; monocyte chemotactic protein 1; integrins; matrix metalloproteinases) and endogenous inhibitors of angiogenesis (angiostatin; endostatin; thrombospondin 1; soluble VEGRF1; tissue inhibitors of matrix metalloproteinases; platelet factor 4). Angiogenesis is present in adults in processes such as wound healing, formation of corpus luteum after ovulation, formation of new endometrium after menstruation and exercise remodelling. Many diseases are associated with chronic angiogenesis such as tumour growth, rheumatoid disease; chronic limb ischemia, arterial occlusive disease. Skeletal muscle is richly supplied with blood vessels: arteries, capillaries and veins. The amount of blood required by skeletal muscle is determined by cardiac and vascular factors, depending on its state of activity. Skeletal muscle circulation and blood flow are greatly increased during exercise. Skeletal muscle requires approximately 20% of cardiac output in basal conditions and blood flow can increase 10 to 20 times during exercise. The distribution of blood volume that occurs during exercise, so that the active muscles receive the greatest proportion of cardiac output, results from: vasoconstriction of the arterioles (resistance vessels) supplying the metabolically less active areas of the body and vasodilatation of the arterioles supplying the metabolically more active skeletal muscle. Numerous investigators have demonstrated the implication of oxidative stress in exercise and in critical illness. Moderate exercise is a pro-oxidant factor: a small amount of reactive oxygen species stimulates growth, vascular tonus and angiogenesis, but causes an increase of the endogenous antioxidant defenses. Stimulation of the angiogenesis is a new concept in the treatment of peripheral arterial disease and critical limb ischemia. Exercise hyperemia determines vascular remodeling in response to exercise and may help resolve a critical limb ischemia. In most patients with intermittent claudication, invasive procedures are not indicated, and physical exercise is the primary treatment strategy. Because most patients studied have mild to moderate claudication, little is known about the clinical benefits of exercise in critical limb ischemia. Exercise serves as a kinetotherapy method and an alternative antioxidant strategy in patients with critical limb ischemia.
- Subjects
NEOVASCULARIZATION; EXERCISE; ISCHEMIA; CATASTROPHIC illness; MATRICES (Mathematics); METALLOPROTEINASES; TISSUE inhibitors of metalloproteinases
- Publication
Palestrica of the Third Millennium Civilization & Sport, 2013, Vol 14, Issue 2, p134
- ISSN
1582-1943
- Publication type
Article