PMID 29871697

Research
All papers

The effects of upper and lower limb exercise on the microvascular reactivity in limited cutaneous systemic sclerosis patients

Mitropoulos A, Gumber A, Crank H, Akil M, Klonizakis M

Question

Can upper-limb or lower-limb aerobic HIIT improve microvascular reactivity and fitness in limited cutaneous systemic sclerosis patients?

Summary

This randomized trial tested whether 12 weeks of twice-weekly supervised HIIT using either arm cranking or cycling could improve vascular function, fitness, and quality of life in people with limited cutaneous systemic sclerosis. Both exercise modes were feasible, highly compliant, and produced high heart-rate responses with no exercise-related complications. Arm-crank HIIT showed the clearest signal for improved digital microvascular endothelial-dependent function, while both exercise groups improved VO2peak and life satisfaction and reported less Raynaud's pain.

Methodology

  • Limited cutaneous systemic sclerosis patients with disease duration 1-10 years, mostly women, able to exercise.
  • 34 participants.
  • Arm crank ergometer or cycle ergometer.
  • Work intervals: 30 s.
  • Recovery: 30 s passive recovery.
  • Intensity: 100% peak power output.
  • 40 min including warm-up/cool-down.
  • 2 sessions/week.
  • 12 weeks.
  • Randomized three-group exercise trial comparing arm-crank HIIT, cycle-ergometer HIIT, and no-exercise control.
  • Microvascular reactivity, VO2peak, Raynaud's pain and life satisfaction, and Safety were tracked.

Outcomes

VO2peak

Both ACE and CE improved VO2peak after training; ACE improved significantly compared with control.

Both exercise groups p<0.01 versus baseline; ACE post 21.9 +/- 7.1 ml/kg/min.

Improved

Microvascular endothelial function

Arm-crank exercise showed improved acetylcholine CVCmax while control declined.

ACE ACh CVCmax 1.28 to 1.56; control 1.40 to 0.82; table marks ACE post change p<0.05.

Improved

Feasibility and tolerance

Both exercise groups had high compliance, high heart-rate responses, positive affect, and no exercise-related complications.

Compliance 92% ACE and 88% CE; HR 92.1% and 90.8% peak HR.

Improved

Insights

  • Upper-body HIIT may be useful when the target adaptation involves upper-limb or digital circulation.
  • A 30:30 work-rest structure can drive high heart-rate responses even with RPE around 13 in a supervised clinical population.
  • Clinical translation requires strict screening for systemic sclerosis complications.

Limitations

  • Small clinical sample.
  • No long-term follow-up.
  • Specialized equipment and supervision.
  • Some vascular findings were exploratory or trends.

Safety

  • No exercise-related complications were reported.
  • Control group had digital-ulcer/iloprost complications, including one amputation, but these were not exercise events.