Peripheral arterial disease (PAD) is characterised by lower-limb ischaemic pain during walking, which limits peak exercise performance and oxygen consumption during graded treadmill exercise testing (Hiatt et al. 1987). Upper-limb aerobic exercise, however, is well tolerated by these patients (Zwierska et al. 2002) and an improvement in their cardiorespiratory capacity through a training intervention might also provide an improvement in walking performance.

Following familiarisation with the training and assessment protocols, 27 patients (16 males, 11 females, median age 67 years, range 50-82 years) with stable PAD were randomised into arm- and leg-crank exercise training groups or a non-exercise training control group. Training was performed twice weekly for 24 weeks, with incremental arm- and leg-crank assessments to maximum exercise tolerance being undertaken before and after the intervention period in all groups. A standard electronically braked cycle ergometer (modified for arm-cranking) was used for all incremental assessments, with work rate being increased by 7.5 and 15 W per increment in arm- and leg-crank assessments, respectively. Pulmonary gas exchange variables and blood lactate concentration were recorded at each work increment. Walking performance was assessed at the same time points on flat ground using a shuttle-walk protocol (Walker et al. 2000). Approval for this study was obtained from the North Sheffield Local Research Ethics Committee.

Peak oxygen uptake measured during the incremental arm-crank assessment was unchanged following the intervention period in both exercise training groups and in the controls. However, peak oxygen uptake (mean ± S.E.M.) measured during the incremental leg-crank assessment was improved to a similar degree following both arm (1.02 ± 0.14 versus 1.29 ± 0.16 l min^-1, P < 0.01; ANOVA) and leg (1.03 ± 0.08 versus 1.32 ± 0.12 l min^-1, P < 0.01; ANOVA) training, but not in the controls. Maximum walking distance improved by 27 % (P < 0.01; ANOVA) and 37 % (P < 0.01; ANOVA) following arm and leg training, respectively, and was highly correlated with the change in peak oxygen uptake measured during incremental leg cranking (r = 0.8; P < 0.01) in the leg training group only. Only moderate correlations (r ~0.4; P < 0.05) were observed between blood lactate concentrations measured at the end of the incremental leg-crank assessment and maximum walking distance. Arm-cranking appears to be a good exercise modality for improving walking performance in patients with PAD.

We acknowledge the support of the British Heart Foundation.