But it is not just the heart that is affected - blood flow can be blocked to the legs too, leading to pain when walking, immobility and even in extreme cases, amputation.

Approximately 20% of us will suffer from this peripheral artery disease (PAD) once we are 65 or over, and with risk factors including smoking, diabetes, obesity and high blood pressure it is on the rise. Surgical intervention can sometimes help, but the prognosis is not good.

Encouragingly, new research by Ronald Terjung et al1. published in The Journal of Physiology shows that regular, moderate exercise can go a long way to relieving the symptoms of PAD, and by some unexpected mechanisms.

When a major artery in the leg becomes blocked, the body naturally seeks another route for the blood to pass through by expanding and multiplying the surrounding smaller blood vessels in the area, called collateral blood flow.

The researchers studied rats with a blocked femoral artery and found that collateral blood flow was much more effective in restoring normal muscle function in rats that were put on regular exercise training.

The collateral vessels themselves were larger and less prone to constriction “ a problem exacerbated with PAD “ than in sedentary animals. Surprisingly, the function of blood vessels 'downstream' of the blockage also changed, making them more efficient.

The authors predict that a suitable exercise programme would delay the onset of pain and increase mobility for people suffering with PAD.

"Our findings raise the potential that new collateral vessels, that can develop in patients with PAD who are physically active, will function effectively to help minimize the consequences of the original vascular obstruction." commented Dr Terjung.

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Duloxetine is approved in the United States for the acute and maintenance treatment of major depressive disorder, the acute treatment of generalized anxiety disorder, and the management of diabetic peripheral neuropathic pain and fibromyalgia in adults aged 18 years and older. Duloxetine is not approved for use in pediatric patients.

Safety Information

Duloxetine is approved to treat major depressive disorder and generalized anxiety disorder, and to manage diabetic peripheral neuropathic pain and fibromyalgia. Antidepressants can increase suicidal thoughts and behaviors in children, adolescents, and young adults. Patients should call their doctor right away if they experience new or worsening depression symptoms, unusual changes in behavior, or thoughts of suicide. Be especially observant within the first few months of treatment or after a change in dose. Duloxetine is approved only for adults 18 and over.

Duloxetine is not for everyone. Patients should not take duloxetine if they have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI), are taking Mellaril(R) (thioridazine), or have uncontrolled glaucoma. Patients should speak with their doctor about any medical conditions they may have including kidney problems, glaucoma, or diabetes. Patients should talk to their doctor if they have itching, right upper belly pain, dark urine, yellow skin or eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported. They should also talk to their doctor about alcohol consumption. Patients should tell their doctor about all their medicines, including those for migraine, to avoid a potentially life-threatening condition. Taking duloxetine with NSAID pain relievers, aspirin, or blood thinners may increase bleeding risk. Patients should consult with their doctor before stopping duloxetine or changing the dose and if they are pregnant or nursing.

Patients taking duloxetine may experience dizziness or fainting upon standing. The most common side effects of duloxetine include nausea, dry mouth, sleepiness, and constipation. This is not a complete list of side effects.

For full Patient Information, visit www.cymbalta.

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