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低强度家庭步行运动不能改善外周动脉疾病患者的步行距离
作者:小柯机器人 发布时间:2021/4/7 14:48:34

美国维克森林大学W. Jack Rejeski联合西北大学范伯格医学院Mary M. McDermott团队,研究了低强度与高强度家庭步行运动对外周动脉疾病患者步行距离的影响。

指导性高强度步行运动可引起下肢缺血症状,是治疗下肢周围动脉疾病(PAD)的首选疗法,但依从性较差。

为了确定与可能诱发腿部缺血症状的高强度家庭步行运动,或不运动对照组相比,低强度家庭步行运动是否能显著改善PAD患者的步行能力,研究组在美国4个中心进行了一项多中心随机临床试验,2015年9月25日至2019年12月11日,共招募了305名PAD参与者。将其随机分组,其中低强度步行运动组116名、高强度步行运动组124名,不运动对照组65名,为期12个月。

两个运动组都要求在无监督的环境下每周步行5次,每次最多50分钟,佩戴一个记录运动强度和时间的加速计。低强度组的步行速度没有出现腿部缺血症状。高强度组的步行速度导致中度至重度腿部缺血症状。加速计数据可供教练查看,教练连续12个月每周给参与者打电话,帮助他们坚持规定的锻炼。不运动对照组接受为期12个月的每周教育电话。主要结局是12个月时6分钟步行距离的平均变化。

305例患者的平均年龄为69.3岁,女性146例,占47.9%,黑人181例,占59.3%,共有250例(82%)完成了12个月的随访。低强度运动组的6分钟步行距离从基线检查时的332.1米变为12个月随访时的327.5米,高强度运动组则从338.1米增加至371.2米,组间比较的平均变化为−40.9 m,差异显著。

不运动对照组6分钟步行距离从基线检查时的328.1米变为12个月随访时的317.5米,与低强度运动组的变化相比无显著差异。在184例严重不良事件中,低强度组、高强度组和不运动对照组的事件发生率分别为0.64、0.65和0.46。每个运动组中均有一例与研究有关的严重不良事件。

研究结果表明,对于PAD患者,低强度家庭锻炼的效果明显低于高强度家庭锻炼,且在改善6分钟步行距离方面与不运动对照组无显著差异。

附:英文原文

Title: Effect of Low-Intensity vs High-Intensity Home-Based Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease: The LITE Randomized Clinical Trial

Author: Mary M. McDermott, Bonnie Spring, Lu Tian, Diane Treat-Jacobson, Luigi Ferrucci, Donald Lloyd-Jones, Lihui Zhao, Tamar Polonsky, Melina R. Kibbe, Lydia Bazzano, Jack M. Guralnik, Daniel E. Forman, Al Rego, Dongxue Zhang, Kathryn Domanchuk, Christiaan Leeuwenburgh, Robert Sufit, Brittany Smith, Todd Manini, Michael H. Criqui, W. Jack Rejeski

Issue&Volume: 2021/04/06

Abstract:

Importance  Supervised high-intensity walking exercise that induces ischemic leg symptoms is the first-line therapy for people with lower-extremity peripheral artery disease (PAD), but adherence is poor.

Objective  To determine whether low-intensity home-based walking exercise at a comfortable pace significantly improves walking ability in people with PAD vs high-intensity home-based walking exercise that induces ischemic leg symptoms and vs a nonexercise control.

Design, Setting, and Participants  Multicenter randomized clinical trial conducted at 4 US centers and including 305 participants. Enrollment occurred between September 25, 2015, and December 11, 2019; final follow-up was October 7, 2020.

Interventions  Participants with PAD were randomized to low-intensity walking exercise (n=116), high-intensity walking exercise (n=124), or nonexercise control (n=65) for 12 months. Both exercise groups were asked to walk for exercise in an unsupervised setting 5 times per week for up to 50 minutes per session wearing an accelerometer to document exercise intensity and time. The low-intensity group walked at a pace without ischemic leg symptoms. The high-intensity group walked at a pace eliciting moderate to severe ischemic leg symptoms. Accelerometer data were viewable to a coach who telephoned participants weekly for 12 months and helped them adhere to their prescribed exercise. The nonexercise control group received weekly educational telephone calls for 12 months.

Main Outcomes and Measures  The primary outcome was mean change in 6-minute walk distance at 12 months (minimum clinically important difference, 8-20 m).

Results  Among 305 randomized patients (mean age, 69.3 [SD, 9.5] years, 146 [47.9%] women, 181 [59.3%] Black patients), 250 (82%) completed 12-month follow-up. The 6-minute walk distance changed from 332.1 m at baseline to 327.5 m at 12-month follow-up in the low-intensity exercise group (within-group mean change, 6.4 m [95% CI, 21.5 to 8.8 m]; P=.34) and from 338.1 m to 371.2 m in the high-intensity exercise group (within-group mean change, 34.5 m [95% CI, 20.1 to 48.9 m]; P<.001) and the mean change for the between-group comparison was 40.9 m (97.5% CI, 61.7 to 20.0 m; P<.001). The 6-minute walk distance changed from 328.1 m at baseline to 317.5 m at 12-month follow-up in the nonexercise control group (within-group mean change, 15.1 m [95% CI, 35.8 to 5.7 m]; P=.10), which was not significantly different from the change in the low-intensity exercise group (between-group mean change, 8.7 m [97.5% CI, 17.0 to 34.4 m]; P=.44). Of 184 serious adverse events, the event rate per participant was 0.64 in the low-intensity group, 0.65 in the high-intensity group, and 0.46 in the nonexercise control group. One serious adverse event in each exercise group was related to study participation.

Conclusions and Relevance  Among patients with PAD, low-intensity home-based exercise was significantly less effective than high-intensity home-based exercise and was not significantly different from the nonexercise control for improving 6-minute walk distance. These results do not support the use of low-intensity home-based walking exercise for improving objectively measured walking performance in patients with PAD.

DOI: 10.1001/jama.2021.2536

Source: https://jamanetwork.com/journals/jama/article-abstract/2778112

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex