Gibellini R, Fanello M, Bardile A F, Salerno M, Aloi T
Salvatore Maugeri Foundation, IRCCS, Rehabilitation Institute, Montescano, Italy.
Int Angiol. 2000 Mar;19(1):8-13.
Peripheral arterial occlusive disease (PAOD) at II stage results in a moderate to severe impairment in walking ability. Aim of this study, controlled and randomized, was to evaluate the efficacy of an intensive 4 weeks exercise training in PAOD followed by a six-month period and to analyse the risk factors for atherosclerosis and the site of the lesion for possible predictors of result outcome.
Patients with PAOD were included in the study (ankle/arm ratio < or = 0.7 and < or = 0.5 after exercise) with initial claudication distance (ICD) < or = 200 m and absolute claudication distance (ACD) < or = 500 m evaluated on a constant-load treadmill test (3 km/hr, 0% slope). Forty patients were randomized (all with antiplatelet therapy): 20 to a supervised walking exercise (mean ICD 121.8 m, ACD 289.7 m) and 20 to a non exercising control group (ICD 111.6 m, ACD 230.1 m). Both groups were tested at 4 weeks (T1) and 6 months (T2). Training group was enrolled in a 4-week supervised training program.
In the training group 10% of patients became asymptomatic (>1000 m). At T1 ICD increased 141% (p<0.001) and ACD was with low-pain-claudication >1000 m in 50%, at T2 ICD was 200% (p<0.05) with 70% of asymptomatic for ICD and ACD. Control group has a no significant increase of ICD and ACD at T1 and T2. Only arterial hypertension and intermittent claudication severity emerged as negative predictive factors for the results of training.
Vascular training produces a significant and lasting improvement in walking distance in PAOD.
二期外周动脉闭塞性疾病（PAOD）会导致步行能力出现中度至重度损害。本随机对照研究的目的是评估为期4周的强化运动训练对PAOD患者的疗效，该训练为期6个月，并分析动脉粥样硬化的危险因素以及病变部位，以寻找可能的结果预测指标。
纳入PAOD患者（运动后踝/臂比值≤0.7且≤0.5），初始跛行距离（ICD）≤200米，绝对跛行距离（ACD）≤500米，通过恒定负荷跑步机测试（3公里/小时，0%坡度）进行评估。40名患者被随机分组（均接受抗血小板治疗）：20名接受有监督的步行运动（平均ICD为121.8米，ACD为289.7米），20名进入非运动对照组（ICD为111.6米，ACD为230.1米）。两组均在4周（T1）和6个月（T2）时进行测试。训练组参加为期4周的有监督训练计划。
训练组中10%的患者无症状（>1000米）。在T1时，ICD增加了141%（p<0.001），50%的患者低疼痛性跛行时ACD>1000米；在T2时，ICD为200%（p<0.05），70%的患者ICD和ACD无症状。对照组在T1和T2时ICD和ACD无显著增加。只有动脉高血压和间歇性跛行严重程度是训练结果的负性预测因素。
血管训练能使PAOD患者的步行距离得到显著且持久的改善。
