Carlon Roberto, Morlino Tommaso, Maiolino Pietro
Cardiovascular Department, Cittadella Hospital, Azienda ASSL 15 Alta Padovana, Cittadella, PD, Italy.
Ital Heart J. 2003 Feb;4(2):113-20.
The quality of life and autonomy may be severely hampered in patients with intermittent claudication, but the amputation rate is very low. Supervised exercise training is effective, but still very rarely employed. Many authors think that in these patients exercise over the pain threshold may be dangerous. The aim of this study was to assess whether supervised, 3-month duration, 3 times/week, beyond the pain threshold exercise training is safe and whether it improves both the performance and quality of life in patients with claudication.
Forty-three patients with claudication, confirmed at Doppler study and/or angiography, have been evaluated by means of graded treadmill testing, the ankle-brachial pressure index at rest and after walking and a Walking Impairment Questionnaire before and after 3 months of treadmill training beyond the claudication threshold.
Patients showed an 86% increase in time to onset of claudication pain (p < 0.00001), a 50% increase in total walking time (p < 0.000001) and improved questionnaire scores of pain intensity (%, p < 0.005), distance covered (+87%, p < 0.005), speed (+42%, p < 0.05), and stair climbing (+25%, p = NS). The basal and post-exercise ankle-brachial pressure index was not modified by training. Analysis of all subgroups of patients (</> 65 years of age, with/without coronary artery disease and diabetes mellitus, pre-training time to onset of claudication pain </> 3 min, with angiographic/Doppler occlusion or stenosis) revealed a statistically significant increase in both time to onset of claudication pain and total walking time.
Supervised physical training beyond the claudication threshold significantly improves the walking time and quality of life of patients with claudication.
间歇性跛行患者的生活质量和自主性可能会受到严重影响，但截肢率很低。有监督的运动训练是有效的，但仍然很少被采用。许多作者认为，在这些患者中，超过疼痛阈值的运动可能是危险的。本研究的目的是评估为期3个月、每周3次、超过疼痛阈值的有监督运动训练是否安全，以及它是否能改善跛行患者的运动能力和生活质量。
通过分级平板运动试验、静息及行走后的踝肱压力指数，以及在超过跛行阈值进行3个月平板训练前后使用步行障碍问卷，对43例经多普勒检查和/或血管造影确诊为跛行的患者进行了评估。
患者出现跛行疼痛的时间增加了86%（p < 0.00001），总步行时间增加了50%（p < 0.000001），问卷中疼痛强度（%，p < 0.005）、行走距离（+87%，p < 0.005）、速度（+42%，p < 0.05）和爬楼梯能力（+25%，p =无统计学意义）得分均有所改善。训练前后的基础及运动后踝肱压力指数未因训练而改变。对所有患者亚组（年龄≤65岁、有/无冠状动脉疾病和糖尿病、训练前出现跛行疼痛的时间≤3分钟、有血管造影/多普勒闭塞或狭窄）的分析显示，出现跛行疼痛的时间和总步行时间均有统计学显著增加。
超过跛行阈值的有监督体育训练能显著改善跛行患者的步行时间和生活质量。
