Oka Roberta K, Altman Matt, Giacomini John C, Szuba Andrzej, Cooke John P
University of California San Francisco, Department of Community Health Systems, School of Nursing, San Francisco, California 94143-0608, USA.
J Vasc Nurs. 2005 Dec;23(4):130-6; quiz 137-8. doi: 10.1016/j.jvn.2005.09.003.
Exercise is beneficial in improving claudication and functional capacity in patients with peripheral arterial disease (PAD). However, the physiologic response during and after exercise testing in this patient population has not been fully described. This study examined the cardiovascular response to exercise and explored the potential contribution of vascular noncompliance to exercise-induced hypertension in 124 patients with PAD and claudication and 31 comparison (C) patients with PAD with no walking limitations. Maximal walking distance was determined by an exercise treadmill test. Heart rate and blood pressure were monitored before, during, and immediately after an exercise test. Vascular compliance of the small and large vessels was measured using pulse waveform analysis. Individuals with low supine resting heart rate had longer pain-free walking distance (r = -0.195, P = .019) and maximal walking versus the C group (62 beats/min, standard deviation [SD] = 10, P = .02). Systolic blood pressure during supine rest was significantly lower for the PAD group (mean = 141 mm Hg, +/- SD = 22) versus the C group (mean = 153 mm Hg, +/- SD = 20, P = .003). Vascular compliance of large vessels was higher in the C group (mean = 4.13 +/- 4.13 mL/mm Hg x 100) compared with the PAD group (mean = 2.95 +/- 1.6 mL/mm Hg x 100). This study describes the exaggerated exercise cardiovascular response and impaired vascular compliance in patients with PAD. These results provide further evidence supporting the importance of a monitored treadmill exercise test before initiation of an exercise program to ensure safe and accurate exercise recommendations, and to identify individuals that require more intensive pharmacotherapy to prevent exercise-induced hypertension and tachycardia.
运动对改善外周动脉疾病（PAD）患者的间歇性跛行和功能能力有益。然而，这一患者群体在运动测试期间及之后的生理反应尚未得到充分描述。本研究检测了124例患有间歇性跛行的PAD患者和31例无行走限制的对照（C）PAD患者对运动的心血管反应，并探讨了血管顺应性对运动诱发高血压的潜在影响。通过运动平板试验确定最大行走距离。在运动测试前、期间和之后监测心率和血压。使用脉搏波形分析测量小血管和大血管的血管顺应性。静息心率较低的个体无痛行走距离更长（r = -0.195，P = 0.019），与C组相比最大行走距离更长（62次/分钟，标准差[SD]=10，P = 0.02）。PAD组仰卧位静息时的收缩压显著低于C组（平均值 = 141 mmHg，+/- SD = 22）（平均值 = 153 mmHg，+/- SD = 20，P = 0.003）。与PAD组（平均值 = 2.95 +/- 1.6 mL/mmHg x 100）相比，C组大血管的血管顺应性更高（平均值 = 4.13 +/- 4.13 mL/mmHg x 100）。本研究描述了PAD患者运动时夸张的心血管反应和受损的血管顺应性。这些结果提供了进一步的证据，支持在开始运动计划前进行监测的平板运动试验的重要性，以确保安全准确的运动建议，并识别需要更强化药物治疗以预防运动诱发的高血压和心动过速的个体。
