Manfredini Fabio, Malagoni Anna Maria, Mascoli Francesco, Mandini Simona, Taddia Maria Cristina, Basaglia Nino, Manfredini Roberto, Conconi Francesco, Zamboni Paolo
Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy.
Circ J. 2008 Jun;72(6):946-52. doi: 10.1253/circj.72.946.
Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E).
A total of 143 patients with claudication (117 men, average age 68+/-10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise heart rates (HR), systolic/diastolic brachial pressure (SBP/DBP), ankle pressure (AP), ankle-brachial index (ABI). Ti-To involved 2 daily 10-min home walking sessions at maximal asymptomatic speed and the patient attending monthly check-ups at hospital. Tr-E involved 20-30 min of daily walking at self-selected speeds up to pain tolerance. A total of 126 patients (Ti-To, n=74; Tr-E, n=52) completed the program. Ti-To induced better relief from claudication (p=0.001). Functional parameters improved significantly for both groups (p<0.0001) with significant intergroup difference for Ti-To (p<0.0001). SBP and exercise HR decreased significantly in both groups, with Ti-To improving resting HR (p=0.0002), DBP (p=0.003), lowest AP worse limb (p=0.004) and ABI worse limb (p=0.0002).
In patients with PAD, a Ti-To program had more positive effects on perceived claudication, and functional and hemodynamic parameters than did a Tr-E program.
运动训练可减轻外周动脉疾病（PAD）患者的步行障碍。本非随机研究评估了一种新型家庭康复方法——“训练中测试-训练后测试”（Ti-To）计划，与传统家庭自主步行锻炼（Tr-E）相比，对步行能力和血流动力学参数的影响。
共有143例间歇性跛行患者（117例男性，平均年龄68±10岁）被纳入Ti-To组（n = 83）或Tr-E组（n = 60）。在入组时以及第1、2、3、4和6个月进行评估，评估内容包括：自我报告的间歇性跛行情况、步行能力（即绝对跛行距离、疼痛阈值速度）、静息/运动心率（HR）、肱动脉收缩压/舒张压（SBP/DBP）、踝部压力（AP）、踝臂指数（ABI）。Ti-To计划包括每天两次、每次10分钟的以最大无症状速度进行的家庭步行训练，以及患者每月到医院进行一次检查。Tr-E包括每天以自我选择的速度步行20 - 30分钟，直至疼痛耐受。共有126例患者（Ti-To组，n = 74；Tr-E组，n = 52）完成了该计划。Ti-To计划能更好地缓解间歇性跛行（p = 0.001）。两组的功能参数均有显著改善（p < 0.0001），且Ti-To组与Tr-E组之间存在显著的组间差异（p < 0.0001）。两组的SBP和运动HR均显著降低，Ti-To组还改善了静息HR（p = 0.0002）、DBP（p = 0.003）、较差肢体的最低AP（p = 0.004）以及较差肢体ABI（p = 0.0002）。
在PAD患者中，与Tr-E计划相比，Ti-To计划在缓解间歇性跛行、功能和血流动力学参数方面具有更积极的效果。
