Andreozzi G M, Leone A, Martini R, Laudani R, Salimistraro G, Deinite G
Angiology Care Unit, University Hospital of Padua, Padua, Italy.
Int Angiol. 2008 Oct;27(5):401-7.
The purpose of this study was to assess the costs and effectiveness of a short-course physical training program, consisting of an aerobic protocol with clearly defined working loads in each single training session, in patients with intermittent claudication (IC).
Initial (ICD), absolute (ACD) claudication distance, and recovery time (RT) have been measured by maximal treadmill exercise in 74 claudicants. Ankle brachial index (ABI) has been measured too. Measurements have been repeated after 18 days of supervised physical training consisting of a daily walk reaching either a distance goal of 1-2 km or a time goal of at least 30 min. The working load of each single training session has been tailored at 60-70% of the ACD measured by a non-maximal treadmill exercise.
ICD increased from 56.2 (+/- standard deviation/+/- standard error: 35.3/4.1) to 123.9 (66.5/7.7); ACD increased from 104.8 (49.8/5.8) to 195.1 (81.7/9.5) and RT reduced from 201.2 (98.3/11.4) to 85.8 (43.6/5.1), with P<0.0001 for all parameters. We analyzed separately patients with moderate (M-CL) and severe (S-CL) claudication, and found significant improvements in both groups. The Ds (post-training value minus pretraining value) were: ICD 89.6 (59.9/10.9) in M-CL and 50.2 (29.9/4.6) in S-CL; ACD 102.8 (66.8/11.6) in M-CL and 80.1 (41.5/6.4) in S-CL; RT -98.7 (86.9/15.1) in M-CL and -128.5 (88.1/13.7) in S-CL, with P<0.0001 for all parameters. The differences between M-CL and S-CL were significant only for ICD (P=0.0003) and ACD (P<0.05). ABI showed an increasing trend, which was statistically significant (P<0.001), but clinically irrelevant. The protocol cost was 4179 Euro (average cost 46.30 Euro to walk one additional meter).
Supervised physical training is confirmed to be an effective tool for the treatment of IC, and the proposed short-course protocol gave the same improvements as the longer ones while reducing the costs. The proposed procedure for tailoring the working load of a single session identifies clearly the working load, near maximal pain but avoiding the risk of inflammatory activation.
本研究旨在评估一项短期体育训练计划的成本和效果，该计划包括在每次单独训练中具有明确规定工作负荷的有氧运动方案，用于间歇性跛行（IC）患者。
通过最大跑步机运动测量了74名跛行患者的初始（ICD）、绝对（ACD）跛行距离和恢复时间（RT）。还测量了踝肱指数（ABI）。在进行了18天的监督体育训练后重复测量，训练包括每天步行，达到1 - 2公里的距离目标或至少30分钟的时间目标。每次单独训练的工作负荷根据通过非最大跑步机运动测量的ACD的60 - 70%进行调整。
ICD从56.2（±标准差/±标准误：35.3/4.1）增加到123.9（66.5/7.7）；ACD从104.8（49.8/5.8）增加到195.1（81.7/9.5），RT从201.2（98.3/11.4）减少到85.8（43.6/5.1），所有参数的P<0.0001。我们分别分析了中度（M - CL）和重度（S - CL）跛行患者，发现两组均有显著改善。差值（训练后值减去训练前值）为：M - CL组ICD为89.6（59.9/10.9），S - CL组为50.2（29.9/4.6）；M - CL组ACD为102.8（66.8/11.6），S - CL组为80.1（41.5/6.4）；M - CL组RT为 - 98.7（86.9/15.1），S - CL组为 - 128.5（88.1/13.7），所有参数的P<0.0001。M - CL组和S - CL组之间的差异仅在ICD（P = 0.0003）和ACD（P<0.05）方面显著。ABI呈上升趋势，具有统计学意义（P<0.001），但临床意义不大。该方案成本为4179欧元（每多走一米平均成本46.30欧元）。
监督体育训练被确认为治疗IC的有效工具，所提出的短期方案在降低成本的同时与较长方案具有相同的改善效果。所提出的单次训练工作负荷调整程序能明确确定工作负荷，接近最大疼痛但避免炎症激活风险。
