CMRI Diabetes and Metabolic Research Program, Harold Hamm Oklahoma Diabetes Center, Oklahoma University Health Sciences Center, 1122 NE 13th Street, Oklahoma City, OK 73117, USA.
Circulation. 2011 Feb 8;123(5):491-8. doi: 10.1161/CIRCULATIONAHA.110.963066. Epub 2011 Jan 24.
This prospective, randomized, controlled clinical trial compared changes in exercise performance and daily ambulatory activity in peripheral artery disease patients with intermittent claudication after a home-based exercise program, a supervised exercise program, and usual-care control.
Of the 119 patients randomized, 29 completed home-based exercise, 33 completed supervised exercise, and 30 completed usual-care control. Both exercise programs consisted of intermittent walking to nearly maximal claudication pain for 12 weeks. Patients wore a step activity monitor during each exercise session. Primary outcome measures included claudication onset time and peak walking time obtained from a treadmill exercise test; secondary outcome measures included daily ambulatory cadences measured during a 7-day monitoring period. Adherence to home-based and supervised exercise was similar (P=0.712) and exceeded 80%. Both exercise programs increased claudication onset time (P<0.001) and peak walking time (P<0.01), whereas only home-based exercise increased daily average cadence (P<0.01). No changes were seen in the control group (P>0.05). The changes in claudication onset time and peak walking time were similar between the 2 exercise groups (P>0.05), whereas the change in daily average cadence was greater with home-based exercise (P<0.05).
A home-based exercise program, quantified with a step activity monitor, has high adherence and is efficacious in improving claudication measures similar to a standard supervised exercise program. Furthermore, home-based exercise appears more efficacious in increasing daily ambulatory activity in the community setting than supervised exercise.
本前瞻性、随机、对照临床试验比较了家庭运动方案、监督运动方案和常规护理对照组在间歇性跛行的外周动脉疾病患者中，运动表现和日常活动能力的变化。
在随机分组的 119 例患者中，29 例完成了家庭运动，33 例完成了监督运动，30 例完成了常规护理对照。两种运动方案均包括 12 周间歇性行走至接近跛行疼痛的最大值。患者在每次运动期间佩戴计步器。主要终点测量包括跑步机运动试验中跛行起始时间和最大步行时间；次要终点测量包括 7 天监测期间的日常活动节奏。家庭运动和监督运动的依从性相似（P=0.712），均超过 80%。两种运动方案均增加了跛行起始时间（P<0.001）和最大步行时间（P<0.01），而只有家庭运动增加了日常平均步速（P<0.01）。对照组没有变化（P>0.05）。两种运动方案的跛行起始时间和最大步行时间的变化相似（P>0.05），而家庭运动的日常平均步速变化更大（P<0.05）。
计步器量化的家庭运动方案具有较高的依从性，在改善跛行指标方面与标准监督运动方案同样有效。此外，家庭运动在增加社区日常活动能力方面似乎比监督运动更有效。
