Lauret Gert-Jan, van Dalen Daniëlle C W, Willigendael Edith M, Hendriks Erik J M, de Bie Rob A, Spronk Sandra, Teijink Joep A W
Department of Vascular Surgery, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven.
Vascular. 2012 Feb;20(1):12-9. doi: 10.1258/vasc.2011.ra0052. Epub 2012 Feb 10.
Intermittent claudication (IC) has a high prevalence in the older population and is closely associated with cardiovascular and cerebrovascular disease. High mortality rates are reported due to ongoing atherosclerotic disease. Because of these serious health risks, treatment of IC should address reduction of cardiovascular events (and related morbidity/mortality) and improvement of the poor health-related quality of life (QoL) and functional capacity. In several randomized clinical trials and systematic reviews, supervised exercise therapy (SET) is compared with non-supervised exercise, usual care, placebo, walking advice or vascular interventions. The current evidence supports SET as the primary treatment for IC. SET improves maximum walking distance and health-related QoL with a marginal risk of co-morbidity or mortality. This is also illustrated in contemporary international guidelines. Community-based SET appears to be at least as efficacious as programs provided in a clinical setting. In the Netherlands, a national integrated care network (ClaudicatioNet) providing specialized care for patients with IC is currently being implemented. Besides providing a standardized form of SET, the specialized physical therapists stimulate medication compliance and perform lifestyle coaching. Future research should focus on the influence of co-morbidities on prognosis and effect of SET outcome and the potential beneficial effects of SET combined with a vascular intervention.
间歇性跛行（IC）在老年人群中患病率很高，且与心血管和脑血管疾病密切相关。据报道，由于动脉粥样硬化疾病持续存在，死亡率很高。鉴于这些严重的健康风险，IC的治疗应着眼于降低心血管事件（及相关发病率/死亡率），并改善与健康相关的较差生活质量（QoL）和功能能力。在多项随机临床试验和系统评价中，将监督运动疗法（SET）与非监督运动、常规护理、安慰剂、步行建议或血管干预措施进行了比较。目前的证据支持将SET作为IC的主要治疗方法。SET可增加最大步行距离并改善与健康相关的QoL，同时合并症或死亡率风险极小。当代国际指南也对此进行了说明。基于社区的SET似乎至少与临床环境中提供的项目一样有效。在荷兰，目前正在实施一个为IC患者提供专科护理的全国性综合护理网络（ClaudicatioNet）。除了提供标准化的SET形式外，专业物理治疗师还会促进药物依从性并进行生活方式指导。未来的研究应关注合并症对预后和SET结果的影响，以及SET与血管干预相结合的潜在有益效果。
