University of Pittsburgh, Department of Health and Physical Activity, PA, USA.
Atherosclerosis. 2013 Sep;230(1):125-30. doi: 10.1016/j.atherosclerosis.2013.07.002. Epub 2013 Jul 14.
Though being physically active has associated with a healthier ankle-brachial index (ABI) in observational studies, ABI usually does not change with exercise training in patients with peripheral artery disease (PAD). Less is known about the effect of exercise training on ABI in patients without PAD but at high risk due to the presence of type 2 diabetes (T2DM).
Participants (n = 140) with uncomplicated T2DM, and without known cardiovascular disease or PAD, aged 40-65 years, were randomized to supervised aerobic and resistance training 3 times per week for 6 months or to a usual care control group. ABI was measured before and after the intervention.
Baseline ABI was 1.02 ± 0.02 in exercisers and 1.03 ± 0.01 in controls (p = 0.57). At 6 months, exercisers vs. controls improved ABI by 0.04 ± 0.02 vs. -0.03 ± 0.02 (p = 0.001). This change was driven by an increase in ankle pressures (p < 0.01) with no change in brachial pressures (p = 0.747). In subgroup analysis, ABI increased in exercisers vs. controls among those with baseline ABI <1.0 (0.14 ± 0.03 vs. 0.02 ± 0.02, p = 0.004), but not in those with a baseline ABI ≥1.0 (p = 0.085). The prevalence of ABI between 1.0 and 1.3 increased from 63% to 78% in exercisers and decreased from 62% to 53% in controls. Increased ABI correlated with decreased HbA1c, systolic and diastolic blood pressure, but the effect of exercise on ABI change remained significant after adjustment for these changes (β = 0.061, p = 0.004).
These data suggest a possible role for exercise training in the prevention or delay of PAD in T2DM, particularly among those starting with an ABI <1.0. Clinicaltrials.gov Registry Number: NCT00212303.
尽管观察性研究表明，身体活跃与更健康的踝臂指数（ABI）相关，但运动训练通常不会改变外周动脉疾病（PAD）患者的 ABI。对于由于存在 2 型糖尿病（T2DM）而处于高风险但没有 PAD 的患者，运动训练对 ABI 的影响知之甚少。
将 140 名无并发症的 T2DM 患者（年龄 40-65 岁）随机分为每周 3 次接受监督的有氧和阻力训练组或常规护理对照组。在干预前后测量 ABI。
锻炼者的基线 ABI 为 1.02±0.02，对照组为 1.03±0.01（p=0.57）。6 个月后，与对照组相比，锻炼者的 ABI 改善了 0.04±0.02，而对照组则改善了-0.03±0.02（p=0.001）。这种变化是由于踝部压力增加（p<0.01）而肱部压力没有变化（p=0.747）所致。在亚组分析中，ABI 在基线 ABI<1.0 的锻炼者中增加（0.14±0.03 与 0.02±0.02，p=0.004），但在基线 ABI≥1.0 的患者中则没有增加（p=0.085）。ABI 在 1.0 至 1.3 之间的患者比例，从锻炼者的 63%增加到 78%，从对照组的 62%减少到 53%。ABI 的增加与 HbA1c、收缩压和舒张压的降低相关，但在调整这些变化后，运动对 ABI 变化的影响仍然显著（β=0.061，p=0.004）。
这些数据表明，运动训练可能在预防或延缓 T2DM 患者的 PAD 方面发挥作用，特别是在 ABI<1.0 的患者中。临床试验.gov 注册号：NCT00212303。
