Catharina Hospital, Department of Vascular Surgery, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
Maxima Medical Centre, Department of Vascular Surgery, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; CARIM Research School, Maastricht University, P.O. Box 606, 6200 MD Maastricht, The Netherlands.
Eur J Vasc Endovasc Surg. 2014 Aug;48(2):169-84. doi: 10.1016/j.ejvs.2014.04.019. Epub 2014 Jun 10.
A number of reviews have reported the influence of exercise therapy (ET) for the treatment of intermittent claudication (IC). However, a complete overview of different types of ET is lacking. The aim of this meta-analysis was to study the effect of supervision on walking capacity in patients with IC. It was hypothesized that there was a positive treatment effect in relation to the intensity of supervision and improvement in walking capacity (i.e., a "dose-response" hypothesis).
A systematic search in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases was performed. Only randomized controlled trials (RCTs) evaluating the efficacy of an ET in IC were included. Type of supervision, treadmill protocol, length of ET, total training volume, and change in walking distance were extracted. RCTs were categorised according to type of support: no exercise, walking advice, home-based exercise (HB-ET), and supervised exercise therapy (SET). A standardised mean difference between pre- and post-training maximal walking distance (MWD) and pain-free walking distance (PFWD) was calculated for all subgroups at 6 weeks, and 3 and 6 months of follow up.
Thirty studies involving 1406 patients with IC were included. The overall quality was moderate-to-good, although number of included patients varied widely (20-304). The intensity of supervision was directly related to MWD and PFWD. SET was superior to other conservative treatment regimens with respect to improvement in walking distances at all follow-ups. However, the difference between HB-ET and SET at 6 months of follow up was not significant.
Supervised exercise therapy for intermittent claudication is superior to all other forms of exercise therapy. Intensity of supervision is related to improved walking distance.
有许多综述报道了运动疗法（ET）治疗间歇性跛行（IC）的影响。然而，缺乏对不同类型 ET 的全面概述。本荟萃分析旨在研究监督对 IC 患者步行能力的影响。假设监督强度与步行能力改善之间存在正治疗效应（即“剂量反应”假说）。
在 Cochrane 对照试验中心注册库、MEDLINE 和 EMBASE 数据库中进行系统检索。仅纳入评估 ET 对 IC 疗效的随机对照试验（RCT）。提取监督类型、跑步机方案、ET 时长、总训练量以及步行距离的变化。根据支持类型对 RCT 进行分类：无运动、散步建议、家庭运动（HB-ET）和监督运动治疗（SET）。计算所有亚组在 6 周、3 个月和 6 个月随访时的最大步行距离（MWD）和无痛步行距离（PFWD）的训练前后标准化均数差。
纳入了 30 项研究，共涉及 1406 例 IC 患者。总体质量为中等到良好，尽管纳入患者的数量差异很大（20-304）。监督强度与 MWD 和 PFWD 直接相关。SET 在所有随访中在步行距离改善方面优于其他保守治疗方案。然而，HB-ET 和 SET 在 6 个月随访时的差异无统计学意义。
间歇性跛行的监督运动疗法优于其他所有形式的运动疗法。监督强度与步行距离的改善有关。
