McDermott Mary M, Guralnik Jack M, Criqui Michael H, Ferrucci Luigi, Liu Kiang, Spring Bonnie, Tian Lu, Domanchuk Kathryn, Kibbe Melina, Zhao Lihui, Lloyd Jones Donald, Liao Yihua, Gao Ying, Rejeski W Jack
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.D., D.L.J.) Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.D., K.L., B.S., L.Z., D.L.J., Y.L., Y.G.).
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (J.M.G.).
J Am Heart Assoc. 2015 May 20;4(5):e001659. doi: 10.1161/JAHA.114.001659.
Few medical therapies improve lower extremity functioning in people with lower extremity peripheral artery disease (PAD). Among people with PAD, we studied whether a group-mediated cognitive behavioral intervention promoting home-based unsupervised exercise prevented mobility loss and improved functional performance compared to control.
One hundred ninety-four PAD participants were randomized. During months 1 to 6, the intervention group met weekly with other PAD participants and a facilitator. Group support and self-regulatory skills were used to help participants adhere to walking exercise. Ninety-percent of exercise was conducted at or near home. The control group attended weekly lectures. During months 6 to 12, each group received telephone contact only. Primary outcomes have been reported. Here we compare changes in exploratory outcomes of mobility loss (the inability to climb a flight of stairs or walk one-quarter mile without assistance), walking velocity, and the Short Physical Performance Battery. Compared to controls, fewer participants randomized to the intervention experienced mobility loss at 6-month follow-up: 6.3% versus 26.5%, P=0.002, odds ratio=0.19 (95% CI=0.06 to 0.58) and at 12-month follow-up: 5.2% versus 18.5%, P=0.029, odds ratio=0.24 (95% CI=0.06 to 0.97). The intervention improved fast-paced 4-m walking velocity at 6-month follow-up (P=0.005) and the Short Physical Performance Battery at 12-month follow-up (P=0.027), compared to controls.
In exploratory analyses, a group-mediated cognitive behavioral intervention promoting unsupervised walking exercise prevented mobility loss and improved functioning at 6- and 12-month follow-up in PAD patients.
URL: http://clinicaltrials.gov. Unique identifier: NCT00693940.
很少有医学疗法能改善下肢外周动脉疾病（PAD）患者的下肢功能。在PAD患者中，我们研究了一种以小组为媒介的认知行为干预措施，该措施促进家庭无监督锻炼，与对照组相比，是否能预防行动能力丧失并改善功能表现。
194名PAD参与者被随机分组。在第1至6个月期间，干预组每周与其他PAD参与者及一名指导者会面。通过小组支持和自我调节技能帮助参与者坚持步行锻炼。90%的锻炼在家庭或家庭附近进行。对照组参加每周的讲座。在第6至12个月期间，每组仅接受电话联系。主要结果已报告。在此我们比较行动能力丧失（无法在无帮助的情况下爬一段楼梯或行走四分之一英里）、步行速度和简短体能测试等探索性结果的变化。与对照组相比，随机分配到干预组的参与者在6个月随访时经历行动能力丧失的人数更少：6.3% 对26.5%，P = 0.002，比值比 = 0.19（95%可信区间 = 0.06至0.58），在12个月随访时：5.2% 对18.5%，P = 0.029，比值比 = 0.24（95%可信区间 = 0.06至0.97）。与对照组相比，干预在6个月随访时改善了快节奏4米步行速度（P = 0.005），在12个月随访时改善了简短体能测试结果（P = 0.027）。
在探索性分析中，一种以小组为媒介的认知行为干预措施促进无监督步行锻炼，在6个月和12个月随访时预防了PAD患者的行动能力丧失并改善了功能。
