Aherne Thomas M, Kheirelseid Elrasheid A H, Boland Michael, Carr Shane, Al-Zabi Thekra, Bashar Khalid, Moneley Daragh, Leahy Austin, McCaffrey Noel, Naughton Peter
1 Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
2 Department of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland.
Vasa. 2017 May;46(3):219-222. doi: 10.1024/0301-1526/a000612. Epub 2017 Jan 30.
Supervised exercise therapy (SET) is an effective option in the management of peripheral arterial disease (PAD). Unfortunately, poor compliance remains prevalent. This study aimed to assess patient exercise compliance and to identify factors influencing symptomatic improvement and SET participation.
Data regarding attendance at SET for this cohort study were extracted from a prospectively maintained database of patients with claudication attending SET at Dublin City University. All patients had ankle brachial index confirmed PAD with associated intermittent claudication. Exercise performance and symptomatic data were gathered retrospectively using patient charts and interviews.
Ninety-eight patients were referred for SET during the study period. The mean age was 69.2 (± 10.1) with 18 % being female. Median follow-up was 25.1 months (IQ range 17.0-31.6). Overall, the mean number of sessions attended per patient was 19.5. Exercise compliance was associated with a significant improvement in symptoms (p = 0.001). Other factors including anatomical level of claudication (P = 0.042) and educational level (p = 0.007) were found to affect the outcome of SET. Multivariate analysis revealed hypertension as a predictor of symptomatic outcome after SET (p = 0.045). Furthermore, ex-smokers (p = 0.021) and those previously diagnosed with hypercholesterolaemia (p = 0.020) or ischaemic heart disease (p = 0.029) had superior exercise compliance. Using linear regression, smoking history (p = 0.024) was identified as a predictor of compliance to SET.
Establishing exercise compliance remains challenging in the PAD cohort. Pre-exercise patient education and personalised exercise prescriptions may result in improvements in function and compliance.
监督运动疗法（SET）是外周动脉疾病（PAD）管理中的一种有效选择。不幸的是，依从性差仍然很普遍。本研究旨在评估患者的运动依从性，并确定影响症状改善和SET参与度的因素。
该队列研究中关于SET参与情况的数据，是从都柏林城市大学前瞻性维护的跛行患者SET数据库中提取的。所有患者均经踝肱指数确诊为PAD并伴有间歇性跛行。运动表现和症状数据通过回顾性收集患者病历和访谈获得。
在研究期间，98名患者被转诊接受SET治疗。平均年龄为69.2岁（±10.1），女性占18%。中位随访时间为25.1个月（四分位间距17.0 - 31.6）。总体而言，每位患者平均参加的疗程数为19.5次。运动依从性与症状的显著改善相关（p = 0.001）。发现其他因素，包括跛行的解剖部位（P = 0.042）和教育水平（p = 0.007），会影响SET的治疗效果。多变量分析显示高血压是SET后症状结局的预测因素（p = 0.045）。此外，既往吸烟者（p = 0.021）以及先前被诊断患有高胆固醇血症（p = 0.020）或缺血性心脏病（p = 0.029）的患者，运动依从性更佳。通过线性回归分析，吸烟史（p = 0.024）被确定为SET依从性的预测因素。
在PAD队列中，确立运动依从性仍然具有挑战性。运动前对患者进行教育以及制定个性化运动处方可能会改善功能和依从性。
