Lamberti Nicola, Straudi Sofia, Lissia Efisio, Cavazzini Lorenza, Buja Sergio, Manfredini Roberto, Basaglia Nino, Manfredini Fabio
1 Department of Biomedical and Surgical Specialties Sciences, University of Ferrara, Ferrara, Italy.
2 Unit of Rehabilitation Medicine, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
Vasa. 2018 Apr;47(3):227-234. doi: 10.1024/0301-1526/a000692. Epub 2018 Feb 21.
Peripheral arterial disease (PAD) is a common cardiovascular pathology affecting mobility in elderly. Osteoarticular diseases (ODs), responsible for functional limitations and confounding leg symptoms, may interfere with exercise therapy. This study evaluates the feasibility and effectiveness of a structured home-based exercise programme on rehabilitative outcomes in a cohort of elderly PAD patients with and without coexisting ODs.
Patients were enrolled from 2002 to 2016 in an exercise programme prescribed and controlled at the hospital and based on two daily 10-minute home walking sessions below the self-selected speed. The presence and localization of ODs at baseline were derived from consultation of medical documents. The ankle-brachial index and functional outcomes, defined as speed at the onset of claudication and attainable maximal speed by an incremental treadmill test, were assessed at baseline and discharge. Feasibility was determined according to dropout rate, number of visits, duration of the programme, and adherence.
A total of 1,251 PAD patients were enrolled (931 men; 71 ± 9 years; 0.63 ± 0.19 ankle-brachial index). Eight hundred sixty-four patients were free of ODs (ODfree, 69 %), whereas 387 were affected by ODs (OD, 31 %), predominantly located in the spine (72 %). In the logistic regression models, the presence of ODs was associated with female sex, overweight, sedentary and/or driving professions. At discharge, OD and ODfree did not differ in dropout rates (12 % each), programme duration (378 ± 241 vs. 390 ± 260 days), number of visits (7 ± 3 each), and adherence (80 % each). Similar improvements for OD and ODfree were observed for the ankle-brachial index (0.06 ± 0.12 each), the speed at onset of claudication (0.7 ± 0.7 vs. 0.7 ± 0.8 kmh-1; p = 0.70), and maximal speed (0.4 ± 0.6 vs. 0.4 ± 0.6 kmh-1; p = 0.77).
Equally satisfactory rehabilitative outcomes were observed in elderly patients with claudication limited by ODs who completed a well-tolerated, low-impact structured exercise programme.
外周动脉疾病（PAD）是一种常见的心血管疾病，影响老年人的行动能力。骨关节炎疾病（ODs）会导致功能受限并混淆腿部症状，可能会干扰运动疗法。本研究评估了一项结构化的居家锻炼计划对一组患有和未患有并存ODs的老年PAD患者康复结局的可行性和有效性。
2002年至2016年期间，患者被纳入一项在医院规定和控制的锻炼计划，该计划基于每天两次、每次10分钟、低于自我选择速度的居家步行训练。ODs在基线时的存在情况和定位来自医疗文件的查阅。在基线和出院时评估踝臂指数和功能结局，功能结局定义为跛行发作时的速度以及递增式跑步机测试可达到的最大速度。根据退出率、就诊次数、计划持续时间和依从性来确定可行性。
共纳入1251例PAD患者（931例男性；71±9岁；踝臂指数0.63±0.19）。864例患者无ODs（无ODs组，69%），而387例患者受ODs影响（ODs组，31%），主要位于脊柱（72%）。在逻辑回归模型中，ODs的存在与女性、超重、久坐和/或驾驶职业相关。出院时，ODs组和无ODs组在退出率（均为12%）、计划持续时间（378±241天对390±260天）、就诊次数（均为7±3次）和依从性（均为80%）方面无差异。在踝臂指数（均为0.06±0.12）、跛行发作时的速度（0.7±[具体单位缺失]对0.7±0.8千米/小时；p=0.70）和最大速度（0.4±0.6对0.4±0.6千米/小时；p=0.77）方面，ODs组和无ODs组观察到类似的改善。
在因ODs导致跛行受限的老年患者中，完成一项耐受性良好、低强度的结构化锻炼计划后，观察到了同样令人满意的康复结局。
