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静息痛型跛行患者行无痛家庭运动方案后结局的性别差异。

Gender Differences in Outcomes Following a Pain-Free, Home-Based Exercise Program for Claudication.

机构信息

Department of Medical Sciences, University of Ferrara, Ferrara, Italy.

Clinica Medica Unit, Azienda Ospedaliera-Universitaria, Ferrara, Italy.

出版信息

J Womens Health (Larchmt). 2019 Sep;28(9):1313-1321. doi: 10.1089/jwh.2018.7113. Epub 2018 Sep 15.

Abstract

Peripheral artery disease (PAD) is a common cardiovascular pathology that affects mobility. In previous research, supervised exercise, a recommended treatment for claudication, was less effective in women. This study retrospectively investigated whether functional outcomes exhibit sex differences following a pain-free, home-based exercise program for PAD patients. Patients with PAD and claudication enrolled to a structured home-based program from 2003 to 2016 were studied. The program was prescribed at the hospital and based on two daily 10-minute pain-free walking sessions at progressively increasing speed. Outcome measures, which were assessed at baseline and discharge, were pain threshold speed (PTS) and maximal (Smax) during a treadmill test and pain-free walking distance (PFWD) and total distance walked in 6 minutes (6MWD). The ankle-brachial index (ABI), program duration, and patient adherence were determined. A total of 1007 patients (women;  = 264; 26%) were enrolled. At baseline, compared to men, women exhibited similar ABI values but lower PTS and PFWD values ( < 0.001). At discharge, with similar adherence (score 3/4 ± 1 each) in both groups, superimposable improvements were observed for PTS (0.8 ± 0.8 km/h each), Smax (0.4 ± 0.5 km/h each), PFWD (women 95 ± 100; men 86 ± 104), 6MWD (women 32 ± 65; men 35 ± 58), and ABI (women 0.07 ± 0.12; men 0.06 ± 0.11) without between-group differences (confirmed after propensity analysis). A personalized, structured pain-free exercise program for PAD patients performed inside the home for a few minutes a day was equally effective in both sexes. Programs favoring adherence and functional outcomes in women should be tested in prospective studies.

摘要

外周动脉疾病(PAD)是一种常见的心血管病理学,会影响行动能力。在之前的研究中,对于跛行患者,推荐的治疗方法——监督下的运动锻炼效果在女性中较差。本研究回顾性调查了 PAD 患者在接受无痛、家庭为基础的锻炼计划后,其功能结果是否存在性别差异。 2003 年至 2016 年,患有 PAD 和跛行的患者参加了一项结构化的家庭锻炼计划。该计划在医院开出,基于每天两次各 10 分钟的无痛行走,速度逐渐增加。在基线和出院时评估的结果测量值包括疼痛阈值速度(PTS)和最大速度(Smax)在跑步机测试中以及在无痛步行距离(PFWD)和 6 分钟内行走的总距离(6MWD)。还确定了踝肱指数(ABI)、计划持续时间和患者依从性。 共纳入 1007 名患者(女性; = 264;26%)。在基线时,与男性相比,女性的 ABI 值相似,但 PTS 和 PFWD 值较低( < 0.001)。在出院时,两组的依从性相似(评分各为 3/4 ± 1),观察到 PTS(0.8 ± 0.8 km/h 各)、Smax(0.4 ± 0.5 km/h 各)、PFWD(女性 95 ± 100;男性 86 ± 104)、6MWD(女性 32 ± 65;男性 35 ± 58)和 ABI(女性 0.07 ± 0.12;男性 0.06 ± 0.11)的相似改善,而无组间差异(经倾向评分分析后确认)。 对于 PAD 患者,每天在家中进行几分钟的个性化、结构化的无痛运动锻炼计划,在两性中同样有效。应在前瞻性研究中测试有利于女性依从性和功能结果的计划。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edd4/6743088/f860e4fc5eed/fig-1.jpg

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