Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia.
Br J Surg. 2019 Mar;106(4):319-331. doi: 10.1002/bjs.11101. Epub 2019 Feb 21.
Supervised exercise is recommended for the management of peripheral artery disease (PAD); however, the uptake is limited. Structured home exercise programmes may be more feasible, but their effectiveness is unclear. This systematic review and meta-analysis examined the benefit of structured home exercise programmes for treating PAD in comparison to controls not receiving an exercise programme.
A literature search was conducted to identify RCTs comparing structured home exercise with controls not receiving an exercise programme among patients with PAD. To be included, studies had to report outcomes from treadmill or corridor walking tests, or objective assessment of physical activity. Inverse variance-weighted meta-analysis was performed to compare changes in maximum walking distance and intermittent claudication onset distance in treadmill tests, walking distance during a 6-min walking test, and physical activity measured using a pedometer or accelerometer. Summarized results are presented in terms of standard deviation differences.
Eleven randomized trials involving 807 patients were included. Follow-up ranged from 2 to 24 months; only one trial included follow-up beyond 12 months. Meta-analyses showed that structured home exercise programmes led to significant improvements in maximum walking distance (mean difference (MD) 0·32, 95 per cent c.i. 0·15 to 0·50; P < 0·001), intermittent claudication onset distance (MD 0·45, 0·27 to 0·62; P < 0·001), walking distance in a 6-min walking test (MD 0·28, 0·09 to 0·47; P = 0·004) and physical activity (MD 0·27, 0·11 to 0·43; P = 0·001).
This meta-analysis suggests that structured home exercise programmes are effective at improving walking performance and physical activity in the short term for patients with PAD.
有研究建议采用监督锻炼的方式来治疗外周动脉疾病（PAD）；然而，这种方法的接受度有限。结构化的家庭运动方案可能更可行，但它们的效果尚不清楚。本系统评价和荟萃分析旨在比较结构化家庭运动方案与不接受运动方案的对照组在治疗 PAD 方面的疗效。
我们进行了文献检索，以确定比较结构化家庭运动方案与不接受运动方案的对照组治疗 PAD 的随机对照试验（RCT）。纳入的研究必须报告跑步机或走廊行走测试的结果，或使用计步器或加速度计对身体活动进行的客观评估。使用逆方差加权荟萃分析比较跑步机测试中最大步行距离和间歇性跛行起始距离、6 分钟步行测试中的步行距离以及使用计步器或加速度计测量的身体活动的变化。汇总结果以标准差差异表示。
纳入了 11 项 RCT，共 807 例患者。随访时间从 2 至 24 个月不等；只有一项试验的随访时间超过 12 个月。荟萃分析显示，结构化家庭运动方案可显著改善最大步行距离（平均差（MD）0·32，95%置信区间（CI）0·15 至 0·50；P<0·001）、间歇性跛行起始距离（MD 0·45，0·27 至 0·62；P<0·001）、6 分钟步行测试中的步行距离（MD 0·28，0·09 至 0·47；P=0·004）和身体活动（MD 0·27，0·11 至 0·43；P=0·001）。
本荟萃分析表明，结构化家庭运动方案在短期内可有效提高 PAD 患者的步行能力和身体活动水平。
