Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa.
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
J Vasc Surg. 2019 Oct;70(4):1280-1290. doi: 10.1016/j.jvs.2018.12.056. Epub 2019 Mar 25.
Home-based exercise is an alternative exercise mode to a structured supervised program to improve symptoms in patients with peripheral artery disease (PAD), but little is known about whether the slow-paced and less intense home program also elicits changes in vascular and inflammatory biomarkers. In an exploratory analysis from a randomized controlled trial, we compared changes in vascular and inflammatory biomarkers in patients with symptomatic PAD (typical and atypical of claudication) after home-based exercise and supervised exercise programs and in an attention-control group.
A total of 114 patients were randomized into one of the three groups (n = 38 per group). Two groups performed exercise interventions, consisting of home-based and supervised programs of intermittent walking to mild to moderate claudication pain for 12 weeks; a third group performed light resistance training as a nonwalking attention-control group. Before and after intervention, patients were characterized on treadmill performance and endothelial effects of circulating factors present in sera by a cell culture-based bioassay on primary human arterial endothelial cells, and they were further evaluated on circulating vascular and inflammatory biomarkers.
Treadmill peak walking time increased (P = .008) in the two exercise groups but not in the control group (P > .05). Cultured endothelial cell apoptosis decreased after home-based exercise (P < .001) and supervised exercise (P = .007), and the change in the exercise groups combined was different from that in the control group (P = .005). For circulating biomarkers, increases were found in hydroxyl radical antioxidant capacity (P = .003) and vascular endothelial growth factor A (P = .037), and decreases were observed in E-selectin (P = .007) and blood glucose concentration (P = .012) after home-based exercise only. The changes in hydroxyl radical antioxidant capacity (P = .005), vascular endothelial growth factor A (P = .008), and E-selectin (P = .034) in the exercise groups combined were different from those in the control group.
This exploratory analysis found that both home-based and supervised exercise programs are efficacious to decrease cultured endothelial cell apoptosis in patients with symptomatic PAD. Furthermore, a monitored home-based exercise program elicits additional vascular benefits by improving circulating markers of endogenous antioxidant capacity, angiogenesis, endothelium-derived inflammation, and blood glucose concentration in patients with symptomatic PAD. The novel clinical significance is that important trends were found in this exploratory analysis that a contemporary home-based exercise program and a traditional supervised exercise program may favorably improve vascular and inflammatory biomarkers in addition to the well-described ambulatory improvements in symptomatic patients with PAD.
家庭运动是改善外周动脉疾病（PAD）患者症状的结构化监督方案以外的一种替代运动模式，但对于节奏较慢、强度较低的家庭运动方案是否也能改变血管和炎症生物标志物知之甚少。在一项随机对照试验的探索性分析中，我们比较了家庭运动和监督运动方案以及注意控制组对有症状 PAD（典型和非典型跛行）患者血管和炎症生物标志物的变化。
共有 114 名患者被随机分为三组（每组 38 名）。两组患者进行运动干预，包括家庭和监督间歇性步行至轻度至中度跛行疼痛的方案，持续 12 周；第三组患者进行非步行的轻阻力训练作为注意控制组。干预前后，通过基于细胞培养的生物测定法对原发性人动脉内皮细胞进行了血清中循环因子的内皮效应和跑步机性能评估，并进一步评估了循环血管和炎症生物标志物。
跑步机峰值行走时间在两组运动组中增加（P=0.008），但在对照组中没有增加（P>0.05）。家庭运动后，培养的内皮细胞凋亡减少（P<0.001），监督运动后凋亡减少（P=0.007），且运动组的变化与对照组不同（P=0.005）。对于循环生物标志物，仅家庭运动后羟基自由基抗氧化能力（P=0.003）和血管内皮生长因子 A（P=0.037）增加，E-选择素（P=0.007）和血糖浓度（P=0.012）降低。运动组的羟基自由基抗氧化能力（P=0.005）、血管内皮生长因子 A（P=0.008）和 E-选择素（P=0.034）的变化与对照组不同。
这项探索性分析发现，家庭运动和监督运动方案都能有效降低有症状 PAD 患者培养的内皮细胞凋亡。此外，监测家庭运动方案通过改善有症状 PAD 患者的内源性抗氧化能力、血管生成、内皮衍生炎症和血糖浓度等循环标志物，产生额外的血管益处。这项研究的新颖临床意义在于，这项探索性分析发现，现代家庭运动方案和传统监督运动方案除了改善有症状 PAD 患者的步行能力外，还可能有利于改善血管和炎症生物标志物。
