Akerman Ashley P, Thomas Kate N, van Rij Andre M, Body E Dianne, Alfadhel Mesfer, Cotter James D
School of Physical Education, Sport, and Exercise Sciences, University of Otago , Dunedin , New Zealand.
Department of Surgical Sciences, University of Otago , Dunedin , New Zealand.
Am J Physiol Heart Circ Physiol. 2019 Jun 1;316(6):H1495-H1506. doi: 10.1152/ajpheart.00151.2019. Epub 2019 Apr 19.
Peripheral arterial disease (PAD) is characterized by lower limb atherosclerosis impairing blood supply and causing walking-induced leg pain or claudication. Adherence to traditional exercise training programs is poor due to these symptoms despite exercise being a mainstay of conservative treatment. Heat therapy improves many cardiovascular health outcomes, so this study tested if this was a viable alternative cardiovascular therapy for PAD patients. Volunteers with PAD were randomized to 12 wk of heat ( = 11; mean age 76 ± 8 yr, BMI 28.7 ± 3.5 kg/m, 4 females) or exercise ( = 11; 74 ± 10 yr, 28.5 ± 6.8 kg/m, 3 females). Heat involved spa bathing at ∼39°C, 3-5 days/wk for ≤30 min, followed by ≤30 min of callisthenics. Exercise involved ≤90 min of supervised walking and gym-based exercise, 1-2 days/wk. Following the interventions, total walking distance during a 6-min walk test increased (from ∼350 m) by 41 m (95% CI: [13, 69], = 0.006) regardless of group, and pain-free walking distance increased (from ∼170 m) by 43 m ([22, 63], < 0.001). Systolic blood pressure was reduced more following heat (-7 mmHg, [-4, -10], < 0.001) than following exercise (-3 mmHg, [0, -6], = 0.078), and diastolic and mean arterial pressure decreased by 4 mmHg in both groups ( = 0.002). There were no significant changes in blood volume, ankle-brachial index, or measures of vascular health. There were no differences in the improvement in functional or blood pressure outcomes between heat and exercise in individuals with PAD. Heat therapy via hot-water immersion and supervised exercise both improved walking distance and resting blood pressure in peripheral arterial disease (PAD) patients over 12 wk. Adherence to heat therapy was excellent, and the heat intervention was well tolerated. The results of the current study indicate that heat therapy can improve functional ability and has potential as an effective cardiovascular conditioning tool for individuals with PAD.
外周动脉疾病（PAD）的特征是下肢动脉粥样硬化，损害血液供应并导致行走引起的腿部疼痛或间歇性跛行。尽管运动是保守治疗的主要手段，但由于这些症状，患者对传统运动训练计划的依从性较差。热疗可改善许多心血管健康指标，因此本研究测试了热疗是否是PAD患者可行的替代心血管治疗方法。患有PAD的志愿者被随机分为两组，一组接受为期12周的热疗（n = 11；平均年龄76±8岁，体重指数28.7±3.5kg/m²，4名女性），另一组接受运动治疗（n = 11；74±10岁，28.5±6.8kg/m²，3名女性）。热疗包括在约39°C的水温下进行温泉浴，每周3 - 5天，每次≤30分钟，随后进行≤30分钟的健身操。运动包括每周1 - 2天，进行≤90分钟的有监督的步行和健身房锻炼。干预后，无论组别如何，6分钟步行试验中的总步行距离（从约350米）增加了41米（95%置信区间：[13, 69]，P = 0.006），无痛步行距离（从约170米）增加了43米（[22, 63]，P < 0.001）。热疗后收缩压降低幅度更大（-7 mmHg，[-4, -10]，P < 0.001），而运动后收缩压降低幅度为-3 mmHg（[0, -6]，P = 0.078），两组的舒张压和平均动脉压均降低了4 mmHg（P = 0.002）。血容量、踝臂指数或血管健康指标均无显著变化。在患有PAD的个体中，热疗和运动在功能或血压改善方面没有差异。通过热水浸泡进行的热疗和有监督的运动在12周内均改善了外周动脉疾病（PAD）患者的步行距离和静息血压。热疗的依从性极佳，且热疗干预耐受性良好。本研究结果表明，热疗可以改善功能能力，并且有可能成为PAD患者有效的心血管调节工具。
