Seed Sally A, Harwood Amy E, Sinclair Jonathan, Pymer Sean, Caldow Edward, Ingle Lee, Egun Anselm, Birkett Stefan T
School of Sport and Health Sciences, University of Central Lancashire, Preston, UK.
Centre for Sports, Exercise and Life Sciences, Coventry University, Coventry, UK.
Ann Vasc Surg. 2021 Nov;77:315-323. doi: 10.1016/j.avsg.2021.06.025. Epub 2021 Aug 28.
Current guidelines for intermittent claudication advocate exercise at moderate to maximal claudication pain. However, adherence rates to supervised exercise programmes (SEP) remain poor and claudication pain is a contributing factor. Limited evidence suggests that moderate or pain-free exercise may be just as beneficial and may be better tolerated. However, it remains unclear what 'level' of claudication pain is optimal for improving functional outcomes. We therefore conducted a systematic review to synthesise the evidence for exercise prescribed at different levels of claudication pain.
The CENTRAL, MEDLINE, Embase and CINAHL databases were searched up to October 2020. Randomized controlled trials (RCTs) that directly compared at least 2 different intensities of claudication pain were included. Outcome measures included walking performance, adherence, quality of life and vascular function.
Of 1,543 search results, 2 studies were included. Maximal walking distance improved by 100-128% in the moderate-pain SEP groups, and by 77-90% in the pain-free SEP groups. Importantly, there were no significant differences between the moderate-pain and pain-free SEP groups in either study for improvements in walking performance, though comparison to a maximal-pain SEP group was not made.
The efficacy of SEPs for patients with intermittent claudication is irrefutable, though there is no consensus on the optimal level of pain. Therefore, adequately powered RCTs are required to compare the effect of pain-free SEPs, moderate-pain SEPs and maximal-pain SEPs on functional outcomes. (PROSPERO ID: CRD42020213684).
目前间歇性跛行指南提倡在中度至最大程度的跛行疼痛时进行锻炼。然而，监督锻炼计划（SEP）的依从率仍然很低，跛行疼痛是一个促成因素。有限的证据表明，中度或无痛锻炼可能同样有益，并且可能更易于耐受。然而，尚不清楚何种“程度”的跛行疼痛最有利于改善功能结局。因此，我们进行了一项系统评价，以综合不同程度跛行疼痛时规定锻炼的证据。
检索截至2020年10月的CENTRAL、MEDLINE、Embase和CINAHL数据库。纳入直接比较至少两种不同强度跛行疼痛的随机对照试验（RCT）。结局指标包括步行能力、依从性、生活质量和血管功能。
在1543条检索结果中，纳入了2项研究。中度疼痛SEP组的最大步行距离提高了100%-128%，无痛SEP组提高了77%-90%。重要的是，在两项研究中，中度疼痛和无痛SEP组在步行能力改善方面均无显著差异，不过未与最大疼痛SEP组进行比较。
SEP对间歇性跛行患者的疗效是无可争议的，尽管对于最佳疼痛程度尚无共识。因此，需要有足够样本量的RCT来比较无痛SEP、中度疼痛SEP和最大疼痛SEP对功能结局的影响。（国际前瞻性系统评价注册编号：CRD42020213684）
