University Medical Center Erlangen, Germany.
German Institute for Vascular Research, Berlin, Germany.
Vasa. 2023 Jul;52(4):218-223. doi: 10.1024/0301-1526/a001057. Epub 2023 Feb 3.
To determine the adherence to supervised exercise training and underlying reasons for non-adherence amongst patients with inpatient treatment of symptomatic lower extremity peripheral arterial disease (PAD). This was a prospective questionnaire-based survey study of all consecutively treated inpatients with treatment for either intermittent claudication or chronic limb-threatening ischaemia (CLTI) surveyed at sixteen participating centres in Germany. A total of 235 patients (median age 70 years) were included, thereof 29.4% females and 34.6% with CLTI. The median time from first PAD diagnosis was 4 years (IQR: 1-8). Only 11.4% have previously participated in any walking exercise programme before the index treatment, thereby 10.0% in the IC subgroup and 12.0% with CLTI. Amongst all patients, 35.6% responded they were appropriately informed about the necessity and benefits of walking exercise programmes by their hospital physicians (25.8% by general practitioners), and 65.3% agreed that adherence to supervised exercise may improve their pain-free walking distance. A total of 24.5% responded they had access to necessary information concerning local walking exercise programmes. Amongst 127 free text comments on the reasons for non-adherence to supervised exercise training, 64% of the comments contained lack of information or consent on such measures. Less than 12% of the patients enrolled in the current study have ever participated in a walking exercise programme during their life course. Although all practice guidelines contain corresponding class I recommendations, especially for patients suffering from IC, most patients responded that they were not appropriately informed about the necessity of exercise training along with the fact that 65% agreed that exercise may increase the pain-free walking distance. Taken all together, these results emphasise that we miss an important opportunity in the patient-physician communication. Efforts should be made to improve acceptance and application of structured walking-exercise for patients with PAD.
为了确定患有下肢外周动脉疾病（PAD）住院治疗的患者对监督性运动训练的依从性和不依从的根本原因。这是一项在德国 16 个参与中心进行的所有连续接受间歇性跛行或慢性肢体威胁性缺血（CLTI）治疗的住院患者的前瞻性基于问卷的调查研究。共纳入 235 例患者（中位年龄 70 岁），其中女性占 29.4%，CLTI 占 34.6%。从首次 PAD 诊断到中位时间为 4 年（IQR：1-8）。仅有 11.4%的患者在此前的索引治疗前曾参加过任何步行运动计划，其中 IC 亚组为 10.0%，CLTI 为 12.0%。所有患者中，有 35.6%的患者认为其医院医生（25.8%为全科医生）充分告知了他们参加步行运动计划的必要性和益处，65.3%的患者同意坚持监督性运动可能会提高他们的无痛行走距离。共有 24.5%的患者认为他们可以获得有关当地步行运动计划的必要信息。在对不依从监督性运动训练的原因的 127 条自由文本评论中，有 64%的评论包含缺乏关于这些措施的信息或同意。在当前研究中纳入的患者中，不到 12%的患者在其一生中曾参加过步行运动计划。尽管所有实践指南都包含相应的 I 类推荐，特别是对于患有 IC 的患者，但大多数患者表示他们没有得到适当的运动训练必要性告知，并且有 65%的患者同意运动可能会增加无痛行走距离。总而言之，这些结果强调了我们在医患沟通中错失了一个重要机会。应该努力提高患者对 PAD 结构化步行运动的接受度和应用。
