Faculty of Physical Activity Sciences (Messrs Tremblay and Marcotte-Chénard, Drs Hamelin-Morrissette and Riesco, and Ms Poirier) and Faculty of Medicine and Health Sciences (Drs Perron, Durivage, Mampuya, and Huard), University of Sherbrooke, Sherbrooke, Quebec, Canada; and Research Centre on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada (Messrs Tremblay and Marcotte-Chénard, Drs Hamelin-Morrissette and Riesco, and Ms Poirier).
J Cardiopulm Rehabil Prev. 2023 Sep 1;43(5):318-328. doi: 10.1097/HCR.0000000000000780. Epub 2023 Mar 8.
Despite extensive research on the effect of supervised exercise therapy on walking performance in patients with symptomatic peripheral arterial disease (PAD), it remains unclear which training modality provides the greatest improvement in walking capacity. The objective of this study was to compare the effect of different types of supervised exercise therapy on walking capacity in individuals with symptomatic PAD.
A random-effect network meta-analysis was performed. The following databases were searched from January 1966 to April 2021: SPORTDiscus, CINAHL, MEDLINE, AMED, Academic Search Complete and, Scopus. Trials had to include at least one type of supervised exercise therapy for patients with symptomatic PAD, with an intervention lasting ≥2 wk with ≥5 training sessions, and an objective measure of walking capacity.
Eighteen studies were included for a total sample of 1135 participants. Interventions duration ranged from 6-24 wk and included aerobic exercise (treadmill walking, ergometer, and Nordic walking), resistance training (lower and/or upper body), a combination of both, and underwater exercise. Results showed that combined training improved treadmill walking capacity to a comparable extent to aerobic walking (+122.0 [24.2-219.8] m vs +106.8 [34.2-179.4] m), but with a larger effect size (1.20 [0.50-1.90] vs 0.67 [0.22-1.11]). Similar results were observed for the 6-min walk distance, with combined training being the most promising modality (+57.3 [16.2-98.5] m), followed by underwater training (+56.5 [22.4-90.5] m) and aerobic walking (+39.0 [12.8-65.1] m).
While not statistically superior to aerobic walking, combined exercise seems to be the most promising training modality. Aerobic walking and underwater training also improved walking capacity for patients with symptomatic PAD.
尽管有大量研究探讨了监督下的运动疗法对有症状的外周动脉疾病（PAD）患者行走能力的影响，但哪种训练方式能最大程度地提高行走能力仍不清楚。本研究的目的是比较不同类型的监督下运动疗法对有症状的 PAD 患者行走能力的影响。
进行了随机效应网络荟萃分析。从 1966 年 1 月到 2021 年 4 月，检索了以下数据库：SPORTDiscus、CINAHL、MEDLINE、AMED、Academic Search Complete 和 Scopus。试验必须包括至少一种针对有症状的 PAD 患者的监督下运动疗法，干预时间≥2 周，有≥5 次训练课程，并且有行走能力的客观测量。
纳入了 18 项研究，共 1135 名参与者。干预时间从 6-24 周不等，包括有氧运动（跑步机行走、测力计和北欧式行走）、抗阻训练（下肢和/或上肢）、两者的结合以及水下运动。结果显示，联合训练可使跑步机行走能力提高到与有氧运动相似的程度（+122.0[24.2-219.8]m 与 +106.8[34.2-179.4]m），但效果更大（1.20[0.50-1.90]与 0.67[0.22-1.11]）。6 分钟步行距离也观察到类似的结果，联合训练是最有前途的模式（+57.3[16.2-98.5]m），其次是水下训练（+56.5[22.4-90.5]m）和有氧运动（+39.0[12.8-65.1]m）。
尽管联合运动在统计学上并不优于有氧运动，但似乎是最有前途的训练模式。有氧运动和水下训练也可提高有症状的 PAD 患者的行走能力。
