School of Nursing, University of Minnesota, Minneapolis (Drs Salisbury, Elgersma, and Treat-Jacobson); Minneapolis VA Healthcare System, Minneapolis, Minnesota (Dr Brown); and Lake Region Healthcare, Fergus Falls, Minnesota (Ms Larson).
J Cardiopulm Rehabil Prev. 2023 Sep 1;43(5):361-367. doi: 10.1097/HCR.0000000000000790. Epub 2023 Apr 5.
National guidelines for the treatment and management of symptomatic peripheral artery disease (PAD) recommend supervised exercise therapy (SET) as a first line of therapy. However, it is unknown how these expert opinion-based SET guidelines work in clinical practice as SET programs become established following the 2017 Centers for Medicare & Medicaid Services coverage announcement. The purpose of this prospective, nonrandomized translational study was to evaluate the clinical effectiveness of a SET program and specifically walking exercise modalities that did not incorporate a treadmill (TM).
Participants enrolled in a 12-wk SET program housed in four rural Midwest cardiac rehabilitation settings and were prescribed an exercise program by an exercise physiologist or nurse based on current SET guidelines. Groups included TM walking, total body recumbent stepping (TBRS), TM walking + TBRS, and multimodal. Pre- and post-tests of walking capacity, physical function, and quality of life were administered.
The sample (n = 93) was all White, with 55% female representation, age of 73.7 ± 9.0 yr, and mild-moderate PAD (ankle-brachial index = 0.71 ± 0.19). Collectively, SET significantly improved the 6-min walk test (32.1 ± 6.6 m; P < .01). Within-group changes in the 6-min walk test were seen for all groups except the multimodal group; there were no significant between-group differences in change scores ( P = .30). No significant between-group changes were seen for the TM walking, TBRS, and TM walking + TBRS groups for physical function measures.
This study demonstrates the clinical effectiveness of SET programs following current guidelines and potential utilization of non-TM walking modalities in SET programs.
国家外周动脉疾病（PAD）治疗和管理指南建议将监督下的运动疗法（SET）作为一线治疗方法。然而，在 2017 年医疗保险和医疗补助服务中心（CMS）覆盖范围宣布后，SET 计划建立起来，目前尚不清楚这些基于专家意见的 SET 指南在临床实践中是如何发挥作用的。本前瞻性、非随机转化研究的目的是评估 SET 计划的临床疗效，特别是不包含跑步机（TM）的步行运动方式。
参与者参加了一个为期 12 周的 SET 计划，该计划设在四个中西部农村心脏康复中心，并由运动生理学家或护士根据当前的 SET 指南为其制定运动方案。研究分为 TM 步行、全身斜躺踏步（TBRS）、TM 步行+TBRS 和多模式 4 组。在试验前和试验后对步行能力、身体功能和生活质量进行了测试。
该样本（n=93）均为白人，女性占 55%，年龄为 73.7±9.0 岁，患有轻中度 PAD（踝肱指数=0.71±0.19）。SET 整体上显著提高了 6 分钟步行测试（32.1±6.6 m；P<.01）。除多模式组外，所有组的 6 分钟步行测试均有显著的组内变化，且组间变化无显著差异（P=.30）。TM 步行、TBRS 和 TM 步行+TBRS 组的身体功能测量均未出现显著的组间变化。
本研究表明，在遵循当前指南的情况下，SET 计划具有临床疗效，且在 SET 计划中可能利用非 TM 步行方式。
