Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Phys Ther. 2023 Nov 4;103(11). doi: 10.1093/ptj/pzad086.
The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication.
In total, 166 patients with intermittent claudication (mean age = 72 [SD = 7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA + SEP, or WA + HSEP. All patients received Nordic poles and standardized WA (≥30 min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7 days at baseline and at 3, 6, and 12 months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30 minutes and >60 minutes.
At 1 year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3 months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD = 10.85] min) was significantly different from the mean change for WA (-3.20 [SD = 6.24] min). At 6 months, the number of sitting bouts (>60 min) for SEP was significantly different from WA (mean change = 0.24 [SD = 0.69] vs -0.23 [SD = 0.81]).
This study indicates that the addition of 6 months of HSEP or SEP does not improve PA at 1 year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation.
At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group.
间歇性跛行患者的运动干预对身体活动（PA）的影响仍不确定，因此将客观测量的 PA 作为附加终点非常重要。本研究是一项随机临床试验的预设二次分析，目的是调查单独使用或联合使用医院监督运动（SEP）或家庭结构化运动（HSEP）的非监督北欧杖行走建议（WA）对间歇性跛行患者 PA 的影响。
共纳入 166 名间歇性跛行患者（平均年龄 72 [7.4]岁；41%为女性），随机分为 3 种间歇性跛行治疗策略：WA、WA+SEP 或 WA+HSEP。所有患者均接受北欧杖和标准化 WA（≥30 min，每周 3 次）。随机接受 HSEP 和 SEP 的患者接受额外 6 个月的运动方案。使用基于加速度计的 activPAL3 监测器在基线和 3、6 和 12 个月时测量 7 天的 PA。PA 结果为每天的步数、100 步/分钟以上的步频时间、直立时间、从坐到站的身体转换次数、大于 30 分钟和大于 60 分钟的坐姿时间。
1 年后，任何 PA 变量在组间均无差异，而在 3 个月时，100 步/分钟以上的步频时间内的时间存在显著的组间差异。HSEP 的平均变化（2.47 [10.85]分钟）与 WA 的平均变化（-3.20 [6.24]分钟）有显著差异。在 6 个月时，SEP 的坐姿时间（>60 分钟）与 WA 相比有显著差异（平均变化 0.24 [0.69]分钟与-0.23 [0.81]分钟）。
本研究表明，与单独使用非监督的 WA 相比，6 个月的 HSEP 或 SEP 并不能在 1 年内改善 PA。间歇性跛行患者增加 PA 的重要因素需要进一步研究。
在 1 年随访时，与单独使用非监督的北欧杖 WA 相比，添加针对间歇性跛行的额外运动策略并不能改善患者的日常 PA。未来的研究可能会探索行为改变技术在这一患者群体中增加 PA 的作用。
