Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Health Research and Policy, Stanford University, Stanford, California.
JAMA Netw Open. 2023 Sep 5;6(9):e2334590. doi: 10.1001/jamanetworkopen.2023.34590.
Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear.
To study whether home-based walking exercise improves 6-minute walk (6MW) more than supervised treadmill exercise in people with PAD (defined as Ankle Brachial Index ≤0.90).
Data were combined from 5 randomized clinical trials of exercise therapy for PAD using individual participant data meta-analyses, published from 2009 to 2022.
Of the 5 clinical trials, 3 clinical trials compared supervised treadmill exercise to nonexercise control (N = 370) and 2 clinical trials compared an effective home-based walking exercise intervention to nonexercise control (N = 349).
Individual participant-level data from 5 randomized clinical trials led by 1 investigative team were combined. The 5 randomized clinical trials included 3 clinical trials of supervised treadmill exercise and 2 effective home-based walking exercise interventions.
Change in 6MW distance, maximum treadmill walking distance, and Walking Impairment Questionnaire at 6-month follow-up. The supervised treadmill exercise intervention consisted of treadmill exercise in the presence of an exercise physiologist, conducted 3 days weekly for up to 50 minutes per session. Home-based walking exercise consisted of a behavioral intervention in which a coach helped participants walk for exercise in or around home for up to 5 days per week for 50 minutes per session.
A total of 719 participants with PAD (mean [SD] age, 68.8 [9.5] years; 46.5% female) were included (349 in a home-based exercise clinical trial and 370 in a supervised exercise trial). Compared with nonexercise control, supervised treadmill exercise was associated with significantly improved 6MW by 32.9 m (95% CI, 20.6-45.6; P < .001) and home-based walking exercise was associated with significantly improved 6MW by 50.7 m (95% CI, 34.8-66.7; P < .001). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (between-group difference: 23.8 m [95% CI, 3.6, 44.0; P = .02]) but significantly less improvement in maximum treadmill walking distance (between-group difference:-132.5 m [95% CI, -192.9 to -72.1; P < .001]).
In this individual participant data meta-analyses, compared with supervised exercise, home-based walking exercise was associated with greater improvement in 6MW in people with PAD. These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD.
很少有下肢外周动脉疾病 (PAD) 患者参加医疗保险和医疗补助服务中心涵盖的监督跑步机运动。在 PAD 患者中，家庭步行运动的益处相对于监督运动仍然不清楚。
研究家庭步行运动是否比 PAD 患者（定义为踝肱指数≤0.90）的监督跑步机运动更能改善 6 分钟步行（6MW）。
使用个体参与者数据荟萃分析，从 2009 年至 2022 年发表的 5 项 PAD 运动疗法随机临床试验中合并数据。
在 5 项临床试验中，3 项临床试验比较了监督跑步机运动与非运动对照组（N=370），2 项临床试验比较了有效的家庭步行运动干预与非运动对照组（N=349）。
由一个研究小组领导的 5 项随机临床试验的个体参与者水平数据进行了合并。这 5 项随机临床试验包括 3 项监督跑步机运动的临床试验和 2 项有效的家庭步行运动干预。
6 个月随访时 6MW 距离、最大跑步机步行距离和步行障碍问卷的变化。监督跑步机运动干预包括在运动生理学家的监督下进行跑步机运动，每周进行 3 天，每次最多 50 分钟。家庭步行运动包括行为干预，教练帮助参与者在家中或周围进行步行锻炼，每周最多 5 天，每次 50 分钟。
共有 719 名 PAD 患者（平均[标准差]年龄，68.8[9.5]岁；46.5%女性）被纳入（349 名参加家庭运动临床试验，370 名参加监督运动试验）。与非运动对照组相比，监督跑步机运动与 6MW 显著改善 32.9m（95%CI，20.6-45.6；P<0.001）相关，家庭步行运动与 6MW 显著改善 50.7m（95%CI，34.8-66.7；P<0.001）相关。与监督跑步机运动相比，家庭步行运动与 6MW 距离的显著改善相关（组间差异：23.8m[95%CI，3.6，44.0；P=0.02]），但与最大跑步机步行距离的显著改善相关（组间差异：-132.5m[95%CI，-192.9 至-72.1；P<0.001）。
在这项个体参与者数据荟萃分析中，与监督运动相比，家庭步行运动与 PAD 患者 6MW 的改善更大。这些发现支持家庭步行运动作为 PAD 步行障碍的一线治疗方法。
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