Ingwersen Maja, Kunstmann Ina, Oswald Carolin, Best Norman, Weisser Burkhard, Teichgräber Ulf
Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany; Institute of Physical and Rehabilitation Medicine, Sophien and Hufeland Hospital Weimar, Academic Teaching Hospital, University of Jena, Jena, Germany; Institute of Sports Science, Department of Sports Medicine, Kiel University, Kiel, Germany.
Dtsch Arztebl Int. 2023 Dec 27;120(51-52):879-885. doi: 10.3238/arztebl.m2023.0231.
One-third of all persons with peripheral arterial occlusive disease (PAOD) suffer from intermittent claudication. Exercise training under appropriate supervision is recommended in the pertinent guidelines, but physicians order it too rarely, and so-called vascular exercise groups are not available everywhere. This situation needs improvement in view of the impor - tance of walking ability and cardiorespiratory fitness for patients' quality of life and long-term disease outcome.
We review the scientific evidence on exercise training and on ways to lower barriers to the ordering of exercise training and to patient participation, on the basis of pertinent articles retrieved by a search of PubMed and in specialized sports science journals.
10 meta-analyses, 12 randomized controlled trials (RCTs), and 7 cohort studies were considered for this review. Largescale cohort studies have shown that exercise is associated with a lower risk of death (relative risk 0.65-0.78 after 12 months of exercise training, compared to an inactive lifestyle). Exercise training also improves the maximal walking distance by a mean of 136 m (training at home) or 180-310 m (supervised training). An additional improvement by a mean of 282 m can be expected from a combination of exercise training and endovascular revascularization. Further behavior-modifying interventions, such as goal-setting, planning, and feedback, increase both the maximum walking distance and the weekly duration of exercise.
Exercise improves walking ability and lowers mortality. To attract patients with intermittent claudication to exercise training, a broad assortment of analog, digital and telemetric tools and a dense network of vascular exercise groups should be made available, along with regular contact between physicians and patients.
三分之一的外周动脉闭塞性疾病（PAOD）患者患有间歇性跛行。相关指南推荐在适当监督下进行运动训练，但医生很少开具此类医嘱，而且所谓的血管运动小组并非随处可得。鉴于步行能力和心肺适能对患者生活质量和疾病长期转归的重要性，这种情况需要改善。
我们基于通过检索PubMed及专业运动科学期刊所获取的相关文章，回顾了关于运动训练以及降低运动训练医嘱开具和患者参与障碍方法的科学证据。
本综述纳入了10项荟萃分析、12项随机对照试验（RCT）和7项队列研究。大规模队列研究表明，运动与较低的死亡风险相关（运动训练12个月后，相对风险为0.65 - 0.78，与不运动的生活方式相比）。运动训练还可使最大步行距离平均增加136米（在家训练）或180 - 310米（监督训练）。运动训练与血管内血运重建相结合，预计最大步行距离平均还可额外增加282米。进一步的行为改变干预措施，如目标设定、计划制定和反馈，可增加最大步行距离和每周运动时长。
运动可改善步行能力并降低死亡率。为吸引间歇性跛行患者参与运动训练，应提供种类丰富的模拟、数字和遥测工具以及密集的血管运动小组网络，并保持医生与患者之间的定期联系。
