Hiatt W R, Wolfel E E, Meier R H, Regensteiner J G
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262.
Circulation. 1994 Oct;90(4):1866-74. doi: 10.1161/01.cir.90.4.1866.
In patients with intermittent claudication, a supervised walking exercise program increases peak exercise performance and community-based functional status. Patients with peripheral arterial disease also have muscle weakness in the affected extremity that may contribute to the walking impairment. However, the potential benefits of training modalities other than walking exercise, such as strength training, have not been critically evaluated in this patient population. The present study tested the hypothesis that a strength training program would be as effective as treadmill walking exercise and that combinations of strengthening and walking exercise would be more effective than either alone in improving exercise performance.
Twenty-nine patients with disabling claudication were randomized to 12 weeks of supervised walking exercise on a treadmill (3 h/wk at a work intensity sufficient to produce claudication), strength training (3 h/wk of resistive training of five muscle groups of each leg), or a nonexercising control group. Graded treadmill testing was performed to maximally tolerated claudication pain to define changes in peak exercise performance. After 12 weeks, patients in the treadmill training program had a 74 +/- 58% increase in peak walking time as well as improvements in peak oxygen consumption (VO2) and the onset of claudication pain. Patients in the strength-trained group had a 36 +/- 48% increase in peak walking time but no change in peak VO2 or claudication onset time. Control subjects had no changes in any of these measures over the 12-week period. After the first 12 weeks, patients in the initial walking exercise group continued for 12 more weeks of supervised treadmill training. This resulted in an additional 49 +/- 53% increase in peak walking time (total of 128 +/- 99% increase over the 24 weeks). After the initial 12 weeks, patients in the strength-trained group began 12 weeks of supervised treadmill training, and patients in the control group participated in a 12-week combined program of strengthening and treadmill walking exercise. The combined strength and treadmill training program and treadmill training after 12 weeks of strength training resulted in increases in peak exercise performance similar to those observed with 12 weeks of treadmill training alone.
A supervised treadmill walking exercise program is an effective means to improve exercise performance in patients with intermittent claudication, with continued improvement over 24 weeks of training. In contrast, 12 weeks of strength training was less effective than 12 weeks of supervised treadmill walking exercise. Finally, strength training, whether sequential or concomitant, did not augment the response to a walking exercise program.
在间歇性跛行患者中，一项有监督的步行锻炼计划可提高运动峰值表现和基于社区的功能状态。外周动脉疾病患者受累肢体也存在肌肉无力，这可能导致步行障碍。然而，除步行锻炼外的其他训练方式（如力量训练）的潜在益处尚未在该患者群体中得到严格评估。本研究检验了以下假设：力量训练计划与跑步机步行锻炼同样有效，且力量训练与步行锻炼相结合比单独任何一种方式在改善运动表现方面更有效。
29例致残性跛行患者被随机分为三组，分别接受为期12周的有监督的跑步机步行锻炼（每周3小时，工作强度足以引发跛行）、力量训练（每周3小时，对每条腿的五个肌肉群进行阻力训练）或非锻炼对照组。进行分级跑步机测试以确定最大耐受跛行疼痛，从而定义运动峰值表现变化。12周后，跑步机训练组患者的峰值步行时间增加了74±58%，同时峰值耗氧量（VO2）和跛行疼痛发作时间也有所改善。力量训练组患者的峰值步行时间增加了36±48%，但峰值VO2或跛行发作时间无变化。对照组受试者在这12周内这些指标均无变化。在最初的12周后，最初的步行锻炼组患者继续接受为期12周的有监督的跑步机训练。这导致峰值步行时间额外增加了49±53%（24周内总共增加了128±99%）。在最初的12周后，力量训练组患者开始接受为期12周的有监督的跑步机训练，对照组患者参加为期12周的力量训练与跑步机步行锻炼相结合的计划。力量训练与跑步机训练相结合的计划以及力量训练12周后进行的跑步机训练，导致运动峰值表现的增加与仅进行12周跑步机训练时观察到的相似。
一项有监督的跑步机步行锻炼计划是改善间歇性跛行患者运动表现的有效方法，在24周的训练过程中持续改善。相比之下，12周的力量训练不如12周的有监督的跑步机步行锻炼有效。最后，力量训练，无论是相继进行还是同时进行，都没有增强对步行锻炼计划的反应。
