Regensteiner J G, Steiner J F, Hiatt W R
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA.
J Vasc Surg. 1996 Jan;23(1):104-15. doi: 10.1016/s0741-5214(05)80040-0.
In patients with intermittent claudication (IC) a structured walking exercise program improves exercise performance. However, few studies have evaluated the effects of exercise training on functional status during daily activities. We hypothesized that a supervised exercise training program would improve functional status in patients with IC, with 24 weeks of training more beneficial than 12 weeks. A secondary aim was to evaluate the effects of strength training and combinations of strength and treadmill training on functional status.
Twenty-nine men with disabling IC were randomized to 12 weeks of either supervised treadmill training (3 hr/wk at a work intensity sufficient to produce claudication), strength training (3 hr/wk of resistive training of six muscle groups of each leg), or to a nonexercising control group. Functional status was assessed by questionnaires characterizing walking ability (Walking Impairment Questionnaire, WIQ), habitual physical activity level (Physical Activity Recall, PAR), and physical, social, and role functioning, well-being, and overall health (Medical Outcomes Study SF-20, MOS). Patients alos had their activity levels monitored with an activity monitor (Vitalog).
After 12 weeks of treadmill training PAR scores increased by 48 metabolic equivalent hr/wk, the MOS physical functioning score by 24 percentage points, and the number of bouts of walking activity measured by the Vitalog by 4.5 bouts/hr (all p < 0.05). No changes were seen in WIQ scores. After 12 additional weeks of treadmill training improvements initially observed in the PAR, MOS, and Vitalog scores were maintained, and in addition the ability to walk distances (WIQ) improved by 31 percentage points, and the IC severity score had improved by 29 percentage points (both p < 0.05). After 12 weeks of strength training patients improved their WIQ walking speed, stair climbing scores, and MOS well-being scores with no other changes in functional status. Subjects in the control group did not improve functional status by any measure. Twelve weeks of treadmill training after the strength training program maintained WIQ walking speed scores, and activity level defined by Vitalog improved. Twelve weeks of combined treadmill and strength training after the control period had no effect on functional status.
A supervised treadmill training program improved functional status during daily activities, with 24 weeks more effective than 12. In addition, treadmill training alone was more effective in improving functional status in patients with IC than strength training or combinations of the training modalities.
在间歇性跛行（IC）患者中，结构化步行锻炼计划可改善运动表现。然而，很少有研究评估运动训练对日常活动中功能状态的影响。我们假设，一项有监督的运动训练计划将改善IC患者的功能状态，24周训练比12周训练更有益。次要目的是评估力量训练以及力量训练与跑步机训练相结合对功能状态的影响。
29名患有致残性IC的男性被随机分为三组，分别接受12周的有监督跑步机训练（每周3小时，工作强度足以引发跛行）、力量训练（每周3小时，对每条腿的六个肌肉群进行阻力训练），或不运动的对照组。通过描述步行能力的问卷（步行障碍问卷，WIQ）、习惯性身体活动水平（身体活动回忆，PAR）以及身体、社会和角色功能、幸福感和总体健康状况（医学结果研究SF - 20，MOS）来评估功能状态。患者还使用活动监测器（Vitalog）监测其活动水平。
经过12周的跑步机训练，PAR评分增加了48代谢当量小时/周，MOS身体功能评分增加了24个百分点，Vitalog测量的步行活动次数增加了4.5次/小时（所有p < 0.05）。WIQ评分未见变化。在额外进行12周的跑步机训练后，最初在PAR、MOS和Vitalog评分中观察到的改善得以维持，此外，步行距离（WIQ）能力提高了31个百分点，IC严重程度评分提高了29个百分点（均p < 0.05）。经过12周的力量训练，患者的WIQ步行速度、爬楼梯评分和MOS幸福感评分有所改善，功能状态无其他变化。对照组患者在任何测量指标上功能状态均未改善。在力量训练计划后进行12周的跑步机训练，WIQ步行速度评分得以维持，Vitalog定义的活动水平有所改善。在对照组阶段后进行12周的跑步机和力量训练相结合对功能状态没有影响。
一项有监督的跑步机训练计划改善了日常活动中的功能状态，24周比12周更有效。此外，单独的跑步机训练在改善IC患者功能状态方面比力量训练或训练方式的组合更有效。
