Regensteiner J G, Meyer T J, Krupski W C, Cranford L S, Hiatt W R
Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Angiology. 1997 Apr;48(4):291-300. doi: 10.1177/000331979704800402.
Supervised, hospital-based exercise rehabilitation programs are effective for improving functional status for patients with claudication due to peripheral arterial occlusive disease. However, it has been suggested that unsupervised, home-based exercise programs, which have been relatively little evaluated, would be equally efficacious as compared with hospital-based programs. The authors tested the hypothesis that a hospital-based exercise rehabilitation program would improve treadmill exercise performance more than a home-based program. Of 20 consecutively enrolled patients with claudication, 10 were randomly placed into a supervised, hospital-based program and 10 into an unsupervised, home-based program for a three-month period. Exercise performance was evaluated by treadmill testing using a graded protocol. In addition, functional status was evaluated by the Walking Impairment Questionnaire (WIQ) and the Medical Outcomes Study SF-20 questionnaire (MOS). Patients in the hospital-based program were treated with treadmill walking three times a week for one hour/visit. Patients in the home-based program were instructed to walk at least three times a week and were contacted weekly to provide encouragement and to record compliance with the program. Patients in the hospital-based group improved peak walking time by 137%, pain-free walking time by 150%, and peak oxygen consumption by 19% (all P < 0.05). Patients reported an improved walking distance and speed according to WIQ data (both P < 0.05). In addition, the MOS physical functioning score in the hospital-based group improved by 20 percentage points (P < 0.05). In contrast, patients in the home-based program did not improve exercise performance measured on the treadmill. Improvement in the ability to walk on the treadmill was greater in the hospital-based than the home-based program (P < 0.05). The ability to walk distances was the only questionnaire measure that improved in persons who received the home-based program (P < 0.05). Preliminary results suggest that a supervised, hospital-based program is more effective for improving treadmill exercise performance than an unsupervised, home-based program.
基于医院的监督式运动康复计划对于改善因外周动脉闭塞性疾病导致间歇性跛行患者的功能状态是有效的。然而，有人提出，相对较少评估的非监督式家庭运动计划与基于医院的计划相比可能同样有效。作者检验了这样一个假设：基于医院的运动康复计划比家庭计划能更有效地改善跑步机运动表现。在连续纳入的20例间歇性跛行患者中，10例被随机分配到基于医院的监督式计划，10例被分配到非监督式家庭计划，为期三个月。使用分级方案通过跑步机测试评估运动表现。此外，通过步行障碍问卷（WIQ）和医学结局研究SF - 20问卷（MOS）评估功能状态。基于医院的计划组患者每周在跑步机上行走三次，每次一小时。家庭计划组的患者被指示每周至少行走三次，并且每周与他们联系以提供鼓励并记录对计划的依从性。基于医院的组患者的峰值行走时间提高了137%，无痛行走时间提高了150%，峰值耗氧量提高了19%（所有P < 0.05）。根据WIQ数据，患者报告行走距离和速度有所改善（两者P < 0.05）。此外，基于医院的组的MOS身体功能评分提高了20个百分点（P < 0.05）。相比之下，家庭计划组的患者在跑步机上测量的运动表现没有改善。基于医院的计划比家庭计划在跑步机上行走能力的改善更大（P < 0.05）。行走距离的能力是接受家庭计划的人中唯一得到改善的问卷测量指标（P < 0.05）。初步结果表明，基于医院的监督式计划比非监督式家庭计划在改善跑步机运动表现方面更有效。
