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Keywords:

  • exercise;
  • intermittent claudication;
  • meta-analysis;
  • peripheral arterial disease;
  • walk
  • 运动;
  • 间歇性跛行;
  • meta分析;
  • 外周动脉疾病;
  • 强化步行运动

Abstract

Background

Supervised treadmill exercise is the recommended therapy for peripheral arterial disease (PAD) patients with intermittent claudication (IC). However, most PAD patients do not exhibit typical symptoms of IC. The aim of the present study was to explore the efficacy and safety of intensive walking exercise in PAD patients with and without IC.

Methods

The PubMed, Embase and Cochrane Library databases were systematically searched. Randomized controlled trials comparing the effects of intensive walking exercise with usual care in patients with PAD were included for systematic review and meta-analysis.

Results

Eighteen trials with 1200 patients were eligible for the present analysis. Compared with usual care, intensive walking exercise significantly improved the maximal walking distance (MWD), pain-free walking distance, and the 6-min walking distance in patients with PAD (P < 0.00001 for all). Subgroup analyses indicated that a lesser improvement in MWD was observed in the subgroup with more diabetes patients, and that the subgroup with better baseline walking ability exhibited greater improvement in walking performance. In addition, similar improvements in walking performance were observed for exercise programs of different durations and modalities. No significant difference was found in adverse events between the intensive walking and usual care groups (relative risk 0.84; 95% confidence interval 0.51, 1.39; P = 0.50).

Conclusions

Regardless of exercise length and modality, regularly intensive walking exercise improves walking ability in PAD patients more than usual care. The presence of diabetes may attenuate the improvements in walking performance in patients with PAD following exercise.

摘要

背景

监督下的踏车运动是伴间歇性跛行(Intermittent claudication,IC)的外周动脉疾病(Peripheral arterial disease,PAD)患者的一线治疗方法,但是绝大多数的PAD患者并没有典型的IC症状。本系统评价旨在探讨强化步行运动对伴和不伴IC的PAD患者的有效性和安全性。方法:计算机系统检索PubMed、Ovid Embase和Cochrane图书馆,检索并筛选以强化步行运动为干预措施治疗PAD,以日常活动为对照,随访时间不少于12周的临床随机对照试验,并提取有效数据进行系统综述和meta分析。

结果

本系统评价共纳入18项研究,共1200例伴和不伴IC的PAD患者。与对照组相比,强化步行运动可显著提高PAD患者的最大步行距离、无痛行走距离和6分钟步行距离(所有P < 0.00001)。进一步的亚组分析提示,强化步行运动对PAD患者的疗效与患者是否合并糖尿病有关,在糖尿病比例高的亚组中疗效较差。强化步行运动对PAD患者的疗效与患者的基线运动功能相关,在基线运动功能较好的PAD患者中效果更为明显;但不同的运动疗程和运动模式(无痛到轻度疼痛的步行训练与中到重度疼痛的步行训练)对PAD患者运动功能的改善无明显统计学差异。强化步行运动组与对照组组间的不良事件发生率无明显差异(RR = 0.84;95% CI = [0.51,1.39];P = 0.50)。

结论

与对照组相比,无论运动疗程和模式,强化步行运动均可提高PAD患者的运动耐受性,改善运动功能。若PAD患者合并糖尿病,可能会降低运动治疗的疗效。