Attendance at Supervised Exercise Sessions and Walking Outcomes in Peripheral Artery Disease: Results From 2 Randomized Clinical Trials.
Attendance at Supervised Exercise Sessions and Walking Outcomes in Peripheral Artery Disease: Results From 2 Randomized Clinical Trials.
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DOI：
10.1161/jaha.122.026136
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发表时间：
2022-12-20
影响因子：
5.4
通讯作者：
McDermott, Mary M.
中科院分区：
文献类型：
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作者：
Hammond, Michael M.;Tian, Lu;Zhao, Lihui;Zhang, Dongxue;McDermott, Mary M.
关键词：
有监督的运动疗法（SET）是外周动脉疾病（PAD）中行走障碍的一线疗法。本研究评估了PAD患者与对照组相比，参加SET和改善步行能力之间的相关性。合并2项SET治疗PAD的随机临床试验的数据。在每项试验中，参与者被随机分配到每周3次有监督的跑步机运动或注意力控制组，为期6个月（最多77次运动）。随机分配到SET的参与者根据他们参加的运动课程的比例分为三分之一。根据年龄、性别、人种、基线行走能力、合并症和其他潜在混杂因素调整结果。共纳入272名患有PAD的参与者（平均年龄，67.9±9.3岁; 44%为女性; 61%为黑人）。对于随机分配到SET的参与者，运动课程的出席率三分位数如下：11%至68%（N=45），69%至<85%（N=46）和≥85%（N=46）。与对照组相比，每个SET三分位数的6分钟步行平均改善显著更大：三分位数1的平均值（95% CI）为27.9 m（1.3-54.4 m; P=0.04），三分位数2为38.2 m（12.2-64.2 m; P=0.001），三分位数3为56.9 m（29.9-83.8 m; P<0.0001）。在随机分配到SET的参与者中，更多的SET出勤率与6分钟步行距离的更大改善相关（趋势的总体P =0.025）。与对照组相比，在每个SET出勤三分位数中，最大跑步机步行时间的改善更大：（3.3分钟[95% CI，1.7-4.8分钟]; P<0.0001），三分位数2（3.8分钟[95%CI，2.3-5.3分钟]; P<0.0001）和三分位数3（5.4分钟[95%CI，3.9-7.0分钟]; P：<0.0001）。在随机分配到SET组的参与者中，更多的SET参与者与最大跑步机步行时间的改善无显著相关性（趋势的总体P =0.064）。在随机分配到SET的PAD患者中，更好地参加运动课程与6分钟步行改善显著相关。在所有患有PAD的参与者中，与不锻炼的对照组相比，即使相对较低的SET出勤率也与步行表现的显著改善相关。网址：https://clinicaltrials.gov/ct2/show/NCT01408901。网址：https://clinicaltrials.gov/ct2/show/NCT00106327
Supervised exercise therapy (SET) is the first‐line therapy for walking impairment in peripheral artery disease (PAD). This study evaluated the association between attendance at SET and improved walking performance, compared with a control group, in PAD. Data from 2 randomized clinical trials of SET for PAD were combined. In each trial, participants were randomized to 3 times weekly supervised treadmill exercise or an attention control group for 6 months (maximum, 77 exercise sessions). Participants randomized to SET were categorized into tertiles, according to the proportion of exercise sessions they attended. Results adjusted for age, sex, race, baseline walking performance, comorbidities, and other potential confounders. A total of 272 participants with PAD (mean age, 67.9±9.3 years; 44% women; 61% Black race) were included. For participants randomized to SET, tertiles of attendance rates at exercise sessions were as follows: 11% to 68% (N=45), 69% to <85% (N=46), and ≥85% (N=46). Compared with control, mean improvement in 6‐minute walk was significantly greater in each SET tertile: mean (95% CI) for tertile 1, 27.9 m (1.3–54.4 m; P=0.04), tertile 2, 38.2 m (12.2–64.2 m; P=0.001), and tertile 3, 56.9 m (29.9–83.8 m; P<0.0001). Among participants randomized to SET, greater SET attendance was associated with greater improvement in 6‐minute walk distance (overall P for trend=0.025). Compared with control, improvement in maximal treadmill walking time was greater in each SET attendance tertile: tertile 1 (3.3 minutes [95% CI, 1.7–4.8 minutes]; P<0.0001), tertile 2 (3.8 minutes [95% CI, 2.3–5.3 minutes]; P<0.0001), and tertile 3 (5.4 minutes [95% CI, 3.9–7.0 minutes]; P:<0.0001). Among participants randomized to SET, greater attendance at SET was not significantly associated with greater improvement in maximal treadmill walking time (overall P for trend=0.064). Among people with PAD randomized to SET, better attendance at exercise sessions was associated with significantly greater 6‐minute walk improvement. Among all participants with PAD, even relatively low SET attendance was associated with significantly greater improvement in walking performance, compared with a control group who did not exercise. URL: https://clinicaltrials.gov/ct2/show/NCT01408901. URL: https://clinicaltrials.gov/ct2/show/NCT00106327