EXERCISE FOR ELDERLY PERIPHERAL REVASCULARIZED PATIENTS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。外周动脉闭塞性疾病（PAOD）患者在腹股沟下血运重建术后外周循环得到改善。尽管有这种血流动力学益处，但功能状态几乎没有变化，许多患者仍有残余的运动功能障碍。血运重建术患者缺乏功能改善可能是由于他们先前存在的严重肢体威胁缺血继发的极端身体条件下降。因此，我们假设有氧运动训练计划是必要的，可以通过改善步行经济性、心肺功能和外周循环的进一步改善机制来优化步行、自由生活的日常身体活动和健康相关的生活质量。这项随机对照临床试验比较了进行分级跑步机行走计划的运动组和延迟进入的非运动对照组，旨在解决以下两个目标：(1)确定3个月的运动康复计划是否会改善老年、血运重建的pad患者的跛行距离、自由生活的日常身体活动和健康相关的生活质量；(2)确定运动康复影响上述功能结局的主要机制是否通过改变步行经济性、外周循环和心肺功能。80例血运重建的pad患者将被随机分为运动组（N=40）和延迟进入非运动组（N=40）。为期3个月的锻炼计划将包括每周3次循序渐进的跑步机步行，运动时间从15分钟增加到40分钟，运动强度从运动能力的50%增加到80%。我们相信，这项研究将证明运动康复是血运重建术的重要辅助手段，可以使伴有严重肢体缺血的pad患者在行走、自由生活的日常身体活动和生活质量方面获得临床意义上的改善。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Peripheral arterial occlusive disease (PAOD) patients with critical limb-threatening ischemia have improved peripheral circulation following infrainguinal revascularization. Despite this hemodynamic benefit, little change in functional status occurs, and many patients have residual ambulatory dysfunction. The lack of functional improvement in revascularized patients may be due to extreme physical deconditioning secondary to their pre-existing critical limb-threatening ischemia. Therefore, we hypothesize that a program of aerobic exercise training is necessary to optimize ambulation, free-living daily physical activity, and health-related quality of life through the mechanisms of improved walking economy, cardiopulmonary function, and further gains in peripheral circulation. This randomized controlled clinical trial comparing an exercise group undergoing a program of graded treadmill walking, and a delayed-entry non-exercise control group will address the following two aims: (1) to determine whether a 3-month exercise rehabilitation program will improve claudication distances, free-living daily physical activity, and health-related quality of life of older, revascularized patients with PAOD, and (2) to determine whether the primary mechanisms by which exercise rehabilitation affects the above functional outcomes are through alterations in walking economy, peripheral circulation, and cardiopulmonary function. Eighty revascularized PAOD patients will be randomized and complete either the exercise group (N=40) or the delayed-entry non-exercise group (N=40). The 3-month exercise program will consist of graded treadmill walking 3 times per week with progressive increments in exercise duration from 15 to 40 minutes, and progressive increments in exercise intensity from 50 to 80% of exercise capacity. We believe this study will demonstrate that exercise rehabilitation is an important adjuvant to revascularization surgery to achieve clinically meaningful gains in ambulation, free-living daily physical activity, and quality of life in PAOD patients with critical limb-threatening ischemia.