HOME VS SUPERVISED EXERCISE FOR ELDERLY CLAUDICANTS (UNFUNDED)

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 外周动脉疾病(PAD)是导致发病率的主要原因，原因是间歇性跛行导致的活动受限。间歇性跛行是指小腿、大腿或臀部肌肉群在行走过程中出现的缺血性肌肉疼痛，当步速超过外周循环的能力时，就会充分灌流活跃的下肢肌肉系统。间歇性跛行困扰着5%的55岁以上的美国人口，从而限制了日常体力活动，并对许多老年人的生活质量产生了负面影响。由于步行是老年人进行的主要体力活动之一，因此PAD受试者采取久坐不动的生活方式并通常聚集在体力活动谱的极低端也就不足为奇了。PAD患者的步行功能障碍和久坐不动的生活方式可能会引发其他身体功能领域的下降。例如，与非PAD对照组相比，PAD患者的下肢力量减弱，平衡受损，跌倒的发生率更高，甚至在跛行疼痛发生之前就改变了步态，自我感觉的步行功能更差，与健康相关的生活质量更低。因此，PAD受试者很难完成利用下肢的日常生活活动，而一些受试者则无法完全完成这些任务。间歇性跛行的PAD患者的主要治疗目标是通过运动康复恢复失去的身体功能。在过去的35年里，医学指导下的锻炼计划得到了广泛的研究，并在间歇性跛行的临床治疗中取得了有效的效果。具体地说，有监督的运动康复改善了标准化跑步机测试中的初始跛行距离(ICD)和绝对跛行距离(ACD)，以及间歇性跛行患者的地面步行功能、感知步行功能、体力活动水平、生活质量和小腿血流。因此，运动介导的跛行疼痛的改善是一个触发事件，它打破了PAD患者身体功能的螺旋式下降链。间歇性跛行继发的步行功能障碍是老年PAD患者身体功能螺旋式下降的第一步。该项目的总体假设是，利用新的体力活动监测技术量化步行的数量和强度的家庭锻炼计划将与标准的医院监督锻炼计划一样有效，并通过改善步行经济、小腿肌肉循环和小腿肌肉氧合的生理机制，改善步行、身体功能、血管功能和健康相关的生活质量，并优于通常的护理控制。这一假设将在一项前瞻性的随机对照临床试验中得到验证，该试验比较了基于家庭的运动组、基于医院的运动组和延迟进入的非运动组。

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 disease (PAD) is a leading cause of morbidity due to ambulatory limitations associated with intermittent claudication. Intermittent claudication is ischemic muscular pain that occurs in the calf, thigh, or buttock muscle groups during ambulation when the pace exceeds the capacity of the peripheral circulation to adequately perfuse the active lower extremity musculature. Intermittent claudication afflicts 5% of the US population older than 55 years of age, thereby limiting daily physical activities and negatively affecting quality of life in many older adults. Because ambulation is one of the primary physical activities performed by the elderly, it is not surprising that PAD subjects adopt a sedentary lifestyle and typically cluster around the extreme low end of the physical activity spectrum. The ambulatory dysfunction and sedentary lifestyle in subjects with PAD may trigger a decline in other domains of physical function. For example, PAD subjects have reduced strength in the lower extremities, impaired balance and higher prevalence of falling, altered gait even before claudication pain occurs, worse self-perceived ambulatory function, and lower health-related quality of life than non-PAD controls. Consequently, PAD subjects have difficulty completing activities of daily living that utilize the lower extremities, while some subjects are unable to perform these tasks altogether. A primary therapeutic goal for PAD patients with intermittent claudication is to regain lost physical function through exercise rehabilitation. Medically supervised exercise programs have been studied extensively over the past 35 years, and are efficacious in the clinical management of intermittent claudication. Specifically, supervised exercise rehabilitation improves initial claudication distance (ICD) and absolute claudication distance (ACD) during a standardized treadmill test, as well as overground ambulatory function, perceived ambulatory function, physical activity level, quality of life, and calf blood flow in PAD patients with intermittent claudication. Consequently, exercise-mediated improvement in claudication pain is a triggering event that breaks the downward spiraling chain of events in physical function in PAD patients. Ambulatory dysfunction secondary to intermittent claudication is the initial step in a downward spiral of physical function in older patients with PAD. The overall hypothesis of this project is that a home-based exercise program utilizing new physical activity monitoring technology that quantifies the volume and intensity of walking will be as equally efficacious as a standard hospital-based supervised exercise program and better than usual care control in improving ambulation, physical function, vascular function, and health-related quality of life through the physiologic mechanisms of improved walking economy, calf muscle circulation, and calf muscle oxygenation. This hypothesis will be tested in a prospective, randomized controlled clinical trial that compares a home-based exercise group, a hospital-based exercise group, and a delayed-entry, non-exercise group.