EXERCISE FOR ELDERLY PERIPHERAL REVASCULARIZED PATIENTS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。伴有严重肢体威胁缺血的外周动脉闭塞症(PAOD)患者在腹股沟下血运重建术后改善了外周循环。尽管有这种血流动力学方面的好处，但功能状态几乎没有改变，而且许多患者仍有残余的步行功能障碍。血运重建患者的功能缺乏改善可能是由于他们先前存在的严重肢体威胁缺血继发于极端的身体解除条件。因此，我们假设，有氧运动训练计划是必要的，以通过改善步行经济、心肺功能和外周循环的进一步改善来优化步行、自由生活的日常体力活动和与健康相关的生活质量。这项随机对照临床试验将对接受分级跑步机步行计划的运动组和延迟进入非运动控制组的患者进行比较，以解决以下两个目标：(1)确定为期3个月的运动康复计划是否将改善老年血运重建的PAOD患者的跛行距离、自由生活日常体力活动和与健康相关的生活质量；(2)确定运动康复影响上述功能结果的主要机制是否通过改变步行经济、外周循环和心肺功能来实现。将80例血运重建的PAOD患者随机分为运动组(N=40)和延迟进入非运动组(N=40)。为期3个月的运动计划将包括每周3次分级跑步机步行，运动持续时间从15分钟到40分钟递增，运动强度从运动量的50%到80%递增。我们相信，这项研究将证明运动康复是血管重建术的重要辅助手段，可以在患有严重肢体威胁缺血的PAOD患者的行走、自由生活的日常体力活动和生活质量方面获得临床上有意义的改善。

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.