HOME VS SUPERVISED EXERCISE FOR ELDERLY CLAUDICANTS (UNFUNDED)

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。外周动脉疾病（PAD）是由于间歇性跛行相关的活动受限而导致发病率的主要原因。间歇性跛行是行走时小腿、大腿或臀部肌肉群发生的缺血性肌肉疼痛，当步伐超过外周循环充分灌注活动下肢肌肉组织的能力时。美国55岁以上人口中有5%患有间歇性跛行，因此限制了日常身体活动，并对许多老年人的生活质量产生了负面影响。由于行走是老年人进行的主要身体活动之一，PAD患者采用久坐的生活方式并通常聚集在身体活动谱的极端低端也就不足为奇了。PAD患者的运动功能障碍和久坐的生活方式可能引发其他身体功能领域的下降。例如，与非PAD对照组相比，PAD受试者下肢力量减弱，平衡受损，摔倒的发生率更高，甚至在跛行疼痛发生之前就改变了步态，自我感知的行走功能更差，与健康相关的生活质量更低。因此，PAD患者难以完成使用下肢的日常生活活动，而一些患者完全无法完成这些任务。PAD患者间歇性跛行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，医学监督的运动项目已经被广泛研究，并且在间歇性跛行的临床管理中是有效的。具体而言，有监督的运动康复改善了PAD间歇性跛行患者的初始跛行距离（ICD）和绝对跛行距离（ACD），以及地上行走功能、感知行走功能、身体活动水平、生活质量和小腿血流量。因此，运动介导的跛行性疼痛的改善是一个触发事件，打破了PAD患者身体功能的下行螺旋链。继发于间歇性跛行的行走功能障碍是老年PAD患者身体功能螺旋式下降的第一步。这个项目的总体假设是，一个基于家庭的锻炼计划，利用新的身体活动监测技术，量化步行的量和强度，将与标准的医院监督锻炼计划一样有效，并且在改善步行、身体功能、血管功能和健康相关的生活质量方面优于通常的护理控制，通过改善步行经济、小腿肌肉循环、和小腿肌肉的氧合。这一假设将在一项前瞻性、随机对照临床试验中得到验证，该试验将家庭锻炼组、医院锻炼组和延迟进入的非锻炼组进行比较

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 standarized 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