Safety and efficacy of home-based walking exercise for peripheral artery disease.

IF 3.9 2区医学 Q1 PERIPHERAL VASCULAR DISEASE Journal of Vascular Surgery Pub Date : 2024-10-17 DOI:10.1016/j.jvs.2024.10.013

Neela D Thangada, Dongxue Zhang, Lihui Zhao, Lu Tian, Mary M McDermott

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Abstract

Objective: Home-based walking exercise is first-line therapy for peripheral artery disease (PAD), but benefits of home-based walking exercise are variable. This study evaluated whether specific clinical characteristics were associated with greater improvement after home-based walking exercise or with higher rates of serious adverse events (SAEs).

Methods: Data were combined from two randomized clinical trials comparing home-based walking exercise with control in PAD. The home-based exercise interventions used behavioral interventions to help participants adhere to exercise. The primary outcome was the proportion of PAD participants who improved 6-minute walk (6 MW) by at least 20 meters. Serious adverse events consisted of overnight hospitalizations or death that occurred during the randomized clinical trial.

Results: Of 376 participants with PAD (69.6 years; 54.5% Black; 49.5% women), 217 were randomized to exercise and 159 to control. Home-based exercise improved 6 MW by at least 20 meters in 100 participants (54.9%), compared with 37 (28.0%) in control (odds ratio, 3.13; 95% confidence interval, 1.94-5.06; P < .001. Age, sex, race, comorbidities, baseline 6 MW, and income did not significantly alter the effect of home-based exercise on improved 6 MW. SAEs occurred in 28.1% and 23.3% of participants randomized to exercise and control, respectively (P = .29). There were statistically significant interactions, indicating that home-based exercise increased SAE rates, compared with control, in Black compared with non-Black participants (P interaction < .001), in those with vs without coronary artery disease (CAD) (P interaction < .001), and in people with vs without history of heart failure (P interaction = .005).

Conclusions: Among people with PAD, home-based exercise improved 6 MW by at least 20 meters in 54.9% of people. Older age, female sex, Black race, and specific comorbidities were not associated with lower rates of attaining meaningful improvement in 6 MW following home-based exercise. Further study is needed to establish whether certain patient characteristics, such as history of coronary artery disease, may affect SAE rates in patients with PAD participating in home-based exercise.

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居家步行锻炼治疗外周动脉疾病的安全性和有效性

导言：居家步行锻炼是治疗外周动脉疾病（PAD）的一线疗法，但居家步行锻炼的益处各不相同。本研究评估了特定的临床特征是否与居家步行锻炼后病情改善程度更大或严重不良事件（SAEs）发生率更高相关：方法：综合了两项随机临床试验的数据，这两项试验比较了PAD患者在家进行步行锻炼与对照组进行步行锻炼的情况。居家锻炼干预采用行为干预，帮助参与者坚持锻炼。主要结果是PAD参与者中6分钟步行（6MW）至少提高20米的比例。严重不良事件包括随机临床试验期间发生的过夜住院或死亡：在 376 名 PAD 参与者（69.6 岁，54.5% 为黑人，49.5% 为女性）中，217 人被随机分配到运动疗法，159 人被随机分配到对照疗法。与对照组的 37 人（28.0%）相比，100 人（54.9%）的家庭锻炼将 6MW 至少提高了 20 米（Odds Ratio 3.13 (95% CI: 1.94,5.06)，P< 0.001）。年龄、性别、种族、合并症、基线 6MW 和收入并不会显著改变家庭锻炼对改善 6MW 的影响。分别有 28.1% 和 23.3% 的随机运动参与者和对照组参与者发生了 SAE（P=0.29）。两者之间存在统计学意义上的交互作用，表明与对照组相比，在家中进行锻炼的黑人参与者比非黑人参与者的SAE发生率更高（P交互作用结论：在PAD患者中，在家中进行锻炼对改善6MW的影响更大：在 PAD 患者中，54.9% 的人通过居家锻炼将 6MW 至少提高了 20 米。年龄偏大、性别为女性、黑人种族和特定的合并症与在家锻炼后6MW获得有意义改善的比例较低无关。还需要进一步研究，以确定某些患者特征（如冠状动脉疾病史）是否会影响参与居家锻炼的 PAD 患者的 SAE 发生率。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.