個別化運動訓練對周邊動脈疾病術後患者在動脈功能與行走能力及生活品質上的效果

Abstract

研究背景及目的：目前文獻少見運動訓練對術後周邊動脈疾患的訓練效果。本研究目的在探討個別化運動訓練對於改善術後周邊動脈疾患的血管功能，以及行走能力與生活品質的效果，並探討三者改變量間的相關性。方法：本研究徵召三十二位仍有症候的周邊動脈疾病術後患者，隨機分配至控制組與接受十二週個別化運動訓練計畫的運動組，所有受試者在研究期間維持原來的生活習慣、飲食習慣與藥物服用，並於收案時與十二週後分別接受一次血管功能、行走能力 (包含行走損傷問卷分數)與血管疾病生活品質問卷的評估。最後運動組十二位、控制組十三位完成測試。統計分析以independent t-test及Chi-square test比較兩組的基本資料，以2 × 2 two-way mixed ANOVA model比較所有參數之組間與組內差異，平均血壓則作為動脈功能參數分析的共同變項。Pearson’s correlation analysis則用以分析血管功能、行走能力及生活品質參數改變量間的相關性。結果：兩組受試者在收入時除舒張壓有顯著差異外，其餘各項參數均無顯著差異。疼痛發生及最大行走時間、行走損傷問卷上下樓梯分數、患側或較嚴重側硬化指數、兩側足趾血流量、血管疾病生活品質活動分數、症狀分數及總分等參數有顯著交互作用，post-hoc發現除患側或較嚴重側硬化指數在控制組內顯著增加外，其餘參數皆在運動組內有顯著變化，後測值組間比較則於患側或較嚴重側足趾血流量及血管疾病生活品質活動分數呈現顯著差異，其餘參數均無。在無顯著交互作用的參數中，行走損傷問卷的症狀與行走速度分數以及血管疾病生活品質情緒分數有顯著整體組內差異。相關性方面，足趾血流改變量與行走能力改變量間、足趾壓力改變量與行走能力改變量間、行走能力改變量與生活品質改變量間有顯著正相關，而脈波速率改變量與行走能力改變量間有顯著負相關。結論：本研究證實個別化運動訓練能顯著改善術後周邊動脈疾患的足趾血流量，行走時間與上下樓梯等行走能力，以及活動、症狀相關的生活品質。

Background and purpose: Fewer studies investigated the exercise training effects on patients with peripheral arterial disease (PAD) after vascular intervention. The purposes of this study were to investigate individualized exercise training effects on arterial function, walking ability and quality of life (QoL), and correlations among changes of all variables in these patients. Methods: Thirty-two symptomatic post-vascular intervention subjects were recruited and randomly assigned into control group and exercise group whom received 12-week individualized exercise program. All subjects were asked to maintain their life style, diet, and medicine during study period and had arterial function, walking ability (including grades of Walking Impairment Questionnaire (WIQ)), and Vascular Quality of Life questionnaire (VascuQoL) measured at baseline and 12 weeks after. Twelve subjects in exercise group and 13 in control group completed the study. Independent t-test and Chi-square test were performed to compare the baseline data between groups. A 2 × 2 two-way mixed ANOVA model was performed to compare the between- and within-group differences in all variables. Mean arterial pressure was used as the covariate in analyzing the effects on variables of arterial function. Pearson correlation analysis was used to investigate the correlations among the changes in arterial function, walking ability and QoL. Results: There were no significant differences in baseline data between groups except diastolic blood pressure. Significant interactions were noted in variables of reflection index (RI) of more affected side, toe fluxs of two sides, initial claudication and maximal walking time, stairs grades of WIQ, acivity and symptom and sum grades of VascuQoL. Post-hocs showed significant within-control-group change in RI of more affected side, within-exercise-group changes in other variables with significant interaction, and between-group post-test differences in toe flux of more affected side and acivity grades of VascuQoL. Other variables with significant interaction showed no between-group post-test differences. For those without significant interactions, symptom and speed grades of WIQ and emotion grades of VascuQoL showed only significant within-group main differences. For correlations, positive relationships were noted between changes of toe flux and walking ability, toe pressure and walking ability, as well as walking ability and QoL. Negative relationship was noted between changes of brachial-ankle pulse wave velocity and walking ability. Conclusion: Individualized exercise training could significantly improve toe fluxs, walking time and ability of up/down stairs, as well as activity- and symptom-associated QoL in PAD patients post-vascular intervention.