水中平板运动对外周动脉疾病患者下肢经皮氧分压及运动能力影响的研究
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摘要
目的:观察水中平板运动训练(UWTT)和普通平板运动训练(LTT)对外周动脉疾病(PAD)患者下肢经皮氧分压及运动能力的影响。方法:将58例轻、中度外周动脉疾病患者随机分为对照组(18例)、普通平板运动组(20例)及水中平板运动组(20例)。对照组只接受常规药物治疗,普通平板运动组和水中平板运动组,在常规药物治疗的基础上,分别给予普通平板运动训练和水中平板运动训练。训练频率均为每天1次,每周5天,持续12周。观察以下指数在治疗前后的评估结果:踝肱指数(ABI);PAD运动能力相关指标:运动平板测试、小腿经皮氧分压(TcPO_2)、6分钟步行距离测试(6MWDT)及行走受损问卷(WIQ);骨骼肌力量及平衡能力相关指标:肌肉力量测试、富尔顿高级平衡量表平衡评分(FAB-scale)。结果:所有测试指标,对照组治疗前后都无显著性差异(P>0.05);普通平板运动及水中平板运动与本组治疗前相比,ABI、诱发跛行疼痛时间及达到跛行严重疼痛时间、TcPO_2、6MWDT、WIQ、肌肉力量、FAB量表评分值均明显提高(P<0.05或P<0.01);与对照组治疗后相比,普通平板运动及水中平板运动诱发跛行疼痛时间及达到跛行严重疼痛时间均明显延长(P<0.001),TcPO_2、6MWDT、WIQ、肌肉力量、FAB量表评分均显著提高(P<0.05或P<0.01);水中平板运动与普通平板运动相比,诱发跛行疼痛时间及达到跛行严重疼痛时间、6MWDT、肌肉力量、FAB量表评分均显著升高(P<0.05或P<0.01)。结论:普通平板运动组与水中平板运动组均可以改善外周动脉疾病患者下肢经皮氧分压及运动能力,且水中平板运动效果优于普通平板运动。
Objective: To observe effects of underwater treadmill training(UWTT) and land treadmill training(LTT) on low limbs percutaneous oxygen tension and exercise capacity of patients with peripheral arterial disease(PAD).Method: Totally 58 mild-to-moderate PAD patients were randomly divided into control group(n=18), land treadmill training group(n=20) and underwater treadmill training group(n=20). The control group received only conventional drug therapy. Land treadmill training group and underwater treadmill training group, on the basis of conventional drug therapy, were given treadmill training and water treadmill training. Training is once a day, 5 days a week for 12 weeks. The following indices were taken before and after treatment: ankle-brachialindex(ABI); PAD exercise-related indicators: exercise treadmill test, transcutaneous oxygen tension(TcPO_2), 6-minute walking distance test(6 MWDT) and walking impairment questionnaire(WIQ); skeletal muscle strength and balance ability related indicators: muscle strength test, Fullerton advanced balance scale(FAB-scale).Result: All indexes of control group were not significantly increased after treatment(P>0.05). ABI, claudication pain beginning time, severe claudication pain time, TcPO2, 6 MWDT, WIQ, isokenetic muscle strength, and FAB-scale all significantly increased(P<0.05 or P<0.01) in both treatment groups. Compared with the control group after treatment, the time of induction of the claudication pain and the time to achieve severe pain of the average treadmill exercise group and the water treadmill exercise group were significantly prolonged(P<0.001), TcPO_2, 6 MWDT, WIQ, muscle strength, and FAB-scale were all significantly increased(P<0.05 or P<0.01). The time of induction of the claudication pain and the time to achieve severe pain, 6 MWDT, muscle strength, and FAB-scale were significantly more increased(P<0.05 or P<0.01) for the average treadmill exercise group compared with the water treadmill exercise group.Conclusion: Both the land treadmill training group and the underwater treadmill training group can improve the percutaneous oxygen tension and exercise ability of the lower limbs in patients with peripheral arterial disease. And the effect of underwater treadmill training is better than that of land treadmill training.
Objective: To observe effects of underwater treadmill training(UWTT) and land treadmill training(LTT) on low limbs percutaneous oxygen tension and exercise capacity of patients with peripheral arterial disease(PAD).Method: Totally 58 mild-to-moderate PAD patients were randomly divided into control group(n=18), land treadmill training group(n=20) and underwater treadmill training group(n=20). The control group received only conventional drug therapy. Land treadmill training group and underwater treadmill training group, on the basis of conventional drug therapy, were given treadmill training and water treadmill training. Training is once a day, 5 days a week for 12 weeks. The following indices were taken before and after treatment: ankle-brachialindex(ABI); PAD exercise-related indicators: exercise treadmill test, transcutaneous oxygen tension(TcPO_2), 6-minute walking distance test(6 MWDT) and walking impairment questionnaire(WIQ); skeletal muscle strength and balance ability related indicators: muscle strength test, Fullerton advanced balance scale(FAB-scale).Result: All indexes of control group were not significantly increased after treatment(P>0.05). ABI, claudication pain beginning time, severe claudication pain time, TcPO2, 6 MWDT, WIQ, isokenetic muscle strength, and FAB-scale all significantly increased(P<0.05 or P<0.01) in both treatment groups. Compared with the control group after treatment, the time of induction of the claudication pain and the time to achieve severe pain of the average treadmill exercise group and the water treadmill exercise group were significantly prolonged(P<0.001), TcPO_2, 6 MWDT, WIQ, muscle strength, and FAB-scale were all significantly increased(P<0.05 or P<0.01). The time of induction of the claudication pain and the time to achieve severe pain, 6 MWDT, muscle strength, and FAB-scale were significantly more increased(P<0.05 or P<0.01) for the average treadmill exercise group compared with the water treadmill exercise group.Conclusion: Both the land treadmill training group and the underwater treadmill training group can improve the percutaneous oxygen tension and exercise ability of the lower limbs in patients with peripheral arterial disease. And the effect of underwater treadmill training is better than that of land treadmill training.
引文
[1]赵喆,王蕊,高前进.运动训练与外周动脉疾病关系的研究进展[J].中国康复理论与实践,2013,19(12):1135—1139.
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[5]唐焱,周宏,周峻林,等.超声多普勒血流探测仪测定2型糖尿病患者踝肱指数的临床研究[J].中南医学科学杂志,2016,(3):290—292.
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[9] Schlenstedt C, Brombacher S, Hartwigsen G, et al. Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease[J]. Phys Ther, 2016, 96(4):494—501.
[10] Otsuka S, Morisawa T, Yuguchi S, et al. Clinical importance of change in physical activity after endovascular treatment combined with exercise training in patients with peripheral arterial disease[J]. Heart Vessels, 2017, 32(2):143—148.
[11] Parmenter BJ, Dieberg G, Smart NA. Exercise training for management of peripheral arterial disease:a systematic review and meta-analysis[J]. Sports Med, 2015, 45(2):231—244.
[12] Szymczak M, Oszkinis G, Majchrzycki M. The Impact of Walking Exercises and Resistance Training upon the Walking Distance in Patients with Chronic Lower Limb Ischaemia[J]. Biomed Res Int, 2016,(2016):7515238.
[13]吴玉玲,周先珊,沈良册,等.水中平板运动在踝关节骨折内固定术后康复中的疗效分析[J].颈腰痛杂志,2016,37(6):522—524.
[14] Stevens SL, Caputo JL, Fuller DK, et al. Effects of underwater treadmill training on leg strength, balance, and walking performance in adults with incomplete spinal cord injury[J]. J Spinal Cord Med, 2015, 38(1):91—101.
[15] Ayan C, Varela S, Vila MH, et al. Treadmill training combined with water and land-based exercise programs:Effects on Parkinson's disease patients[J]. Neuro Rehabilitation,2016, 39(2):295—299.
[16]王磊,高真真,王尊,等.艾灸联合平板运动治疗外周动脉疾病患者下肢运动功能的疗效观察[J].中国康复医学杂志,2015,30(2):164—167.
[17] Benfield RD, Hortobágyi T, Tanner CJ, et al. The effects of hydrotherapy on anxiety, pain, neuroendocrine responses,and contraction dynamics during labor[J]. Biol Res Nurs,2010, 12(1):28—36.
[18] Gass EM, Gass GC, Pitetti K. Thermoregulatory responses to exercise and warm water immersion in physically trained men with tetraplegia[J]. Spinal Cord, 2002, 40(9):474—480.
[2] Lee DG, Jeong SK, Kim YD. Effects of underwater treadmill walking training on the peak torque of the knee in hemiplegic patients[J]. J Phys Ther Sci, 2015, 27(9):2871—2873.
[3] Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease(compilation of2005 and 2011 ACCF/AHA guideline recommendations):a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2013, 127(13):1425—1443.
[4]王俊,黄犇,杨占宇,等.水中平板步行训练对脑卒中患者步行能力改善的研究[J].中国康复医学杂志,2015,(7):692—695.
[5]唐焱,周宏,周峻林,等.超声多普勒血流探测仪测定2型糖尿病患者踝肱指数的临床研究[J].中南医学科学杂志,2016,(3):290—292.
[6] Capodaglio P, De Souza SA, Parisio C, et al. Reference values for the 6-Min Walking Test in obese subjects[J]. Disabil Rehabil, 2013, 35(14):1199—1203.
[7] Mays RJ, Regensteiner JG. Exercise therapy for claudication:latest advances[J]. Curr Treat Options Cardiovasc Med,2013, 15(2):188—199.
[8]蔡前鑫,赵之光,魏文哲.肌氧饱和度与局部肌肉耐力的关系探究[J].山东体育科技,2015,37(2):84—86.
[9] Schlenstedt C, Brombacher S, Hartwigsen G, et al. Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease[J]. Phys Ther, 2016, 96(4):494—501.
[10] Otsuka S, Morisawa T, Yuguchi S, et al. Clinical importance of change in physical activity after endovascular treatment combined with exercise training in patients with peripheral arterial disease[J]. Heart Vessels, 2017, 32(2):143—148.
[11] Parmenter BJ, Dieberg G, Smart NA. Exercise training for management of peripheral arterial disease:a systematic review and meta-analysis[J]. Sports Med, 2015, 45(2):231—244.
[12] Szymczak M, Oszkinis G, Majchrzycki M. The Impact of Walking Exercises and Resistance Training upon the Walking Distance in Patients with Chronic Lower Limb Ischaemia[J]. Biomed Res Int, 2016,(2016):7515238.
[13]吴玉玲,周先珊,沈良册,等.水中平板运动在踝关节骨折内固定术后康复中的疗效分析[J].颈腰痛杂志,2016,37(6):522—524.
[14] Stevens SL, Caputo JL, Fuller DK, et al. Effects of underwater treadmill training on leg strength, balance, and walking performance in adults with incomplete spinal cord injury[J]. J Spinal Cord Med, 2015, 38(1):91—101.
[15] Ayan C, Varela S, Vila MH, et al. Treadmill training combined with water and land-based exercise programs:Effects on Parkinson's disease patients[J]. Neuro Rehabilitation,2016, 39(2):295—299.
[16]王磊,高真真,王尊,等.艾灸联合平板运动治疗外周动脉疾病患者下肢运动功能的疗效观察[J].中国康复医学杂志,2015,30(2):164—167.
[17] Benfield RD, Hortobágyi T, Tanner CJ, et al. The effects of hydrotherapy on anxiety, pain, neuroendocrine responses,and contraction dynamics during labor[J]. Biol Res Nurs,2010, 12(1):28—36.
[18] Gass EM, Gass GC, Pitetti K. Thermoregulatory responses to exercise and warm water immersion in physically trained men with tetraplegia[J]. Spinal Cord, 2002, 40(9):474—480.