<p>Uvod-Kardiovaskularne bolesti su vodeći uzrok smrti i radne nesposobnosti u Evropi, predstavljaju<br />veliko socijalno i ekonomsko opterećenje. Bolesti periferne arterijske cirkulacije se mogu podeliti u<br />dve celine i to na okluzivne i neokluzivne bolesti, odnosno funkcionalne smetnje. Učestalost<br />arterijske bolesti donjih ekstremiteta snažno je povezana sa godinama starosti. Faktori rizika za<br />perifernu arterijsku bolest su slični onima koji su važni u etiologiji koronarne arterijske bolesti:<br />gojaznost, pu&scaron;enje, dislipidemija, &scaron;ećerna bolest, hipertenzija. Najtipičnija prezentacija periferne<br />arterijske bolesti je intermitentna klaudikacija koja se karakteri&scaron;e bolom u listovima koji se<br />pojačava pri hodanju; bol obično nestaje u miru. Svi gojazni pacijenti sa perifernom arterijskom<br />bole&scaron;ću donjih ekstremiteta imaju povećan rizik od budućih kardiovaskularnih događaja, te je kod<br />njih obavezna op&scaron;ta sekundarna prevencija u cilju pobolj&scaron;anja prognoze. Fizičko vežbanje<br />predstavlja metodu izbora kod obolelih od periferne arterijske bolesti donjih ekstremiteta.<br />Cilj istraživanja: Uporediti efekte programirane fizičke aktivnosti i medikamentozne terapije na<br />hemodinamiku i riziko faktore za kardiovaskularna obolenja kod gojaznih osoba obolelih od<br />periferne arterijske bolesti donjih ekstremiteta.<br />Ispitanici i metode istraživanja: Obavila se retrospektivna-prospektivna, klinički deskriptivna,<br />kontrolisana studija, na ispitanicima Javne Ustanove Domovi Zdravlja Kantona Sarajevo -<br />Specijalističko konsultativna delatnost. OJ Specijalističko konsultativna delatnost predstavlja<br />sekundarni vanbolnički nivo zdravstvene za&scaron;tite. Ovom studijom se evaluirao period od 20 nedelja<br />(140 dana). U studiju je uključeno 75 ispitanika. Na početku istraživanja, na osnovu nalaza kolor<br />Doppler sonografije pedalnih arterija, nalaza ejekcione frakcije leve komore, spirometrijskog<br />nalaza, vrednosti pulsnog aortalnog pritiska te utvrđivanja preterane uhranjosti &ndash; gojaznosti<br />ispitanici su uključeni u istraživanje. Osim ultrazvučnog nalaza i nalaza spirometrije, pacijenti su<br />dali i iscrpnu anamnezu o prethodnim obolenjima. Uradilo se merenje indeksa telesne težine, obim<br />struka i klaudikacione distance. Lipidogram kao i jutarnji &scaron;ećer su bili urađeni za svakog pacijenta.<br />Pacijentima je prepisana ili produžena medikamentozna terapija, te data detaljna upustva za<br />svakodnevni program vazoaktivne &scaron;etnje.<br />Rezultati istraživanja: Na početku istraživanja prosečna vrednost obima struka ispitanika je<br />iznosila 87,94&plusmn;3,07cm, nakon dve sedmice prosečan obim struka je iznosio 87,10&plusmn;2,0 cm, a na<br />kraju istraživanja 84,96&plusmn;1,98cm. Na početku istraživanja ispitanici ispitivane grupe su imali indeks<br />telesne mase od 28,93&plusmn;2,10 kg/m2. Nakon dve sedmice istraživanja i provedene terapije indeks<br />telesne mase se smanjio i iznosio 28,36&plusmn;1,99 kg/m2, da bi na kraju istraživanja prosečna vrednost<br />indeksa telesne mase u ispitivanoj grupi iznosio 27,26&plusmn;1,87 kg/m2. Prosečna vrednost glukoze u<br />krvi na početku istraživanja je iznosila 5,77&plusmn;0,96 mmol/L, tokom istraživanja ta vrednost je bila<br />5,42&plusmn;0,88 mmol/L, a na kraju istraživanja 5,30&plusmn;0,92 mmol/L. Postprandijalna vrednost glukoze u<br />krvi je na početku istraživanja iznosila7,48&plusmn;0,85 mmol/L, tokom istraživanja ta vrednost je bila<br />6,82&plusmn;0,62 mmol/L, a na kraju istraživanja 6,44&plusmn;0,64 mmol/L. Na početku istraživanja vrednost<br />HbA1c je iznosila 5,52&plusmn;0,91%, tokom istraživanja 5,32&plusmn;0,97%, a na kraju istraživanja<br />5,09&plusmn;0,73%.Prosečna vrednost CRP-a na početku istraživanja je iznosila 3,77&plusmn;1,12mg/L, tokom<br />istraživanja vrednost je iznosila 3,66&plusmn;1,36mg/L, da bi na kraju istraživanja ta vrednost iznosila<br />3,61&plusmn;1,21mg/L. Uparenim t-testom nije ustanovljeno statistički značajno smanjenje ili povečanje<br />CRP-a tokom istraživanja. Prosečna vrednost holestarola u krvi ispitanika na početku istraživanja<br />je bila iznad referentnih vrednosti i iznosila 6,58&plusmn;0,90 mmol/L. Nakon dve sedmice istraživanja i<br />provedene terapije vrednost je iznosila 4,96&plusmn;0,46 mmol/L, da bi na kraju istraživanja vrednost<br />iznosila 4,15&plusmn;0,54 mmol/L. Prosečne vrednosti triglicerida na početku i tokom istraživanja su bile<br />povi&scaron;ene, da bi na kraju istraživanja bile u okvirima referentnih vrednosti. Razlika između<br />VI<br />vrednosti leptina kod mu&scaron;karaca na početku i kraju istraživanja je iznosila 2,66&plusmn;1,52 ng/ml<br />(t=3,024; p=0,094) dok kod ispitanica ženskog pola nije do&scaron;lo do statistički značajne razlike.<br />Prosečne vrednosti viskoznosti plazme su na početku i tokom istraživanja bile iznad referentnih<br />vrednosti da bi na kraju istraživanja ta vrednost bila u granicama fiziolo&scaron;kih vrednosti. Prosečne<br />vrednosti PSV na početku i tokom istraživanja su bile u granicama patolo&scaron;kih vrednosti da bi na<br />kraju istraživanja vrednost bila u granicma fiziolo&scaron;kih vrednosti. Na početku istraživanja prosečna<br />vrednost PSV-a je bila 25,64&plusmn;5,38 cm/s, tokom istraživanja 26,94&plusmn;5,31 cm/s, da bi na kraju<br />istraživanja iznosila 35,84&plusmn;5,73 cm/s. Tokom sva tri merenja do&scaron;lo je do statistički značajnog<br />pobolj&scaron;anja. Na početku i tokom istraživanja ispitanici ispitivane grupe su imali patolo&scaron;ke<br />vrednosti klaudikacione distance, da bi na kraju istraživanja ta vrednost bila u fiziolo&scaron;kim<br />granicama. Ustanovljeno je statistički značajno smanjenje pulsa tokom istraživanja i to u<br />fiziolo&scaron;kim okvirima. Iako je do&scaron;lo do statistički značajnog pobolj&scaron;anja EFLV ipak su vrednosti na<br />kraju istraživanja bile na donjim granicama fiziolo&scaron;kih vrednosti. U toku istraživanja dobilo se i<br />statistički značajno pobolj&scaron;anje vrednosti pulsnog aortalnog pritiska. Iako je do&scaron;lo do statistički<br />značajnog pobolj&scaron;anja FEV1 ipak su vrednosti na kraju istraživanja bile na donjim granicama<br />fiziolo&scaron;kih vrednosti.<br />Zaključak - Vrednosti indeksa telesne mase ispitanika na kraju istraživanja su se statistički<br />značajno smanjile. Prosečna vrednost holesterola i triglicerida, kao i prosečna vrednost PSV-a,<br />BMI, EFLV, FEV1, kao i svih ostali poređenih parametara značajno se smanjila nakon oba<br />tretmana. Na osnovu dobijenih rezultata ustanovljeno je da je klaudikaciona distanca statistički<br />značajno manja u odnosu na početne vrednosti. Poredeći efekte medikamentoznog tretmana sa<br />efektima kombinovanog terapijskog pristupa dolazi se do zaključka da su svi poređeni parametri,<br />izuzev C-reaktivnog proteina u krvi, statistički značajno pobolj&scaron;ani na kraju kombinovanog<br />tretmana u odnosu na vrednosti na kraju medikamentoznog tretmana.</p> / <p>they represent a large social and economic burden. Diseases of peripheral arterial circulation can be<br />divided into two groups - the occlusive and non-occlusive disease, or functional impairment.<br />Incidence of arterial disease of the lower extremities is strongly associated with age. Risk factors<br />for peripheral arterial disease are similar to those that are important in the etiology of coronary<br />artery disease: obesity, smoking, dyslipidaemia, diabetes and hypertension. The most typical<br />presentation of peripheral arterial disease is intermittent claudication, which is characterized with<br />pain in the leaves, which increases during walking; the pain usually goes away in peace. All obese<br />patients with peripheral arterial disease of the lower extremities have an increased risk of future<br />cardiovascular incidents, and they require general secondary prevention in order to improve their<br />health forecasts. Physical activity represents the method of choice in patients with peripheral<br />arterial disease of the lower extremities.<br />Aim of the research: Compare the effects of programmed physical activity and medical therapy on<br />hemodynamic and risk factors for cardiovascular diseases in patients with peripheral arterial<br />diseases of the lower extremities.<br />Subjects and methods of research: A retrospective-prospective, clinically descriptive, controlled<br />study was conducted on subjects of the Public Institution Health Care Centre of Sarajevo Canton&ndash;<br />Specialist-consultative unit. Specialist-consultative unit represents secondary outpatient level of<br />health care. This study evaluated a period of 20 weeks (140 days). The study involved 75 subjects.<br />At the beginning of the study, based on the findings of colour Doppler sonography of the pedal<br />arteries, the findings of ejection fraction of the left ventricle, spirometry findings, values of<br />pulmonary aortic pressure and the determination of overweight - obesity subjects were included in<br />the research. In addition to ultrasound findings and spirometry findings, patients provided an<br />exhaustive history of previous illnesses. Measurement of the body weight index, waist<br />circumference and claudication distance were performed. Lipid status and morning blood glucose<br />level were performed for each patient. Prescribed or prolonged medicinal therapy was performed<br />for patients, and detailed instructions for everyday vasoactive walking program were given.<br />Research resultsAt the beginning of the study, the average volume of the subjects&#39; waist<br />circumference was 87.94 &plusmn; 3.07cm, after two weeks the average volume of the waist was 87.10 &plusmn;<br />2.0 cm, and at the end of the study 84.96 &plusmn; 1.98cm. At the beginning of the study, subjects of the<br />tested group had a body mass index of 28.93 &plusmn; 2.10 kg / m2. After two weeks of research and<br />performed therapy, the body mass index decreased and amounted to 28.36 &plusmn; 1.99 kg / m2, so that at<br />the end of the study, the average body mass index in the tested group was 27.26 &plusmn; 1.87 kg / m2.<br />The mean blood glucose level at the beginning of the study was 5.77 &plusmn; 0.96 mmol / L, during the<br />study this value was 5.42 &plusmn; 0.88 mmol / L, and at the end of the study, 5.30 &plusmn; 0.92 mmol / L. The<br />postprandial blood glucose level at the beginning of the study was 7,48 &plusmn; 0,85 mmol / L, during the<br />study, this value was 6.82 &plusmn; 0.62 mmol / L, and at the end of the study, 6.44 &plusmn; 0.64 mmol / L. At<br />the beginning of the study, the HbA1c value was 5.52 &plusmn; 0.91%, during the study 5.32 &plusmn; 0.97%, and<br />at the end of the study, 5.09 &plusmn; 0.73%. The C-reactive protein (CRP) mean at the beginning of the<br />study was 3.77 &plusmn; 1.12mg / L, during the study, the value was 3.66 &plusmn; 1.36mg / L, and at the end of<br />the study, this value was 3.61 &plusmn; 1.21mg / L. Paired t-test did not show a statistically significant<br />reduction or an increase in CRP during the study. The average blood cholesterol of the subjects at<br />the beginning of the study was above the reference values and amounted to 6.58 &plusmn; 0.90 mmol / L.<br />After two weeks of research and therapy, the value was 4.96 &plusmn; 0.46 mmol / L, and at the end of the<br />study the value was 4.15 &plusmn; 0.54 mmol / L. The average triglyceride values at the beginning and<br />during the study were elevated so that at the end of the study they were within the reference values.<br />VIII<br />The difference between the values of leptin in male subjects at the beginning and at the end of the<br />study were 2.66 &plusmn; 1.52 ng / ml (t = 3.024; p = 0.094) while there was no statistically significant<br />difference in female subjects. The average values of plasma viscosity were initially and during the<br />study above the reference values, and at the end of the study this value was within the limits of<br />physiological values. The mean values of PSV at the beginning and during the study were within<br />the limits of pathological values, and at the end of the study the value was within the physiological<br />limits. At the beginning of the study, the mean PSV value was 25.64 &plusmn; 5.38 cm / s, during the study<br />26.94 &plusmn; 5.31 cm / s, and at the end of the study it was 35.84 &plusmn; 5.73 cm / s. During all three<br />measurements statistically significant improvement was observed. At the beginning and during the<br />study, the subjects of the tested group had pathological values of claudication distance, and at the<br />end of the study this value was within the physiological limits. A statistically significant reduction<br />in pulse was observed during the study, in physiological frameworks. Although there was<br />statistically significant improvement in EFLV, however, the values at the end of the study were at<br />the lower limits of physiological values. During the study, statistically significant improvement in<br />the value of pulmonary aortic pressure was obtained. Although there was statistically significant<br />improvement in FEV1, the values at the end of the study were at the lower limits of physiological<br />values.<br />Conclusion - The values of the body mass index of subjects involved at the end of the study were<br />statistically significantly reduced. The average value of cholesterol and triglycerides, as well as the<br />average value of PSV, BMI, EFLV, FEV1 as well as all other comparable parameters, decreased<br />significantly after both treatments. Based on the obtained results it was found that the claudication<br />distance was statistically significantly lower than the baseline values. Comparing the effects of<br />medicinal treatment with the effects of the combined therapeutic approach, it is concluded that all<br />the compared parameters, other than C-reactive protein in the blood, were statistically significantly<br />improved at the end of the combined treatment compared to the values at the end of the medicinal<br />treatment.</p>