Fujiwara M, Asakuma S, Iwasaki T
First Department of Internal Medicine, Hyogo College of Medicine.
J Cardiol. 2000 Oct;36(4):213-9.
Improvement in exercise tolerance is an important goal in cardiac rehabilitation, but improvement in quality of life (QOL) must also be considered. Therefore, we planned a non-supervised walking exercise program at home for 1 year in patients in the convalescent phase of myocardial infarction to study the exercise tolerance and QOL.
Thirty-two patients (mean age 60.3 +/- 10 years, 23 men and 9 women) performed our non-supervised home exercise program in which the exercise prescription was based on the rating of perceived exertion. Before discharge, 1 month and 1 year after discharge, exercise tolerance was measured by the cardiopulmonary treadmill exercise test, and QOL was investigated by questionnaire.
Anaerobic threshold increased from 15.8 +/- 3.4 ml/kg/min before discharge to 17.5 +/- 3.0 ml/kg/min 1 month after (p < 0.05) and to 18.3 +/- 3.0 ml/min/kg 1 year after (p < 0.05 vs at discharge), and peak oxygen consumption increased from 22.2 +/- 4.3 to 25.2 +/- 5.1 ml/kg/min (p < 0.05) and to 26.4 +/- 5.2 ml/kg/min (p < 0.05 vs at discharge), respectively. QOL score by questionnaire was maintained in 13 patients (improved in 3, same in 10) and decreased in 19 of 32 patients from discharge to 1 month, and the score was maintained in 18 patients (improved in 13, same in 5) and decreased in 14 of 32 patients from 1 month to 1 year after discharge.
In patients with myocardial infarction in the convalescent phase, our non-supervised home exercise program resulted in improvement in exercise tolerance, but QOL score decreased gradually. Therefore, we should not only prescribe an exercise program, but also must give more psychosocial support to the patients. The reasons for the decreased QOL by cardiac rehabilitation must be further investigated.
提高运动耐量是心脏康复的一个重要目标，但生活质量（QOL）的改善也必须予以考虑。因此，我们为心肌梗死恢复期患者制定了一项为期1年的非监督性居家步行锻炼计划，以研究运动耐量和生活质量。
32例患者（平均年龄60.3±10岁，男性23例，女性9例）执行我们的非监督性居家锻炼计划，其中运动处方基于主观用力程度分级。出院前、出院后1个月和1年，通过心肺跑步机运动试验测量运动耐量，并通过问卷调查研究生活质量。
无氧阈从出院前的15.8±3.4 ml/kg/min增加至出院后1个月的17.5±3.0 ml/kg/min（p<0.05）以及出院后1年的18.3±3.0 ml/min/kg（与出院时相比p<0.05），峰值耗氧量分别从22.2±4.3增加至25.2±5.1 ml/kg/min（p<0.05）以及26.4±5.2 ml/kg/min（与出院时相比p<0.05）。问卷调查的生活质量评分在出院至1个月期间，13例患者保持（3例改善，10例相同），32例患者中有19例下降；在出院后1个月至1年期间，18例患者保持（13例改善，5例相同），32例患者中有14例下降。
对于心肌梗死恢复期患者，我们的非监督性居家锻炼计划可提高运动耐量，但生活质量评分逐渐下降。因此，我们不仅应开具锻炼计划，还必须给予患者更多的心理社会支持。心脏康复导致生活质量下降的原因必须进一步研究。
