Tegtbur Uwe, Busse Martin W, Jung Karsten, Pethig Klaus, Haverich Axel
Department for Sports Medicine, Leipzig, Germany.
J Heart Lung Transplant. 2005 Mar;24(3):270-4. doi: 10.1016/j.healun.2003.12.010.
Exercise rehabilitation improves physical capacity in heart transplant recipients. The time course of physical reconditioning and skeletal muscle adaptation late after transplantation are unknown.
Twenty-one heart transplant recipients, at 5.2 +/- 2.1 years after transplantation, completed 1 year of an individually tailored home ergometer-training program (2.1 +/- 0.7 sessions weekly with matched heart rates, intensity at 10% below anaerobic threshold). We analyzed time course of physical reconditioning data for each home-training session (n = 2,396). Constant-load tests with consistent blood lactate concentrations were performed quarterly (n = 105) to estimate the time course of skeletal muscle adaptation. Nine heart transplant recipients served as a control group (CG).
After 12 months, exercise capacity for matched heart rates (112 +/- 11 beats/min; CG, 114 +/- 8 beats/min) increased by 35% +/- 19% (from 43 +/- 14 to 58 +/- 18 W; p < 0.001; CG, 53 +/- 18 to 54 +/- 18 W); 24% of the increase was caused by improved skeletal muscle function and 11% by central functioning. Physical reconditioning showed its greatest increase within the first 3 months (+18%; p < 0.001); 50% of the increase consisted of better skeletal muscle or central functioning. Between the 4(th) and 12(th) months, exercise capacity increased continuously (+15%; p < 0.001), mainly because of better skeletal muscle functioning.
The persistent improvement in exercise capacity along with consistent lactate concentrations during 12 months of training indicates that exercise training could counteract the negative side effects of immunosuppressive treatment on skeletal muscles. Even late after heart transplantation, physical training should be performed regularly to prevent the accelerated decrease in exercise capacity and in skeletal muscle function.
运动康复可提高心脏移植受者的身体能力。移植后期身体功能恢复和骨骼肌适应的时间进程尚不清楚。
21名心脏移植受者在移植后5.2±2.1年，完成了为期1年的个性化家用测力计训练计划（每周2.1±0.7次训练，心率匹配，强度低于无氧阈值10%）。我们分析了每次家庭训练课程（n = 2396）的身体功能恢复数据的时间进程。每季度进行一次恒定负荷测试，血乳酸浓度一致（n = 105），以估计骨骼肌适应的时间进程。9名心脏移植受者作为对照组（CG）。
12个月后，匹配心率（112±11次/分钟；CG组为114±8次/分钟）时的运动能力提高了35%±19%（从43±14瓦增加到58±18瓦；p < 0.001；CG组从53±18瓦增加到54±18瓦）；增加的24%是由于骨骼肌功能改善，11%是由于中枢功能改善。身体功能恢复在最初3个月内增加最多（+18%；p < 0.001）；增加的50%包括更好的骨骼肌或中枢功能。在第4个月至第12个月之间，运动能力持续增加（+15%；p < 0.001），主要是由于骨骼肌功能改善。
在12个月的训练中，运动能力持续提高且血乳酸浓度保持一致，这表明运动训练可以抵消免疫抑制治疗对骨骼肌的负面影响。即使在心脏移植后很长时间，也应定期进行体育锻炼，以防止运动能力和骨骼肌功能加速下降。
