Tanne David, Freimark Dov, Poreh Amir, Merzeliak Oleg, Bruck Bella, Schwammenthal Yvonne, Schwammenthal Ehud, Motro Michael, Adler Yehuda
Department of Neurology and Neuro-Vascular Laboratory, Sheba Medical Center, Israel.
Int J Cardiol. 2005 Aug 18;103(2):145-9. doi: 10.1016/j.ijcard.2004.08.044. Epub 2005 Jan 12.
Congestive heart failure is associated with cognitive impairment, particularly of attentional skills. We assessed, in a hypothesis-generating study, the effect of an exercise training program on cognitive functions among patients with severe congestive heart failure.
Patients with severe congestive heart failure (n=20; New York Heart Association functional class III; left ventricular ejection fraction < or =35%) were evaluated before and following a standardized and supervised exercise training program (x2/week for 18 weeks; exercise group), while 5 additional patients did not undergo an exercise training program (control group). A battery of cognitive tests was used to assess cognitive functions. Physical performance was assessed by the 6-min walk test and the modified Bruce exercise test, cardiac index and systemic vascular resistance using thoracic electrical bioimpedance, and cerebral vasomotor reactivity to hypercapnia by means of the breath-holding index using transcranial Doppler.
Time of completion of the trail making A (105+/-116 to 75+/-52; p=0.02) and B (169+/-100 to 119+/-65; p=0.002) tests, and of the Stroop part A (40+/-13 to 37+/-13; p=0.04) was shorter in patients completing the exercise training program, but not in control patients, while the other neuropsychological measures remained unchanged in both groups. Cerebral vasomotor reactivity to hypercapnia remained diminished (breath-holding index 0.64+/-0.27 vs. 0.68+/-0.37) despite significant improvements in exercise capacity (6-min walk test 308+/-87 to 423+/-91 m, p<0.001; modified Bruce exercise test 5.6+/-3.8 to 9.8+/-3.4 min, p<0.001).
Patients with severe congestive heart failure undergoing an exercise training program improve in some measures of cognitive functions that are limited to general attention and psychomotor speed. Based on these preliminary findings, further evaluations are designed within the framework of a larger controlled clinical trial.
充血性心力衰竭与认知障碍相关，尤其是注意力技能方面。在一项假设生成研究中，我们评估了运动训练计划对重度充血性心力衰竭患者认知功能的影响。
对重度充血性心力衰竭患者（n = 20；纽约心脏协会功能分级III级；左心室射血分数≤35%）在标准化监督运动训练计划前后进行评估（每周2次，共18周；运动组），同时另外5名患者未接受运动训练计划（对照组）。使用一系列认知测试评估认知功能。通过6分钟步行试验和改良布鲁斯运动试验评估身体性能，使用胸电阻抗法评估心脏指数和全身血管阻力，通过经颅多普勒使用屏气指数评估脑血管对高碳酸血症的血管运动反应性。
完成运动训练计划的患者在完成连线测验A（105±116至75±52；p = 0.02）和B（169±100至119±65；p = 0.002）测试以及斯特鲁普测验A部分（40±13至37±13；p = 0.04）的时间较短，但对照组患者未出现这种情况，而两组的其他神经心理学指标均保持不变。尽管运动能力有显著改善（6分钟步行试验从308±87米增至423±91米，p<0.001；改良布鲁斯运动试验从5.6±3.8分钟增至9.8±3.4分钟，p<0.001），但脑血管对高碳酸血症的血管运动反应性仍降低（屏气指数0.64±0.27对0.68±0.37）。
接受运动训练计划的重度充血性心力衰竭患者在某些认知功能指标上有所改善，这些指标仅限于一般注意力和心理运动速度。基于这些初步发现，在更大规模的对照临床试验框架内设计了进一步的评估。
