Volaklis Konstantinos A, Tokmakidis Savvas P
Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece.
Sports Med. 2005;35(12):1085-103. doi: 10.2165/00007256-200535120-00006.
The utility, safety and physiological adaptations of resistance exercise training in patients with chronic heart failure (CHF) are reviewed and recommendations based on current research are presented. Patients with CHF have a poor clinical status and impaired exercise capacity due to both cardiac limitations and peripheral maladaptations of the skeletal musculature. Because muscle atrophy has been demonstrated to be a hallmark of CHF, the main principle of exercise programmes in such patients is to train the peripheral muscles effectively without producing great cardiovascular stress. For this reason, new modes of training as well as new training methods have been applied. Dynamic resistance training, based on the principles of interval training, has recently been established as a safe and effective mode of exercise in patients with CHF. Patients perform dynamic strength exercises slowly, on specific machines at an intensity usually in the range of 50-60% of one repetition maximum; work phases are of short duration (< or =60 seconds) and should be followed by an adequate recovery period (work/recovery ratio >1 : 2). Patients with a low cardiac reserve can use small free weights (0.5, 1 or 3 kg), elastic bands with 8-10 repetitions, or they can perform resistance exercises in a segmental fashion. Based on recent scientific evidence, the application of specific resistance exercise programmes is safe and induces significant histochemical, metabolic and functional adaptations in skeletal muscles, contributing to the treatment of muscle weakness and specific myopathy occurring in the majority of CHF patients. Increased exercise tolerance and peak oxygen consumption (V-dotO(2peak)), changes in muscle composition, increases in muscle mass, alterations in skeletal muscle metabolism, improvement in muscular strength and endurance have also been reported in the literature after resistance exercise alone or in combination with aerobic exercise. According to new scientific evidence, appropriate dynamic resistance exercise should be recommended as a safe and effective alternative training mode (supplementary to conventional aerobic exercise) in order to counteract peripheral maladaptation and improve muscle strength, which is necessary for recreational and daily living activities, and thus quality of life, of patients with stable, CHF.
本文综述了慢性心力衰竭（CHF）患者进行抗阻运动训练的效用、安全性及生理适应性，并基于当前研究提出了相关建议。CHF患者临床状况不佳，运动能力受损，这是由心脏功能受限以及骨骼肌外周适应不良共同导致的。由于肌肉萎缩已被证明是CHF的一个标志，因此这类患者运动计划的主要原则是在不产生巨大心血管压力的情况下有效训练外周肌肉。出于这个原因，新的训练模式和训练方法已被应用。基于间歇训练原则的动态抗阻训练，最近已被确立为CHF患者一种安全有效的运动模式。患者在特定器械上缓慢进行动态力量训练，强度通常为一次重复最大值的50%-60%；工作阶段持续时间较短（≤60秒），之后应有足够的恢复期（工作/恢复比>1:2）。心脏储备功能低的患者可以使用小重量自由器械（0.5、1或3千克）、弹力带进行8-10次重复训练，或者进行分段抗阻训练。基于近期科学证据，应用特定的抗阻运动计划是安全的，并且能在骨骼肌中引起显著的组织化学、代谢和功能适应性变化，有助于治疗大多数CHF患者出现的肌肉无力和特定肌病。单独进行抗阻运动或与有氧运动相结合后，文献中也报道了运动耐力和峰值摄氧量（V̇O₂peak）增加、肌肉成分改变、肌肉质量增加、骨骼肌代谢变化、肌肉力量和耐力改善。根据新的科学证据，应推荐适当的动态抗阻运动作为一种安全有效的替代训练模式（作为传统有氧运动的补充），以对抗外周适应不良并提高肌肉力量，这对于稳定期CHF患者进行娱乐和日常生活活动以及提高生活质量是必要的。
