Andersen Karl, Jónsdóttir Sórún, Sigurethsson Axel F, Sigurethsson Stefán B
Laeknabladid. 2006 Nov;92(11):759-64.
Supervised cardiac rehabilitation programs have been offered to patients following myocardial infarct (MI), coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) for many years. However, limited information is available on the usefulness of rehabilitation programs in chronic heart failure (CHF). The aim of our study was to evaluate the outcome of supervised physical training on CHF patients by measuring both central and peripheral factors.
This was a prospective randomized study, including 43 patients with CHF, New York Heart Association (NYHA) class II or III, mean age 68 years. After initial measurements of V02peak, 6 minute walk distance, muscle strength, plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), echocardiogram, measurements of pulmonary function and quality of life questionnaire, patients were randomized to either a training group (n=21) or a control group (n=22). The training group had supervised aerobic and resistance training program twice a week for five months. After the training program was completed, all measurements were repeated in both groups.
No training related adverse events were reported. Significant improvement was found between groups in the six minute walk test (+37.1 m vs. +5.3 m, p=0.01), work load on the bicycle exercise test (+6.1W vs. +2.1 W, p=0.03), time on the bicycle exercise test (+41 s vs +0 s, p=0.02) and quadriceps muscle strength test (+2.8 kg vs +0.2 kg, 0.003). Quality of life factors that reflect exercise tolerance and general health, improved significantly in the training group compared to the control group. No other significant changes were found between the two groups.
Supervised physical training as used in this study appears safe for CHF patients in NYHA class II or III. The improvement in functional capacity observed in the training group seems to be related more to increased muscle performance rather than central cardiovascular conditioning.
多年来，监督性心脏康复项目一直提供给心肌梗死（MI）、冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）后的患者。然而，关于康复项目对慢性心力衰竭（CHF）患者的有效性的信息有限。我们研究的目的是通过测量中心和外周因素来评估监督性体育锻炼对CHF患者的效果。
这是一项前瞻性随机研究，包括43例CHF患者，纽约心脏协会（NYHA）心功能分级为II或III级，平均年龄68岁。在初步测量峰值摄氧量、6分钟步行距离、肌肉力量、心房利钠肽（ANP）和脑利钠肽（BNP）的血浆水平、超声心动图、肺功能测量和生活质量问卷后，患者被随机分为训练组（n = 21）或对照组（n = 22）。训练组每周进行两次监督性有氧运动和抗阻训练项目，持续五个月。训练项目完成后，两组均重复所有测量。
未报告与训练相关的不良事件。两组在6分钟步行试验（分别增加37.1米和5.3米，p = 0.01）、自行车运动试验的工作量（分别增加6.1瓦和2.1瓦，p = 0.03）、自行车运动试验的时间（分别增加41秒和0秒，p = 0.02）和股四头肌力量试验（分别增加2.8千克和0.2千克，p = 0.003）方面有显著改善。与对照组相比，训练组中反映运动耐力和总体健康的生活质量因素有显著改善。两组之间未发现其他显著变化。
本研究中使用的监督性体育锻炼对NYHA II或III级CHF患者似乎是安全的。训练组中观察到的功能能力改善似乎更多地与肌肉性能增加有关，而不是中心心血管调节。
