Goyal Deepak, Logie Ing-Marie, Nadar Sunil K, Lip Gregory Y H, Macfadyen Robert J
Clinical Research Fellow, Department of Cardiology, Sandwell and West Birmingham NHS Trust, City Hospital, England, UK.
Cardiovasc Ther. 2009 Spring;27(1):10-6. doi: 10.1111/j.1755-5922.2008.00067.x.
The management of obesity is linked to defining its impact on exercise. One impact of obesity in coronary disease care is in the quantification of exercise limitation by treadmill protocols. In this study, we considered the impact of obesity as definition by body mass index (BMI) or waist-hip ratio (WHR) on perceived exercise limiting symptoms, which are accepted and valuable targets for drug or lifestyle modification. We gathered morphometric data prospectively using bioimpedance (Bodystat Quadscan 3000), BMI, and WHR in 228 unselected cardiac patients attending for diagnostic Bruce treadmill tests. The patients were categorized as obese (BMI >30 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), or normal weight (BMI <25 kg/m(2)). A quantitative visual analog scale (10 cm) of perceived breathlessness was defined by the subjects at the end of each stage along with standard exercise data. In total, 188 patients were included for the final analysis excluding 12 patients with severe LV dysfunction and 10 patients with severe inducible ischemia necessitating an early termination of the test. There was no difference by obesity indices in the distribution of reasons for stopping the test (elective arrhythmia, inducible ischemia, or intolerable functional symptoms). Perceived symptom score on the visual analog scale were persistently higher at the end of stages 1, 2, and 3 of the Bruce protocol in obese individuals as compared with overweight and normal weight subjects. (P= 0.034, 0.003, and 0.042, respectively). Perceived symptoms during exercise when assessed by WHR did not show any statistical difference in severity. Generalized obesity associated with a high BMI is associated with increased perceived breathlessness during standard exercise testing regardless of ischemia or known left ventricular systolic function. This clearly indicates that perceived breathlessness does not correlate with obesity as defined by WHR, which is known to be a more sensitive marker of coronary disease. Therapeutic interventions in obesity should take into account the frame of reference of definition of obesity.
肥胖管理与明确其对运动的影响相关。肥胖在冠心病护理中的一个影响在于通过跑步机方案对运动受限进行量化。在本研究中，我们将体重指数（BMI）或腰臀比（WHR）所定义的肥胖对可感知的运动受限症状的影响纳入考量，这些症状是药物或生活方式改变可接受且有价值的目标。我们前瞻性地收集了228名未经过挑选、前来进行诊断性布鲁斯跑步机测试的心脏病患者的形态学数据，采用生物电阻抗法（Bodystat Quadscan 3000）、BMI和WHR。患者被分为肥胖组（BMI>30 kg/m²）、超重组（BMI 25.0 - 29.9 kg/m²）或正常体重组（BMI<25 kg/m²）。在每个阶段结束时，受试者用定量视觉模拟评分法（10厘米）确定可感知的呼吸困难程度，并记录标准运动数据。最终分析共纳入188名患者，排除了12名严重左心室功能不全患者和10名因严重诱发性缺血而需提前终止测试的患者。在停止测试的原因（选择性心律失常、诱发性缺血或无法耐受的功能症状）分布方面，肥胖指标之间没有差异。与超重和正常体重受试者相比，肥胖个体在布鲁斯方案第1、2和3阶段结束时，视觉模拟评分法上的可感知症状评分持续更高（P值分别为0.034、0.003和0.042）。通过WHR评估运动期间的可感知症状时，严重程度未显示出任何统计学差异。与高BMI相关的全身性肥胖与标准运动测试期间可感知的呼吸困难增加相关，无论是否存在缺血或已知的左心室收缩功能情况。这清楚地表明，可感知的呼吸困难与WHR所定义的肥胖无关，而WHR是已知的更敏感的冠心病标志物。肥胖的治疗干预应考虑肥胖定义的参照标准。
