Milani Richard V, Lavie Carl J
Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
Am J Med. 2009 Oct;122(10):931-8. doi: 10.1016/j.amjmed.2009.03.028. Epub 2009 Aug 13.
Exercise training reduces mortality in patients with coronary artery disease. Behavioral characteristics, including depression, hostility, and overall psychosocial stress, have been shown to be independent risk factors for recurrent myocardial infarction and death in these patients. Exercise training can reduce these high-risk behaviors, but it remains uncertain as to what extent the health benefits of exercise training can be attributed to improving these behaviors.
We evaluated the impact of exercise training during cardiac rehabilitation on mortality in 53 patients with coronary artery disease with high levels of psychosocial stress and in 469 patients with coronary artery disease with low levels of psychosocial stress and compared them with 27 control patients with high psychosocial stress who did not undergo formal cardiac rehabilitation and exercise training.
Mortality was approximately 4-fold greater in patients with high psychosocial stress than in those with low psychosocial stress (22% vs 5%; P = .003). Exercise training decreased the prevalence of psychosocial stress from 10% to 4% (P<.0001) and similarly improved peak oxygen uptake in patients with high and low psychosocial stress. Mortality in patients who improved exercise capacity by>or=10% (high exercise change) was 60% lower than in patients who had<10% improvement in exercise capacity (low exercise change) (P=.009). Mortality was lower in patients with high psychosocial stress with high exercise change compared with patients with high psychosocial stress with low exercise change (0% vs 19%; P=.009). In contrast, there was no significant improvement in mortality in patients with high versus low exercise change with low psychosocial stress (4% vs 8%; P=.14).
Psychosocial stress is an independent risk factor for mortality in patients with coronary artery disease, and exercise training can effectively reduce its prevalence. Exercise training reduces mortality in patients with coronary artery disease, and this effect seems to be mediated in part because of the salutary effects of exercise on psychosocial stress.
运动训练可降低冠心病患者的死亡率。行为特征，包括抑郁、敌意和总体心理社会压力，已被证明是这些患者复发性心肌梗死和死亡的独立危险因素。运动训练可以减少这些高危行为，但运动训练对健康的益处能在多大程度上归因于改善这些行为仍不确定。
我们评估了心脏康复期间运动训练对53例心理社会压力水平高的冠心病患者和469例心理社会压力水平低的冠心病患者死亡率的影响，并将其与27例未接受正规心脏康复和运动训练、心理社会压力高的对照患者进行比较。
心理社会压力高的患者死亡率约为心理社会压力低的患者的4倍（22%对5%；P = 0.003）。运动训练使心理社会压力的患病率从10%降至4%（P<0.0001），并且同样改善了心理社会压力高和低的患者的峰值摄氧量。运动能力提高≥10%（高运动变化）的患者死亡率比运动能力提高<10%（低运动变化）的患者低60%（P = 0.009）。与运动变化低的心理社会压力高的患者相比，运动变化高的心理社会压力高的患者死亡率更低（0%对19%；P = 0.009）。相比之下，心理社会压力低的患者中，运动变化高与低的患者死亡率没有显著改善（4%对8%；P = 0.14）。
心理社会压力是冠心病患者死亡的独立危险因素，运动训练可有效降低其患病率。运动训练可降低冠心病患者的死亡率，这种效果似乎部分是由于运动对心理社会压力的有益影响所致。
