Smart Neil A, Murison Robert
School of Science and Technology, University of New England, Armidale, NSW, Australia.
Congest Heart Fail. 2013 Jan-Feb;19(1):1-5. doi: 10.1111/chf.12002. Epub 2012 Sep 11.
Exercise training appears to improve peak oxygen consumption (VO(2) ) and quality of life (QOL) in heart failure patients, although disease etiology, patient demographics and medication may alter the rate of adaptation. The authors sought to identify rate of change from baseline in fitness, QOL, and depression following exercise training in a cohort of patients with congestive heart failure. Thirty male systolic heart failure patients (aged 63.8±8.3 years, baseline peak VO(2) 12.2±4.8 mL/kg/min, left ventricular ejection fraction 28.2±9.4%, New York Heart Association class II/II 22/8) undertook 52 weeks of exercise training, 16 weeks as an outpatient and a further 36 weeks of home exercise. Peak VO(2) and QOL was measured using the Minnesota Living With Heart Failure (MLWHF) questionnaire and depression using the Hare-Davis scale. The authors analyzed the rate of change in peak VO(2) and MLWHF after grouping patients according to clinical, demographic, and pharmacologic characteristics. Peak VO(2) measurements varied over time, with no effect of disease pathology or β-blocker on peak VO(2) . The rate of change in physical MLWHF score was significantly greater (improved) during 0 to 16 weeks in patients with dilated pathology, but was not significantly affected by β-blocker use or age. The exercise training venue and supervision, or lack thereof, is the major determinant of adaptation to the intervention in heart failure patients, although age, β-adrenergic medication, and heart failure etiology also explain some of the variation in adaptive responses observed.
运动训练似乎能改善心力衰竭患者的峰值耗氧量（VO₂）和生活质量（QOL），尽管疾病病因、患者人口统计学特征和药物治疗可能会改变适应速度。作者试图确定一组充血性心力衰竭患者在运动训练后，其身体适应性、生活质量和抑郁状况相对于基线水平的变化率。30名男性收缩性心力衰竭患者（年龄63.8±8.3岁，基线峰值VO₂为12.2±4.8 mL/kg/min，左心室射血分数为28.2±9.4%，纽约心脏协会心功能分级II/III级的患者分别为22/8例）接受了52周的运动训练，其中16周为门诊训练，另外36周为家庭训练。使用明尼苏达心力衰竭生活问卷（MLWHF）测量峰值VO₂和生活质量，使用黑尔-戴维斯量表测量抑郁状况。作者根据临床、人口统计学和药理学特征对患者进行分组后，分析了峰值VO₂和MLWHF的变化率。峰值VO₂测量值随时间变化，疾病病理类型或β受体阻滞剂对峰值VO₂没有影响。在0至16周期间，扩张型病理类型患者的身体MLWHF评分变化率显著更大（改善更明显），但不受β受体阻滞剂使用情况或年龄的显著影响。运动训练的场地和监督情况，或缺乏监督，是心力衰竭患者对干预措施适应性的主要决定因素，尽管年龄、β肾上腺素能药物治疗和心力衰竭病因也能解释观察到的适应性反应中的一些差异。
