Department of Cardiovascular Sciences, Sections of Cardiac Rehabilitation and Prevention, Lancisi Heart Institute, Ancona, Italy.
J Am Coll Cardiol. 2012 Oct 16;60(16):1521-8. doi: 10.1016/j.jacc.2012.06.036. Epub 2012 Sep 19.
This study investigated the effect of a very long-term exercise training program is not known in chronic heart failure (CHF) patients.
We previously showed that long-term moderate exercise training (ET) improves functional capacity and quality of life in New York Heart Association class II and III CHF patients.
We studied 123 patients with CHF whose condition was stable over the previous 3 months. After randomization, a trained group (T group, n = 63) underwent a supervised ET at 60% of peak oxygen consumption (Vo(2)), 2 times weekly for 10 years, whereas a nontrained group (NT group, n = 60) did not exercise formally. The ET program was supervised and performed mostly at a coronary club with periodic control sessions twice yearly at the hospital's gym.
In the T group, peak Vo(2) was more than 60% of age- and gender-predicted maximum Vo(2) each year during the 10-year study (p < 0.05 vs. the NT group). In NT patients, peak Vo(2) decreased progressively with an average of 52 ± 8% of maximum Vo(2) predicted. Ventilation relative to carbon dioxide output (VE/Vco(2)) slope was significantly lower (35 ± 9) in T patients versus NT patients (42 ± 11, p < 0.01). Quality-of-life score was significantly better in the T group versus the NT group (43 ± 12 vs. 58 ± 14, p < 0.05). During the 10-year study, T patients had a significant lower rate of hospital readmission (hazard ratio: 0.64, p < 0.001) and cardiac mortality (hazard ratio: 0.68, p < 0.001) than controls. Multivariate analysis selected peak Vo(2) and resting heart rate as independent predictors of events.
Moderate supervised ET performed twice weekly for 10 years maintains functional capacity of more than 60% of maximum Vo(2) and confers a sustained improvement in quality of life compared with NT patients. These sustained improvements are associated with reduction in major cardiovascular events, including hospitalizations for CHF and cardiac mortality.
本研究旨在探讨长期运动训练对慢性心力衰竭（CHF）患者的影响。
我们之前的研究表明，长期中等强度的运动训练（ET）可改善纽约心脏协会（NYHA）Ⅱ级和Ⅲ级 CHF 患者的功能能力和生活质量。
我们研究了 123 例 CHF 患者，这些患者在过去 3 个月内病情稳定。随机分组后，接受训练的一组（T 组，n = 63）接受 60%峰值摄氧量（Vo（2））的监督 ET，每周 2 次，持续 10 年，而未接受训练的一组（NT 组，n = 60）则不进行正式锻炼。ET 方案由经过培训的人员监督，主要在心脏俱乐部进行，每年在医院健身房进行两次定期控制。
在 10 年的研究中，T 组的峰值 Vo（2）每年都超过了年龄和性别预测的最大 Vo（2）的 60%（p < 0.05 与 NT 组相比）。在 NT 患者中，峰值 Vo（2）逐渐下降，平均为最大 Vo（2）预测值的 52 ± 8%。T 患者的二氧化碳通气量（VE/Vco（2））斜率明显低于 NT 患者（35 ± 9 对 42 ± 11，p < 0.01）。与 NT 组相比，T 组的生活质量评分明显更好（43 ± 12 对 58 ± 14，p < 0.05）。在 10 年的研究期间，T 组的住院再入院率（危险比：0.64，p < 0.001）和心脏死亡率（危险比：0.68，p < 0.001）均明显低于对照组。多变量分析选择峰值 Vo（2）和静息心率作为事件的独立预测因子。
每周两次中等强度监督的 ET 持续 10 年，可维持超过最大 Vo（2）的 60%的功能能力，并与 NT 患者相比持续改善生活质量。这些持续的改善与主要心血管事件（包括心力衰竭住院和心脏死亡率）的减少有关。
