Leifer Eric S, Brawner Clinton A, Fleg Jerome L, Kraus William E, Whellan David J, Piña Ileana L, Keteyian Steven J
1Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD; 2Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI; 3Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD; 4Department of Medicine, Duke University Medical Center, Durham, NC; 5Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA; and 6Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY.
Med Sci Sports Exerc. 2014 Feb;46(2):219-24. doi: 10.1249/MSS.0b013e3182a44164.
Aerobic exercise training has been used in patients with stable heart failure (HF) to reduce the risk of clinical events. However, due to patient heterogeneity, some patients may experience a decrease in functional capacity due to such training. The purpose of this study was to estimate the proportion of HF patients participating in a training program who had negative responses to such therapy and to compare them with a concurrent control group.
Baseline and 3-month peak V˙O2 measurements were obtained on 1870 HF subjects who were randomized to receive either an exercise training program or a control program of usual care without exercise training. The exercise program consisted of supervised walking or stationary cycling 3 d·wk(-1) for 12 wk as well as a 2-d·wk(-1) home exercise program after completing 18 supervised sessions. A negative response was defined as a baseline-to-3-month decrease in peak V˙O2 of at least 5 mL·kg(-1) min(-1), which was two times the SD of the control group's change in peak V˙O2.
The mean ± SD change in peak V˙O2 in the exercise group and control group was 0.8 ± 2.5 mL·kg(-1)min(-1) and 0.2 ± 2.5 mL·kg(-1)min(-1), respectively (P < 0.001). The percentage of negative responders in the exercise and control groups was 0.9% and 2.3% (P = 0.02).
The low negative response rate in the exercise group combined with the slightly higher rate in the control group and equal variability in the exercise and control groups suggests that few if any subjects had training-related negative peak V˙O2 responses. These findings support current exercise recommendations for HF patients.
有氧运动训练已应用于稳定型心力衰竭（HF）患者，以降低临床事件风险。然而，由于患者的异质性，一些患者可能因这种训练而出现功能能力下降。本研究的目的是评估参与训练计划的HF患者中对该治疗有负面反应的比例，并将其与同期对照组进行比较。
对1870名HF受试者进行了基线和3个月时的峰值摄氧量（V˙O2）测量，这些受试者被随机分为接受运动训练计划或不进行运动训练的常规护理对照组。运动计划包括在监督下每周步行或固定自行车运动3天，持续12周，完成18次监督训练后，还有每周2天的家庭运动计划。负面反应定义为从基线到3个月时峰值V˙O2下降至少5 mL·kg(-1)·min(-1)，这是对照组峰值V˙O2变化标准差的两倍。
运动组和对照组峰值V˙O2的平均±标准差变化分别为0.8±2.5 mL·kg(-1)·min(-1)和0.2±2.5 mL·kg(-1)·min(-1)（P<0.001）。运动组和对照组中负面反应者的百分比分别为0.9%和2.3%（P = 0.02）。
运动组的低负面反应率，结合对照组略高的比率以及运动组和对照组相同的变异性，表明几乎没有受试者有与训练相关的负面峰值V˙O2反应。这些发现支持目前对HF患者的运动建议。
