1Center for Research in Environmental Epidemiology (CREAL) - Hospital del Mar Research Institute (IMIM), Barcelona, Spain.
COPD. 2014 Apr;11(2):190-6. doi: 10.3109/15412555.2013.831401. Epub 2013 Dec 30.
Abnormalities of autonomic function have been reported in patients with chronic obstructive pulmonary disease. The effect of the exercise training in heart rate recovery (HRR) has not been established in patients with COPD.
To assess the effects of 8-weeks' endurance training program on parasympathetic nervous system response measured as heart rate recovery in a sample of moderate-to-severe COPD patients.
We recruited a consecutive sample of patients with COPD candidates to participate in a pulmonary rehabilitation program from respiratory outpatient clinics of a tertiary hospital. HRR was calculated, before and after training, as the difference in heart rate between end-exercise and one minute thereafter (HRR1) in a constant-work rate protocol.
A total of 73 COPD patients were included: mean (SD) age 66 (8) years, median (P25-P75) post-bronchodilator FEV1 39 (29-53)%. The prevalence of slow HRR1 (≤12 beats) at baseline was 63%, and was associated with spirometric severity (mean FEV1 35% in slow HRR1 vs 53 in normal HRR1, p < 0.001). After 8-weeks training, HRR1 improved from mean (SD) 10 (7) to 12 (7) beats (p = 0.0127). Multivariate linear regression models showed that the only variable related to post-training HRR1 was pre-training HRR1 (p < 0.001).
These results suggest that training enhances HRR in patients with moderate-to-severe COPD. HRR is an easy tool to evaluate ANS such that it may be a useful clinical marker of parasympathetic nervous system response in patients with COPD.
慢性阻塞性肺疾病患者的自主功能异常已有报道。运动训练对慢性阻塞性肺疾病患者心率恢复（HRR）的影响尚未确定。
评估 8 周耐力训练方案对中重度慢性阻塞性肺疾病患者自主神经功能的影响，表现为心率恢复的变化。
我们连续招募了来自三级医院呼吸门诊的慢性阻塞性肺疾病患者，将其纳入肺康复计划。在恒功运动试验中，计算运动结束时和 1 分钟后的心率差（HRR1），以此评估心率恢复。
共纳入 73 例慢性阻塞性肺疾病患者，平均（SD）年龄 66（8）岁，支气管扩张剂后 FEV1 中位数（P25-P75）为 39（29-53）%。基线时 HRR1 较慢（≤12 次）的患者占 63%，与肺功能严重程度相关（HRR1 较慢的患者平均 FEV1 为 35%，而 HRR1 正常的患者为 53%，p < 0.001）。经过 8 周的训练，HRR1 从平均（SD）10（7）次增加到 12（7）次（p = 0.0127）。多元线性回归模型显示，与训练后 HRR1 相关的唯一变量是训练前的 HRR1（p < 0.001）。
这些结果表明，训练可增强中重度慢性阻塞性肺疾病患者的 HRR。HRR 是评估自主神经功能的简单工具，可能是慢性阻塞性肺疾病患者副交感神经反应的有用临床标志物。
