Nolte Kathleen, Herrmann-Lingen Christoph, Wachter Rolf, Gelbrich Götz, Düngen Hans-Dirk, Duvinage André, Hoischen Nadine, von Oehsen Karima, Schwarz Silja, Hasenfuss Gerd, Halle Martin, Pieske Burkert, Edelmann Frank
Department of Cardiology, University of Göttingen, Göttingen, Germany.
Department of Psychosomatic Medicine, University of Göttingen, Göttingen, Germany German Center for Cardiovascular Research (DZHK) Site Göttingen, Germany.
Eur J Prev Cardiol. 2015 May;22(5):582-93. doi: 10.1177/2047487314526071. Epub 2014 Mar 13.
Despite suffering from poor prognosis, progressive exercise intolerance, and impaired quality of life (QoL), effective therapeutic strategies in heart failure with preserved ejection fraction (HFpEF) are sparse. Exercise training (ET) improves physical QoL in HFpEF, but the effects on other aspects of QoL are unknown.
The multicentre, prospective, randomized, controlled Exercise training in Diastolic Heart Failure Pilot study included 64 HFpEF patients (65 ± 7 years, 56% female). They were randomized to supervised endurance/resistance training in addition to usual care (ET, n = 44) or usual care alone (UC, n = 20). At baseline and after 3 months, QoL was assessed (36-item Short-form Health Survey (SF-36), Minnesota Living With Heart Failure Questionnaire (MLWHFQ), and Patient Health Questionnaire (PHQ-9).
Exercise improved the following SF-36 dimensions: physical functioning (p < 0.001, p = 0.001 vs. UC), bodily pain (p = 0.046), general health perception (p < 0.001, p = 0.016 vs. UC), general mental health (p = 0.002), vitality (p = 0.003), social functioning (p < 0.001) physical (p < 0.001, p = 0.001 vs. UC), and mental component score (p = 0.030). ET did not improve role limitations due to physical and emotional problems. The MLWHFQ total scale (p < 0.001) and the MLWHFQ physical limitation scale (p < 0.001, p = 0.04 vs. UC) also improved with ET. The MLWHFQ emotional limitation scale did not change with ET. With ET, also the PHQ-9 total score improved significantly (p = 0.004, p = 0.735 vs. UC).
In patients with HFpEF, exercise training improved emotional status, physical and social dimensions of QoL as well as symptoms of depression from pre to post test. Physical dimensions of QoL and general health perception also improved significantly with exercise in comparison to usual care.
尽管射血分数保留的心力衰竭（HFpEF）患者预后较差、运动耐量进行性下降且生活质量（QoL）受损，但针对此类患者的有效治疗策略却很稀少。运动训练（ET）可改善HFpEF患者的身体生活质量，但其对生活质量其他方面的影响尚不清楚。
多中心、前瞻性、随机对照的舒张性心力衰竭运动训练试点研究纳入了64例HFpEF患者（65±7岁，56%为女性）。他们被随机分为接受常规护理加监督性耐力/阻力训练（ET组，n = 44）或仅接受常规护理（UC组，n = 20）。在基线和3个月后，对生活质量进行评估（36项简短健康调查问卷（SF - 36）、明尼苏达心力衰竭生活问卷（MLWHFQ）和患者健康问卷（PHQ - 9））。
运动改善了以下SF - 36维度：身体功能（p < 0.001，与UC组相比p = 0.001）、身体疼痛（p = 0.046）、总体健康感知（p < 0.001，与UC组相比p = 0.016）、总体心理健康（p = 0.002）、活力（p = 0.003）、社会功能（p < 0.001）、身体（p < 0.001，与UC组相比p = 0.001）以及心理成分得分（p = 0.030）。ET并未改善因身体和情感问题导致的角色限制。ET组的MLWHFQ总分（p < 0.001）和MLWHFQ身体限制量表（p < 0.001，与UC组相比p = 0.04）也有所改善。ET组的MLWHFQ情感限制量表未发生变化。ET组的PHQ - 9总分也显著改善（p = 0.004，与UC组相比p = 0.735）。
在HFpEF患者中，运动训练从测试前到测试后改善了情绪状态、生活质量的身体和社会维度以及抑郁症状。与常规护理相比，运动也显著改善了生活质量的身体维度和总体健康感知。
