Plateforme d'Investigation Technologique Inserm CIC 1432, University Hospital of Dijon, Dijon, France -
Eur J Phys Rehabil Med. 2016 Apr;52(2):159-68. Epub 2015 Jan 14.
The eccentric (ECC) training, in spite of its potential interest (slightest request of the cardiorespiratory system) compared with the concentric (CON) training, is not applied during the rehabilitation of the chronic heart failure (CHF). The main reasons are the difficulty personalizing the ECC exercises by avoiding the muscle complications and the lack of information concerning the specific effects on the maximal capacities in CHF patients.
To compare - following a prior study on the feasibility and on the functional impacts - the effects on maximal capacities and tolerance in CHF of ECC training tailored by a low rate of perceived exertion (RPE) and those of conventionally tailored CON training.
Prospective randomized comparative study.
A Rehabilitation Department in a University Hospital.
CHF outpatients with reduced ejection fraction randomized to either ECC (N.=21) or CON training (N.=21).
ECC and CON training were respectively tailored by a low RPE (RPE between 9 and 11 on the Borg scale) and a heart rate (HR) corresponding to the first ventilatory threshold. Cardiopulmonary exercise test, maximal muscle strength tests (quadriceps, triceps surae) and 6-minute walk test were performed before and after training. Tolerance to training was assessed by RPE, muscle soreness, increase of HR, blood pressure and plasma NT-proBNP.
Improvement in peak work rate was similar for both groups (+20%, P<0.01), but VO2 peak and VO2 at the first ventilatory threshold were only increased in the CON group (+13.5%, P<0.01). Maximal strength of the triceps surae was increased in the ECC group only (+23%, P<0.01). Improvement in the walk test distance was similar in both groups, but the corresponding VO2 was only increased after CON training. Tolerance to training was good in both groups, except higher increment of training HR in the CON group (P<0.05).
ECC training tailored by a low RPE is well tolerated in CHF patients and induces an improvement in maximal capacities similar to that with conventional CON training despite lower demands on the cardiorespiratory system, showing a better energetic efficiency, potentially interesting for these patients with reduced energetic reserve.
与向心性（CON）训练相比，离心（ECC）训练的潜在益处（对心肺系统的最低要求），在慢性心力衰竭（CHF）的康复中并未得到应用。主要原因是避免肌肉并发症而难以个性化 ECC 运动，以及缺乏有关 CHF 患者最大能力的具体影响的信息。
在先前对可行性和功能影响的研究之后，比较 ECC 训练（通过低感觉费力程度 [RPE] 定制）和传统定制 CON 训练对 CHF 患者最大能力和耐受性的影响。
前瞻性随机对照研究。
大学医院康复科。
射血分数降低的 CHF 门诊患者，随机分为 ECC（N=21）或 CON 训练（N=21）组。
ECC 和 CON 训练分别通过低 RPE（Borg 量表上的 9 到 11）和相应的心率（HR）来定制，以达到第一通气阈值。在训练前后进行心肺运动试验、最大肌肉力量测试（股四头肌、小腿三头肌）和 6 分钟步行测试。通过 RPE、肌肉酸痛、HR、血压和血浆 NT-proBNP 的增加来评估训练的耐受性。
两组的峰值工作率均有所提高（均增加 20%，P<0.01），但仅 CON 组的峰值摄氧量和第一通气阈值时的摄氧量增加（分别增加 13.5%，P<0.01）。ECC 组仅小腿三头肌的最大力量增加（增加 23%，P<0.01）。两组的步行试验距离改善相似，但仅 CON 训练后相应的摄氧量增加。两组的训练耐受性均良好，除 CON 组的训练 HR 增加更高（P<0.05）。
通过低 RPE 定制的 ECC 训练在 CHF 患者中耐受性良好，并诱导最大能力的改善与传统 CON 训练相似，尽管对心肺系统的要求较低，但表现出更好的能量效率，对能量储备减少的这些患者可能具有潜在的益处。
