Brassard Patrice, Gustafsson Finn
Department of Kinesiology, Faculty of Medicine, Université Laval, Québec City, Québec, Canada; Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Can J Cardiol. 2016 Apr;32(4):475-84. doi: 10.1016/j.cjca.2015.12.021. Epub 2015 Dec 29.
Exercise tolerance is affected in patients with heart failure (HF). Although the inability of the heart to pump blood to the working muscle has been the conventional mechanism proposed to explain the lowered capacity of patients with HF to exercise, evidence suggests that the pathophysiological mechanisms associated with their exercise intolerance is more complex. Recent findings indicate that lowered cerebral blood flow (CBF) and oxygenation likely represent limiting factors for exercise capacity in patients with HF. After an overview of cardiac and peripheral responses during acute and chronic exercise in healthy individuals, we succinctly review cardiac and noncardiac mechanisms by which HF influences exercise tolerance. We then consider how HF, comorbidity, and HF treatment influence CBF and oxygenation at rest and during exercise. Finally, we provide suggestions for further research to improve our understanding of the role of the brain in exercise intolerance in HF.
心力衰竭（HF）患者的运动耐量会受到影响。尽管心脏无法将血液泵送到工作肌肉一直是用来解释HF患者运动能力下降的传统机制，但有证据表明，与他们运动不耐受相关的病理生理机制更为复杂。最近的研究结果表明，脑血流量（CBF）降低和氧合作用可能是HF患者运动能力的限制因素。在概述健康个体急性和慢性运动期间的心脏和外周反应后，我们简要回顾HF影响运动耐量的心脏和非心脏机制。然后，我们考虑HF、合并症和HF治疗如何影响静息和运动期间的CBF和氧合作用。最后，我们为进一步研究提供建议，以增进我们对大脑在HF运动不耐受中作用的理解。
