Fu Tieh-Cheng, Huang Shu-Chun, Hsu Chih-Chin, Wang Chao-Hung, Wang Jong-Shyan
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung; ; Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung; ; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan;
Acta Cardiol Sin. 2014 Sep;30(5):353-9.
Reduced exercise capacity negatively affects the ability of patients with heart failure (HF) to perform activities required for daily life, further decreasing their independence and quality of life (QoL). Cardiac rehabilitation (CR) can effectively improve aerobic fitness and overall health status in patients with HF. Low referral rate is an important limitation that may impede successful CR, whereas the automatic referral and liaison strategies performed by some healthcare providers manifestly increase the CR referral rate. However, there is still controversy regarding the most effective exercise strategy for improving hemodynamic efficiency during daily activities in the HF population. Aerobic interval training (AIT), that includes alternating high- and low-intensity exercise sessions, may be a more effective modality for improving functional capacity than traditional moderate continuous training (MCT) in patients with HF. A novel AIT regimen designed in our previous study may substantially enhance the ability of ventilation-perfusion matching during exercise, which effects are accompanied by an improved global and disease-specific QoL in HF patients. Conversely, the traditional MCT regimen may only maintain these physiologic responses to exercise at pre-interventional status. By elucidating the relationship between physical activity and hemodynamic property, this review attempts to provide a CR strategy for developing suitable exercise prescription that ameliorates hemodynamic disturbance, further retarding the disease progression and improving health-related QoL in patients with HF.
Aerobic capacity; Heart failure; Hemodynamics; Rehabilitation.
运动能力下降对心力衰竭（HF）患者进行日常生活所需活动的能力产生负面影响，进一步降低他们的独立性和生活质量（QoL）。心脏康复（CR）可以有效改善HF患者的有氧适能和整体健康状况。转诊率低是一个可能阻碍CR成功实施的重要限制因素，而一些医疗服务提供者实施的自动转诊和联络策略明显提高了CR转诊率。然而，对于HF人群在日常活动中提高血流动力学效率的最有效运动策略仍存在争议。有氧间歇训练（AIT），包括交替进行高强度和低强度运动时段，在HF患者中可能是一种比传统中度持续训练（MCT）更有效的提高功能能力的方式。我们之前研究中设计的一种新型AIT方案可能会在运动期间大幅增强通气-灌注匹配能力，其效果伴随着HF患者整体和疾病特异性QoL的改善。相反，传统的MCT方案可能只会将这些对运动的生理反应维持在干预前的状态。通过阐明身体活动与血流动力学特性之间的关系，本综述试图提供一种CR策略，以制定合适的运动处方，改善血流动力学紊乱，进一步延缓疾病进展并提高HF患者与健康相关的QoL。
有氧能力；心力衰竭；血流动力学；康复
