deFilippi Christopher R, de Lemos James A, Newman Anne B, Guralnik Jack M, Christenson Robert H, Pahor Marco, Church Timothy, Espeland Mark, Krithevsky Stephen B, Stafford Randall, Seliger Stephen L
Inova Heart and Vascular Institute, Falls Church, VA.
Department of Medicine, University of Texas Southwestern, Dallas, TX.
Am Heart J. 2016 Sep;179:151-6. doi: 10.1016/j.ahj.2016.07.001. Epub 2016 Jul 12.
In animal models, physical activity (PA) prevents cardiac myocyte cell death. Data for PA mitigating myocyte injury in humans are limited to observational studies. Using a randomized controlled trial design, we sought to determine if introducing moderate PA to previously sedentary older adults could reduce the trajectory of myocardial injury as measured by the high-sensitive cardiac troponin T (hs-cTnT) assay.
Participants (age ≥70 years) were assigned to a 1-year intervention of moderate PA or health education control. High-sensitive cTnT was measured at baseline and 1 year in the 307 of 424 subjects who had available stored serum. Changes in hs-cTnT within 1 year were compared between PA and control groups, as were differences in the proportion of subjects with a significant rise in hs-cTnT (prospectively defined as a>50% increase at follow-up from baseline). Moderate to vigorous PA in kcal/wk was estimated with the CHAMPS questionnaire.
Baseline hs-cTnT levels and PA kcal/wk were similar for both groups. Activity kcal/wk increased in the PA, but not in the control group at 1 year. The median increase in hs-cTnT level from baseline was >3 times larger in the control (0.73 ng/L, interquartile range -0.64 to 2.59) vs the PA group (0.19ng/L, interquartile range -1.10 to 1.93) (P=.02). The proportion with a>50% increase in hs-cTnT was larger in the control group than in the PA group (9.3% vs 5.1%), but this difference was not statistically significant (P=.16).
Initiation of moderate PA in sedentary older adults may favorably modify subclinical myocardial injury.
在动物模型中，体育活动（PA）可预防心肌细胞死亡。关于PA减轻人类心肌细胞损伤的数据仅限于观察性研究。我们采用随机对照试验设计，试图确定对先前久坐不动的老年人引入适度PA是否能降低通过高敏心肌肌钙蛋白T（hs-cTnT）检测所测得的心肌损伤轨迹。
参与者（年龄≥70岁）被分配到为期1年的适度PA干预组或健康教育对照组。在424名有可用储存血清的受试者中的307名中，于基线和1年时测量高敏cTnT。比较PA组和对照组1年内hs-cTnT的变化，以及hs-cTnT显著升高（前瞻性定义为随访时较基线增加>50%）的受试者比例差异。使用CHAMPS问卷估计以千卡/周为单位的中度至剧烈PA。
两组的基线hs-cTnT水平和千卡/周的PA量相似。PA组的千卡/周活动量在1年时增加，而对照组未增加。对照组hs-cTnT水平较基线的中位数增加量（0.73 ng/L，四分位间距-0.64至2.59）是PA组（0.19 ng/L，四分位间距-1.10至1.93）的>3倍（P = 0.02）。hs-cTnT增加>50%的比例在对照组中高于PA组（9.3%对5.1%），但这种差异无统计学意义（P = 0.16）。
对久坐不动的老年人开始进行适度PA可能会有利地改善亚临床心肌损伤。
