Christle Jeffrey Wilcox, Schlumberger Anna, Haller Bernhard, Gloeckl Rainer, Halle Martin, Pressler Axel
a Department of Prevention and Sports Medicine , Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich , Germany.
b Division of Cardiovascular Medicine , Stanford University , Stanford , CA , USA.
Disabil Rehabil. 2017 Dec;39(25):2566-2571. doi: 10.1080/09638288.2016.1242174. Epub 2016 Oct 28.
Important goals of cardiac rehabilitation maintenance programs (CMP) are to increase leisure time physical activity (LTPA) and improve health-related quality of life (HRQoL). Elderly patients with cardiac disease and low exercise capacity are simultaneously the most severely affected and have the most to gain from exercise-based rehabilitation. Individualized combined exercise (ICE) may be an effective modality to achieve these goals. We compared six months of ICE to CMP in their effects on LTPA and HRQoL.
Sixty patients (70 ± 9 years, 39% female) with cardiac disease and low exercise capacity (<6 MET) were randomly allocated to six months of once-weekly ICE or CMP. The patients in ICE performed moderate endurance and resistance exercise on machines, based on intensities from individual peak exercise testing. Patients in CMP performed weekly sessions of calisthenics, flexibility, coordination and relaxation activities. LTPA and HRQoL were assessed with accelerometry and questionnaires at baseline and six months.
Sixty patients completed the trial. ICE increased vigorous PA (ICE: Δ + 12 MET-min/d, CMP: Δ -5 MET-min/d, p = .02) and steps per day (ICE: +1586 steps/d, CMP: -838 steps/d, p < .01) compared to CMP after six months. ICE significantly improved in several components of HRQoL (vitality, emotional health, social health, positive and negative affect (all p < .05) compared to CMP.
ICE resulted in significant improvements in physical activity levels and health related quality of life in moderate to high-risk patients compared to CMP. Implications for rehabilitation Relatively low volumes and intensities of exercise may lead to substantial improvements in both physical activity levels and health-related quality of life Exercise modes in cardiac rehabilitation maintenance programs should not be limited to calisthenics and large group-based exercise Supplemental resistance exercise may improve health-related quality of life and increase physical activity levels in patients with low exercise capacity Moderate to high-risk elderly patients also benefit from individualized endurance-resistance exercise.
心脏康复维持计划（CMP）的重要目标是增加休闲时间体力活动（LTPA）并改善健康相关生活质量（HRQoL）。患有心脏病且运动能力低的老年患者同时是受影响最严重的群体，并且从基于运动的康复中获益最多。个体化联合运动（ICE）可能是实现这些目标的有效方式。我们比较了为期六个月的ICE和CMP对LTPA和HRQoL的影响。
60例患有心脏病且运动能力低（<6代谢当量）的患者（70±9岁，39%为女性）被随机分配至接受为期六个月的每周一次的ICE或CMP。ICE组患者根据个体峰值运动测试的强度在器械上进行中等强度的耐力和抗阻运动。CMP组患者每周进行体操、柔韧性、协调性和放松活动。在基线和六个月时用加速度计和问卷评估LTPA和HRQoL。
60例患者完成试验。与CMP组相比，六个月后ICE组增加了剧烈身体活动（ICE组：Δ +12代谢当量-分钟/天，CMP组：Δ -5代谢当量-分钟/天，p = 0.02）和每日步数（ICE组：+1586步/天，CMP组：-838步/天，p < 0.01）。与CMP组相比，ICE组在HRQoL的几个方面（活力、情绪健康、社会健康、积极和消极情绪（均p < 0.05））有显著改善。
与CMP相比，ICE使中高风险患者的身体活动水平和健康相关生活质量有显著改善。康复启示：相对低的运动量和强度可能会使身体活动水平和健康相关生活质量都得到显著改善；心脏康复维持计划中的运动模式不应局限于体操和基于大群体的运动；补充抗阻运动可能会改善健康相关生活质量并增加运动能力低的患者的身体活动水平；中高风险的老年患者也能从个体化的耐力-抗阻运动中获益。
