Reed Jennifer L, Blais Angelica Z, Keast Marja-Leena, Pipe Andrew L, Reid Robert D
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
Can J Cardiol. 2017 Jun;33(6):777-784. doi: 10.1016/j.cjca.2017.01.022. Epub 2017 Feb 2.
Patients with heart failure (HF) should exercise at 40%-60% heart rate reserve (HRR) during the first 3 weeks of an outpatient cardiac rehabilitation (CR) program and at 50%-80% HRR thereafter. Arbitrary methods to prescribe exercise intensity such as resting HR (RHR) plus 20 or 30 beats per minute (bpm) (RHR + 20 or RHR + 30) are recommended for inpatients after a myocardial infarction or those recovering from heart surgery. This approach has been repurposed by outpatient CR programs to prescribe exercise intensity for patients with HF, yet its efficacy has not been evaluated.
We examined the appropriateness of RHR + 20/30 for prescribing exercise intensity and improving functional capacity for 55 patients with HF in an outpatient CR program. RHR + 20/30 values were compared to % HRR derived from peak exercise testing in patients with HF. Changes in functional capacity as measured by 6-minute walk test (6MWT) distance, and differences in ratings of perceived exertion (RPE), were examined between patients exercising at RHR + 20-29 and those exercising at RHR + ≥ 30.
During weeks 1-3 and exercise at RHR + 20, 26% of participants would exercise at 40%-60% HRR. At RHR + 30, 38% would exercise at 40%-60% HRR. During weeks 4-12 and exercise at RHR + 20, 20% of participants would exercise at 50%-80% HRR. At RHR + 30, 41% would exercise at 50%-80% HRR. A smaller change in 6MWT distance was observed in participants exercising at RHR + 20-29 than in those exercising at RHR + ≥ 30 (Δ86.6 ± 70.3 vs Δ135.8 ± 73.7 m; P = 0.005). No differences in RPE were observed between participants exercising at RHR + 20-29 and those exercising at RHR + ≥ 30 (P > 0.05).
RHR + 30 was more effective than RHR + 20 in assisting outpatients with HF achieve recommended exercise intensities and improve functional capacity.
心力衰竭（HF）患者在门诊心脏康复（CR）计划的前3周应在心率储备（HRR）的40%-60%进行锻炼，此后应在HRR的50%-80%进行锻炼。对于心肌梗死后的住院患者或心脏手术后正在康复的患者，建议采用如静息心率（RHR）加每分钟20或30次心跳（RHR + 20或RHR + 30）等任意规定运动强度的方法。门诊CR计划已采用这种方法为HF患者规定运动强度，但其疗效尚未得到评估。
我们在一项门诊CR计划中，研究了RHR + 20/30在为55例HF患者规定运动强度和改善功能能力方面的适用性。将RHR + 20/30的值与HF患者峰值运动试验得出的HRR百分比进行比较。比较了在RHR + 20-29运动的患者和在RHR +≥30运动的患者之间，通过6分钟步行试验（6MWT）距离测量的功能能力变化以及自觉用力程度（RPE）评分的差异。
在第1-3周且以RHR + 20进行锻炼时，26%的参与者将在HRR的40%-60%进行锻炼。在RHR + 30时，38%的参与者将在HRR的40%-60%进行锻炼。在第4-12周且以RHR + 20进行锻炼时，20%的参与者将在HRR的50%-80%进行锻炼。在RHR + 30时，41%的参与者将在HRR的50%-80%进行锻炼。与在RHR +≥30运动的参与者相比，在RHR + 20-29运动的参与者6MWT距离的变化较小（分别为Δ86.6±70.3米和Δ135.8±73.7米；P = 0.005）。在RHR + 20-29运动的参与者和在RHR +≥30运动的参与者之间，未观察到RPE评分有差异（P>0.05）。
在帮助HF门诊患者达到推荐的运动强度和改善功能能力方面，RHR + 30比RHR + 20更有效。
