Ambrosy Andrew P, Cerbin Lukasz P, DeVore Adam D, Greene Stephen J, Kraus William E, O'Connor Christopher M, Piña Ileana L, Whellan David J, Wojdyla Daniel, Wu Angie, Mentz Robert J
Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
Duke University Medical Center, Durham, NC, USA.
Am Heart J. 2017 Apr;186:130-138. doi: 10.1016/j.ahj.2016.12.017. Epub 2017 Jan 19.
Although aerobic exercise improves quality of life as assessed by a disease-specific instrument in ambulatory HF patients with a reduced ejection fraction (EF), the impact of an exercise intervention on general health status has not been previously reported.
A secondary analysis was performed of the HF-ACTION trial (ClinicalTrials.gov Number: NCT00047437), which enrolled 2331 medically stable outpatients with HF and an EF ≤35% and randomized them to aerobic exercise training, consisting of 36 supervised sessions followed by home-based training versus usual care for a median follow-up of 30 months. The EuroQOL 5-dimension questionnaire (EQ-5D) was administered to study participants at baseline, 3 months, and 12 months. EQ-5D includes functional dimensions (ie, mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), which were mapped to corresponding utility scores (ie, 0=death and 1=perfect health), and a visual analogue scale (VAS) ranging from 0 (ie, "worst imaginable health state") to 100 (ie, "best imaginable health state").
Study participants had a median (25th, 75th) age of 59 (51, 68) years and 71% were male. A history of ischemic heart disease was reported in 51% of participants and the EF was 25% (20%, 30%). Baseline VAS and mapped utility scores were 65±19 and 0.81±0.14. Exercise training led to an improvement in VAS score compared with usual care from baseline to 3 months (exercise training: 6±17 vs usual care: 3±20; P <.01) although there were no further significant changes at 12 months. Aerobic exercise training did not favorably change mapped utility scores over either timeframe. After multivariable adjustment, lower mapped utility (hazard ratio [HR] 1.19 per 0.1 decrease, 95% CI 1.09-1.29; P < .0001) and VAS scores (HR 1.05 per 10 point decrease, 95% CI 1.02-1.08; P < .01) at baseline were associated with increased risk of death or hospitalization.
Ambulatory HF patients with a reduced EF had impaired health status at baseline which was associated with increased morbidity and mortality, in part mitigated by a structured aerobic exercise regimen.
尽管有氧运动可改善射血分数降低（EF）的非卧床心力衰竭（HF）患者的生活质量（通过特定疾病工具评估），但此前尚未报道运动干预对总体健康状况的影响。
对HF-ACTION试验（ClinicalTrials.gov编号：NCT00047437）进行二次分析，该试验纳入了2331例病情稳定的HF门诊患者，其EF≤35%，并将他们随机分为有氧运动训练组（包括36次监督下的训练，随后进行家庭训练）和常规治疗组，中位随访时间为30个月。在基线、3个月和12个月时，对研究参与者进行欧洲五维健康量表（EQ-5D）评估。EQ-5D包括功能维度（即活动能力、自我护理、日常活动、疼痛/不适和焦虑/抑郁），这些维度对应相应的效用评分（即0=死亡，1=完美健康），以及一个视觉模拟量表（VAS），范围从0（即“可想象到的最差健康状态”）到100（即“可想象到的最佳健康状态”）。
研究参与者的年龄中位数（第25百分位数，第75百分位数）为59（51，68）岁，71%为男性。51%的参与者有缺血性心脏病史，EF为25%（20%，30%）。基线时VAS和映射效用评分分别为65±19和0.81±0.14。与常规治疗相比，从基线到3个月，运动训练使VAS评分有所改善（运动训练组：6±17，常规治疗组：3±20；P<.01），但在12个月时没有进一步的显著变化。在两个时间范围内，有氧运动训练均未使映射效用评分产生有利变化。多变量调整后，基线时较低的映射效用评分（每降低0.1，风险比[HR]为1.19，95%置信区间为1.09-1.29；P<.0001）和VAS评分（每降低10分，HR为1.05，95%置信区间为1.02-1.08；P<.01）与死亡或住院风险增加相关。
EF降低的非卧床HF患者基线时健康状况受损，这与发病率和死亡率增加相关，结构化有氧运动方案可部分缓解这种情况。
