School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia.
Heart Fail Rev. 2018 Jan;23(1):91-108. doi: 10.1007/s10741-017-9662-z.
A large body of evidence exists indicating that autonomic imbalance is characteristic of heart failure, with several parameters of autonomic function associated with adverse clinical outcomes. The aim of this systematic review and meta-analysis was to investigate the effects of exercise training on parameters of autonomic function in patients with heart failure and where possible quantify the size of the effect. We conducted database searches (PubMed, EMBASE and Cochrane Trials Register to 31 March 2017) for exercise-based rehabilitation trials in heart failure; using search terms, exercise training, autonomic function, heart rate recovery, heart rate variability and muscle sympathetic nerve activity. Pooled data indicated a statistically significant increase in heart rate recovery at 1 min (HRR) in exercise compared to control groups mean difference 5.90 bpm (95%CI 5.12, 6.69; p < 0.00001). Pooled data also indicated that exercise training improved the short-term heart rate variability (HRV) parameters of root mean square of successive differences between normal heart beats (RMSSD (ms)) [mean difference 10.44 (95%CI 0.60, 20.28, p = 0.04)] and high-frequency normalised units (HF) [mean difference 7.72 (95%CI 3.32, 12.12, p = 0.0006), which are predominantly reflective of parasympathetic activity. Analyses also indicated a statistically significant decrease in muscle sympathetic nerve activity (MSNA) bursts/minute (mean difference - 11.09 (95%CI - 16.18, - 6.00; p < 0.0001) and MSNA bursts/100 heart beats (mean difference - 15.44 (95%CI - 20.95, -9.92; p < 0.00001) in exercise groups compared to controls. With improvements in HRR, HRV and MSNA, exercise training appears to facilitate an improvement in parasympathetic tone and reduction in sympathetic activity.
大量证据表明，自主神经失衡是心力衰竭的特征，自主神经功能的几个参数与不良临床结局相关。本系统评价和荟萃分析的目的是研究运动训练对心力衰竭患者自主功能参数的影响，并尽可能量化其影响的大小。我们对截至 2017 年 3 月 31 日的心力衰竭运动康复试验进行了数据库检索（PubMed、EMBASE 和 Cochrane 试验登记处）；使用搜索词包括运动训练、自主功能、心率恢复、心率变异性和肌肉交感神经活动。汇总数据表明，与对照组相比，运动组 1 分钟心率恢复（HRR）有统计学意义的显著增加，平均差异为 5.90 bpm（95%CI 5.12, 6.69;p<0.00001）。汇总数据还表明，运动训练改善了短期心率变异性（HRV）参数，包括正常心跳之间连续差异的均方根（RMSSD（ms））[平均差异 10.44（95%CI 0.60, 20.28，p=0.04）]和高频标准化单位（HF）[平均差异 7.72（95%CI 3.32, 12.12，p=0.0006）]，这主要反映了副交感神经活动。分析还表明，肌肉交感神经活动（MSNA）爆发/分钟（mean difference -11.09 (95%CI -16.18, -6.00;p<0.0001）和 MSNA 爆发/100 次心跳（mean difference -15.44 (95%CI -20.95, -9.92;p<0.00001）的统计学意义显著降低，运动组与对照组相比。HRR、HRV 和 MSNA 的改善表明，运动训练似乎促进了副交感神经张力的提高和交感神经活动的减少。
