Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.
Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.
Circulation. 2019 May 7;139(19):2198-2211. doi: 10.1161/CIRCULATIONAHA.118.036747.
There is no consensus on how, when, or at what intensity exercise should be performed after heart transplantation (HTx). We have recently shown that high-intensity interval training (HIT) is safe, well tolerated, and efficacious in the maintenance state after HTx, but studies have not investigated HIT effects in the de novo HTx state. We hypothesized that HIT could be introduced early after HTx and that it could lead to clinically meaningful increases in exercise capacity and health-related quality of life.
This multicenter, prospective, randomized, controlled trial included 81 patients a mean of 11 weeks (range, 7-16 weeks) after an HTx. Patients were randomized 1:1 to 9 months of either HIT (4×4-minute intervals at 85%-95% of peak effort) or moderate-intensity continuous training (60%-80% of peak effort). The primary outcome was the effect of HIT versus moderate-intensity continuous training on the change in aerobic exercise capacity, assessed as the peak oxygen consumption (Vopeak). Secondary outcomes included tolerability, safety, adverse events, isokinetic muscular strength, body composition, health-related quality of life, left ventricular function, hemodynamics, endothelial function, and biomarkers.
From baseline to follow-up, 96% of patients completed the study. There were no serious exercise-related adverse events. The population comprised 73% men, and the mean±SD age was 49±13 years. At the 1-year follow-up, the HIT group demonstrated greater improvements than the moderate-intensity continuous training group; the groups showed significantly different changes in the Vopeak (mean difference between groups, 1.8 mL·kg1·min1), the anaerobic threshold (0.28 L/min), the peak expiratory flow (11%), and the extensor muscle exercise capacity (464 J). The 1.8-mL·kg1·min1 difference was equal to ≈0.5 metabolic equivalents, which is regarded as clinically meaningful and relevant. Health-related quality of life was similar between the groups, as indicated by results from the Short Form-36 (version 2), Hospital Anxiety and Depression Scale, and a visual analog scale.
We demonstrated that HIT was a safe, efficient exercise method in de novo HTx recipients. HIT, compared with moderate-intensity continuous training, resulted in a clinically significantly greater change in exercise capacity based on the Vopeak values (25% versus 15%), anaerobic threshold, peak expiratory flow, and muscular exercise capacity.
URL: https://www.clinicaltrials.gov . Unique identifier NCT01796379.
关于心脏移植（HTx）后应该如何、何时以及以何种强度进行运动，目前尚无共识。我们最近的研究表明，高强度间歇训练（HIT）在 HTx 后的维持期是安全的、耐受良好且有效的，但尚未研究 HIT 在新 HTx 状态下的效果。我们假设 HIT 可以在 HTx 后早期引入，并且可以导致运动能力和健康相关生活质量的临床意义上的提高。
这项多中心、前瞻性、随机、对照试验纳入了 81 例心脏移植后平均 11 周（范围为 7-16 周）的患者。患者以 1:1 的比例随机分为 9 个月的 HIT（4×4 分钟间隔，达到峰值努力的 85%-95%）或中等强度连续训练（达到峰值努力的 60%-80%）。主要结局是 HIT 与中等强度连续训练对有氧运动能力变化的影响，以峰值耗氧量（Vopeak）评估。次要结局包括耐受性、安全性、不良事件、等速肌肉力量、身体成分、健康相关生活质量、左心室功能、血液动力学、内皮功能和生物标志物。
从基线到随访，96%的患者完成了研究。没有严重的与运动相关的不良事件。该人群中 73%为男性，平均年龄为 49±13 岁。在 1 年随访时，HIT 组的改善明显优于中等强度连续训练组；两组在 Vopeak（组间平均差异，1.8 mL·kg1·min1）、无氧阈（0.28 L/min）、呼气峰流速（11%）和伸肌运动能力（464 J）方面均显示出显著不同的变化。1.8 mL·kg1·min1 的差异相当于约 0.5 个代谢当量，这被认为具有临床意义和相关性。两组的健康相关生活质量相似，这反映在 SF-36（第 2 版）、医院焦虑和抑郁量表和视觉模拟量表的结果中。
我们证明 HIT 是新 HTx 受者安全、有效的运动方法。与中等强度连续训练相比，HIT 导致运动能力的变化具有临床意义，根据 Vopeak 值（25%比 15%）、无氧阈、呼气峰流速和肌肉运动能力进行评估。
网址：https://www.clinicaltrials.gov。唯一标识符 NCT01796379。
