National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Nyborg, Denmark (Drs Tang and Zwisler); Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark (Dr Tang); Department of Health Sciences, University of York, England, United Kingdom (Dr Doherty); College of Health Sciences, University of Wisconsin-Milwaukee (Dr Oldridge); Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Dr Berg); and Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (Dr Christensen).
J Cardiopulm Rehabil Prev. 2020 Mar;40(2):102-107. doi: 10.1097/HCR.0000000000000416.
Exercise-based cardiac rehabilitation improves physical performance and health-related quality of life (HRQoL). However, whether improvements in physical performance are associated with changes in HRQoL has not been adequately investigated in a nonischemic cardiac population.
Patients who were ablated for atrial fibrillation, who underwent heart valve surgery or who were treated for infective endocarditis, and who participated in 1 of 3 randomized controlled rehabilitation trials were eligible for the current study. Change in physical performance and HRQoL were measured before and after a 12-wk exercise intervention. Physical performance was assessed using a cardiopulmonary exercise test, a 6-min walk test, and a sit-to-stand test. Health-related quality of life was assessed using the generic 36-Item Short Form Health Survey and the disease-specific HeartQoL questionnaire. Spearman correlation coefficient (ρ) and linear regressions quantified the association between changes in physical outcome measures and changes in HRQoL.
A total of 344 patients were included (mean age: 60.8 ± 11.6 yr and 77% males). Associations between changes in physical outcome measures and HRQoL ranged from very weak to weak (ρ = -0.056 to 0.228). The observed associations were more dominant within physical dimensions of the HRQoL compared with mental or emotional dimensions. After adjusting for sex, age, and diagnosis, changes in physical performance explained no more than 20% of the variation in the HRQoL.
The findings show that the positive improvement in HRQoL from exercise-based cardiac rehabilitation cannot simply be explained by an improvement in physical performance.
基于运动的心脏康复可改善身体机能和健康相关生活质量（HRQoL）。然而，在非缺血性心脏患者人群中，身体机能的改善是否与 HRQoL 的变化相关，尚未得到充分研究。
本研究纳入了参加了 3 项随机对照康复试验中的 1 项的患者，这些患者患有房颤、接受了心脏瓣膜手术或感染性心内膜炎治疗。本研究在 12 周运动干预前后测量了身体机能和 HRQoL 的变化。使用心肺运动试验、6 分钟步行试验和坐立站起试验评估身体机能。使用通用的 36 项简短健康调查问卷和特定于疾病的 HeartQoL 问卷评估健康相关生活质量。Spearman 相关系数（ρ）和线性回归用于量化身体机能测量指标变化与 HRQoL 变化之间的关联。
共纳入 344 例患者（平均年龄：60.8±11.6 岁，77%为男性）。身体机能测量指标变化与 HRQoL 之间的关联从非常弱到弱（ρ=-0.056 至 0.228）。与精神或情绪维度相比，在 HRQoL 的身体维度中观察到的关联更为明显。在校正性别、年龄和诊断后，身体机能的变化最多仅能解释 HRQoL 变化的 20%。
研究结果表明，基于运动的心脏康复所带来的 HRQoL 的积极改善，不能简单地用身体机能的改善来解释。
