Cardiology Department, Máxima Medical Center Veldhoven, the Netherlands; ICIN, Netherlands Heart Institute, Utrecht, the Netherlands.
Cardiology Department, Máxima Medical Center Veldhoven, the Netherlands.
Int J Cardiol. 2020 Jan 15;299:169-174. doi: 10.1016/j.ijcard.2019.07.023. Epub 2019 Jul 12.
CRT leads to improvement in exercise capacity, cardiac function and mortality in selected CHF patients. Exercise capacity improves even greater when combining CRT with moderate-intensity exercise training (ET). However, high-intensity interval training (HIT) as additional therapy to CRT has not yet been established. Given the complementary physiological effects of HIT, we hypothesized that HIT after CRT may have additional effects on exercise capacity.
24 CHF patients, NYHA class II/III and accepted for CRT underwent an echocardiogram, QoL questionnaire and CPET with cardiac output (CO) measurements before implantation, at 3 and 6 months. After 3 months, patients were randomized to usual care (UC) or HIT, consisting of 36 sessions at 85-95% of peak V̇O.
Peak V̇O increased after CRT (17±5.3 to 18.7±6.2 ml/kg/min, p < 0.05); after HIT there was a non-significant increase of 1.4 ml/kg/min (p = 0.12). Peak workload increased after CRT (109±45 to 118±44 W, p = 0.001). An additional significant within- and between group increase after HIT was found in the intervention group (128±42 to 148±48 W, versus 110±50 to 110±50, respectively, p = 0.03). Peak CO did not change significantly after CRT or HIT. V̇O recovery kinetics speeded by 27% after CRT (p = 0.04), no further improvement after HIT was observed. LVEF increased 25% after CRT (p = 0.0001), no additional increase was seen after HIT.
This study demonstrates that HIT provides additional improvement of exercise capacity without a concomitant change in peak V̇O or CO suggesting that the additional effect of HIT is mainly mediated by an improvement of anaerobic performance.
CRT 可改善特定 CHF 患者的运动能力、心功能和死亡率。当 CRT 与中等强度运动训练（ET）结合使用时，运动能力的改善更为显著。然而，高强度间歇训练（HIT）作为 CRT 的附加治疗尚未得到确立。鉴于 HIT 的互补生理效应，我们假设 CRT 后进行 HIT 可能对运动能力有额外的影响。
24 名 CHF 患者，NYHA 分级 II/III，接受 CRT 植入，在植入前、植入后 3 个月和 6 个月进行超声心动图、生活质量问卷和 CPET 以及心输出量（CO）测量。在 3 个月后，患者被随机分为常规治疗（UC）或 HIT 组，HIT 组包括 36 次 85-95%峰值 VO 的训练。
CRT 后峰值 VO 增加（17±5.3 至 18.7±6.2 ml/kg/min，p<0.05）；HIT 后增加 1.4 ml/kg/min，但无统计学意义（p=0.12）。CRT 后峰值工作量增加（109±45 至 118±44 W，p=0.001）。HIT 后干预组的峰值工作量在组内和组间均有显著增加（128±42 至 148±48 W，而 110±50 至 110±50 W，p=0.03）。CRT 或 HIT 后 CO 无显著变化。CRT 后 VO 恢复动力学速度加快 27%（p=0.04），HIT 后未见进一步改善。LVEF 增加 25%（p=0.0001），HIT 后无进一步增加。
本研究表明，HIT 可提供运动能力的额外改善，而峰值 VO 或 CO 无明显变化，提示 HIT 的额外作用主要通过改善无氧性能来介导。
