Vasić Danijela, Novaković Marko, Božič Mijovski Mojca, Barbič Žagar Breda, Jug Borut
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Terme Krka, Šmarješke Toplice, Slovenia.
Front Physiol. 2019 Jul 16;10:903. doi: 10.3389/fphys.2019.00903. eCollection 2019.
We hypothesized that a 2-week twice daily aquatic endurance calisthenics exercise training program: (i) increases aerobic exercise capacity (peak oxygen uptake/ Opeak), (ii) improves endothelium-dependent flow-mediated vasodilation (FMD), and (iii) reduces circulating markers of low-grade inflammation and hemostasis, as compared to land-based endurance calisthenics exercise training or no exercise in patients undergoing short-term residential cardiac rehabilitation after a recent coronary artery disease (CAD) event.
Patients with a recent myocardial infarction or revascularization procedure were randomized into two interventional groups and a control group. The interventional groups underwent supervised aerobic endurance calisthenics exercise training either in thermo-neutral water or on land at moderate intensity (60-80% of the peak heart rate achieved during symptom-limited graded exercise testing) for 30 min twice daily for 2 weeks (i.e., 24 sessions). The control group was deferred from supervised exercise training for the 2-week duration of the intervention, but was advised low-to-moderate intensity physical activity at home while waiting. At baseline and after the intervention period, all participants underwent estimation of aerobic exercise capacity, brachial artery flow-mediated dilatation (FMD, measured ultrasonographically at rest and during reactive hyperemia after 4.5 min of forearm cuff inflation), markers of cardiac dysfunction (NT-proBNP), inflammation (hsCRP, IL-6, IL-8, IL-10), cell adhesion (ICAM, P-selectin), and hemostasis (fibrinogen, D-dimer).
A total of 89 patients (mean age 59.9 ± 8.2 years, 77.5% males, Opeak at baseline 14.8 ± 3.5 ml kg min) completed the study. Both exercise modalities were safe (no significant adverse events recorded) and associated with a significant improvement in Opeak as compared to controls: age and baseline Opeak-adjusted end-of-study Opeak increased to 16.7 (95% CI 16.0-17.4) ml kg min with land-based training ( < 0.001 for change from baseline) and to 18.6 (95% CI 17.9-19.3) ml kg min with water-based training ( < 0.001 for change from baseline), but not in controls (14.9 ml kg min; 95% CI 14.2-15.6; = 0.775 for change from baseline). FMD also increased in both intervention groups (from 5.5 to 8.8%, < 0.001 with land-based, and from 7.2 to 9.2%, < 0.001 with water-based training, respectively), as compared to controls ( for change 0.629). No significant changes were detected in biomarkers of inflammation, cell adhesion or hemostasis, whereas levels of NT-proBNP (marker of cardiac dysfunction) decreased in the water-based training group ( = 0.07 vs. controls).
Endurance calisthenics exercise training in thermo-neutral water is safe, and improves aerobic exercise capacity and vascular function in patients undergoing short-term residential cardiac rehabilitation after a recent CAD event.
www.ClinicalTrials.gov, identifier NCT02831829.
我们假设，与在近期冠心病（CAD）事件后接受短期住院心脏康复治疗的患者进行陆上耐力健美操运动训练或不运动相比，为期2周的每日两次水上耐力健美操运动训练计划：（i）可提高有氧运动能力（峰值摄氧量/ Opeak），（ii）改善内皮依赖性血流介导的血管舒张（FMD），以及（iii）降低低度炎症和止血的循环标志物。
近期发生心肌梗死或接受血管重建手术的患者被随机分为两个干预组和一个对照组。干预组在温度中性的水中或陆地上进行有监督的有氧耐力健美操运动训练，强度为中等强度（症状限制分级运动试验中达到的峰值心率的60 - 80%），每天两次，每次30分钟，共2周（即24次训练）。对照组在干预的2周期间不进行有监督的运动训练，但建议在家中进行低至中等强度的体育活动。在基线和干预期后，所有参与者均接受有氧运动能力评估、肱动脉血流介导的扩张（FMD，在前臂袖带充气4.5分钟后，通过超声心动图在静息和反应性充血期间测量）、心脏功能障碍标志物（NT - proBNP）、炎症标志物（hsCRP、IL - 6、IL - 8、IL - 10）、细胞粘附标志物（ICAM、P - 选择素）和止血标志物（纤维蛋白原、D - 二聚体）的检测。
共有89例患者（平均年龄59.9±8.2岁，男性占77.5%，基线时Opeak为14.8±3.5 ml·kg - 1·min - 1）完成了研究。两种运动方式均安全（未记录到显著不良事件），且与对照组相比，Opeak均有显著改善：经年龄和基线Opeak调整后的研究结束时Opeak，陆上训练组增加至16.7（95%可信区间16.0 - 17.4）ml·kg - 1·min - 1（与基线相比变化<0.001），水上训练组增加至18.6（95%可信区间17.9 - 19.3）ml·kg - 1·min - 1（与基线相比变化<0.001），而对照组无变化（14.9 ml·kg - 1·min - 1；95%可信区间14.2 - 15.6；与基线相比变化P = 0.775）。与对照组相比（变化P = 0.629），两个干预组的FMD也均增加（陆上训练组从5.5%增加至8.8%，P<0.001，水上训练组从7.2%增加至9.2%，P<0.001）。炎症、细胞粘附或止血的生物标志物未检测到显著变化，而水上训练组中NT - proBNP（心脏功能障碍标志物）水平下降（与对照组相比P = 0.07）。
在温度中性的水中进行耐力健美操运动训练是安全的，并且可改善近期CAD事件后接受短期住院心脏康复治疗患者的有氧运动能力和血管功能。
