运动干预改善老年心肌梗死后患者的生活质量：随机临床试验

Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial.

作者信息

Campo Gianluca, Tonet Elisabetta, Chiaranda Giorgio, Sella Gianluigi, Maietti Elisa, Bugani Giulia, Vitali Francesco, Serenelli Matteo, Mazzoni Gianni, Ruggiero Rossella, Villani Giovanni, Biscaglia Simone, Pavasini Rita, Rubboli Andrea, Campana Roberta, Caglioni Serena, Volpato Stefano, Myers Jonathan, Grazzi Giovanni

机构信息

Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy

Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy.

出版信息

Heart. 2020 Nov;106(21):1658-1664. doi: 10.1136/heartjnl-2019-316349. Epub 2020 Mar 6.

DOI:10.1136/heartjnl-2019-316349

PMID:32144189

Abstract

OBJECTIVE

To establish the benefits of an early, tailored and low-cost exercise intervention in older patients hospitalised for acute coronary syndrome (ACS).

METHODS

The study was a multicentre, randomised assessment of an exercise intervention in patients with ACS ≥70 years with reduced physical performance (as defined by the short physical performance battery (SPPB), value 4-9). The exercise intervention included four supervised sessions (1, 2, 3, 4 months after discharge) and home-based exercises. The control group attended a health education programme only. The outcomes were the 6-month and 1-year effects on physical performance, daily activities, anxiety/depression and quality of life. Finally, 1-year occurrence of adverse events was recorded.

RESULTS

Overall, 235 patients with ACS (median age 76 (73-81) years) were randomised 1 month after ACS. Exercise and control groups were well balanced. Exercise intervention improved 6-month and 1-year grip strength and gait speed. Exercise intervention was associated with a better quality of life (as measured by EuroQol-visual analogue scale at 6 months 80 (70-90) vs 70 (50-80) points, p<0.001 and at 1 year 75 (70-87) vs 65 (50-80) points, p<0.001) and with a reduced perception of anxiety and/or depression (6 months: 21% vs 42%, p=0.001; 1 year 32% vs 47%, p=0.03). The occurrence of cardiac death and hospitalisation for cardiac cause was lower in the intervention group (7.5% vs 17%, p=0.04).

CONCLUSIONS

The proposed early, tailored, low-cost exercise intervention improves mobility, daily activities, quality of life and outcomes in older patients with ACS. Larger studies are needed to confirm the clinical benefit.

TRIAL REGISTRATION NUMBER

NCT03021044.

摘要

目的

确定针对因急性冠状动脉综合征（ACS）住院的老年患者进行早期、个性化且低成本运动干预的益处。

方法

本研究是一项多中心随机评估，针对身体机能下降（根据简短体能状况量表（SPPB）定义，分值为4 - 9）的≥70岁ACS患者进行运动干预。运动干预包括四次监督下的训练课程（出院后1、2、3、4个月）以及居家运动。对照组仅参加健康教育项目。结局指标为对6个月和1年时身体机能、日常活动、焦虑/抑郁及生活质量的影响。最后，记录1年时不良事件的发生情况。

结果

总体而言，235例ACS患者（中位年龄76（73 - 81）岁）在ACS发病1个月后被随机分组。运动组和对照组情况均衡。运动干预改善了6个月和1年时的握力和步速。运动干预与更好的生活质量相关（通过欧洲五维度健康量表视觉模拟评分，6个月时80（70 - 90）分对70（50 - 80）分，p<0.001；1年时75（70 - 87）分对65（50 - 80）分，p<0.001）且焦虑和/或抑郁感减轻（6个月时：21%对42%，p = 0.001；1年时32%对47%，p = 0.03）。干预组心脏性死亡和因心脏原因住院的发生率较低（7.5%对17%，p = 0.04）。