Kim Bo Ryun, Kim Sang Rim, Nam Kwang Woo, Lee So Young, Park Yong Geun, Suh Min Ji, Jeon Young Tae
Department of Rehabilitation Medicine.
Department of Orthopaedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
Medicine (Baltimore). 2020 Apr;99(14):e19586. doi: 10.1097/MD.0000000000019586.
To investigate the effects of body weight support (BWS) and gait velocity on cardiovascular responses during walking on an antigravity treadmill early after unilateral and bilateral total knee arthroplasty (TKA).This study was a cross-sectional study design. Fifty patients (7 males and 43 females; average age, 72.0 ± 5.1 years) at 4 weeks after unilateral (n = 25) and bilateral (n = 25) primary TKA were enrolled in the study. Subjects walked on an antigravity treadmill at speeds of 2.5 km/hour and 3.5 km/hour with 3 levels (50%, 25%, and 0%) of BWS. Cardiovascular responses were monitored by measuring oxygen consumption (VO2), heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), the respiratory exchange ratio (RER), and rate pressure product (RPP). Borg rating of perceived exertion (RPE) and a visual analog scale (VAS) of knee pain were recorded immediately after each trial.There were no significant differences in cardiovascular responses between the unilateral and bilateral TKA groups. In the repeated measures Analysis of Variance, VO2 levels, HR, RPP, RPE, RER, and VAS were significantly increased in proportion to 3 levels (50%, 25%, and 0%) of BWS for unilateral and bilateral TKA groups, respectively. Meanwhile, SBP and DBP were unaffected by differences in BWS. At 3.5 km/hour, VO2, RPE, and RER values were statistically greater than those at 2.5 km/hour under the same BWS conditions.We found that the reduction in the metabolic demand of activity, coupled with positive pressure on the lower extremities, reduced VO2 and HR values as BWS increased.Cardiovascular responses vary according to BWS and gait velocity during antigravity treadmill walking. BWS rather than gait velocity had the greatest effect on cardiovascular responses and knee pain.
探讨单侧和双侧全膝关节置换术(TKA)后早期在抗重力跑步机上行走时,体重支持(BWS)和步速对心血管反应的影响。本研究为横断面研究设计。纳入了50例单侧(n = 25)和双侧(n = 25)初次TKA术后4周的患者(7例男性和43例女性;平均年龄72.0±5.1岁)。受试者在抗重力跑步机上以2.5公里/小时和3.5公里/小时的速度行走,BWS分为3个水平(50%、25%和0%)。通过测量耗氧量(VO2)、心率(HR)、收缩压和舒张压(SBP/DBP)、呼吸交换率(RER)以及率压积(RPP)来监测心血管反应。每次试验后立即记录Borg自觉用力程度评分(RPE)和膝关节疼痛视觉模拟量表(VAS)。单侧和双侧TKA组之间的心血管反应无显著差异。在重复测量方差分析中,单侧和双侧TKA组的VO2水平、HR、RPP、RPE、RER和VAS分别随BWS的3个水平(50%、25%和0%)成比例显著增加。同时,SBP和DBP不受BWS差异的影响。在相同BWS条件下,3.5公里/小时时的VO2、RPE和RER值在统计学上高于2.5公里/小时时的值。我们发现,随着BWS增加活动代谢需求降低,同时下肢受到正压,VO2和HR值降低。在抗重力跑步机行走过程中,心血管反应随BWS和步速而变化。BWS而非步速对心血管反应和膝关节疼痛的影响最大。