Institute for Health and Sport (IHES), Victoria University, Melbourne, Australia.
Department of Cardiology, Western Health, Sunshine Hospital, Melbourne, Australia.
J Am Geriatr Soc. 2020 Sep;68(9):1954-1961. doi: 10.1111/jgs.16428. Epub 2020 Apr 15.
To test the hypothesis that (1) older patients with heart failure (HF) can tolerate COMBined moderate-intensity aerobic and resistance training (COMBO), and (2) 4 weeks of Peripheral Remodeling through Intermittent Muscular Exercise (PRIME) before 4 weeks of COMBO will improve aerobic capacity and muscle strength to a greater extent than 8 weeks of COMBO.
Prospective randomized parallel open-label blinded end point.
Single-site Australian metropolitan hospital.
Nineteen adults (72.8 ± 8.4 years of age) with heart failure with reduced ejection fraction (HFrEF).
Participants were randomized to 4 weeks of PRIME or COMBO (phase 1). All participants subsequently completed 4 weeks of COMBO (phase 2). Sessions were twice a week for 60 minutes. PRIME is a low-mass, high-repetition regime (40% one-repetition maximum [1RM], eight strength exercises, 5 minutes each). COMBO training involved combined aerobic (40%-60% of peak aerobic capacity [VO ], up to 20 minutes) and resistance training (50-70% 1RM, eight exercises, two sets of 10 repetitions).
We measured VO , VO at anaerobic threshold (AT), and muscle voluntary contraction (MVC).
The PRIME group significantly increased VO after 8 weeks (2.4 mL/kg/min; 95% confidence interval [CI] = .7-4.1; P = .004), whereas the COMBO group showed minimal change (.2; 95% CI -1.5 to 1.8). This produced a large between-group effect size of 1.0. VO at AT increased in the PRIME group (1.6 mL/kg/min; 95% CI .0-3.2) but not in the COMBO group (-1.2; 95% CI -2.9 to .4), producing a large between-group effect size. Total MVC increased significantly in both groups in comparison with baseline; however, the change was larger in the COMBO group (effect size = .6).
Traditional exercise approaches (COMBO) and PRIME improved strength. Only PRIME training produced statistically and clinically significant improvements to aerobic capacity. Taken together, these findings support the hypothesis that PRIME may have potential advantages for older patients with HFrEF and could be a possible alternative exercise modality.
检验以下假设，（1）患有心力衰竭（HF）的老年患者能够耐受联合中等强度有氧和抗阻训练（COMBO），以及（2）在进行 4 周 COMBO 之前进行 4 周外周重塑间歇性肌肉运动（PRIME），将比进行 8 周 COMBO 更能提高有氧能力和肌肉力量。
前瞻性随机平行开放标签盲终点。
澳大利亚大都市医院的单站点。
19 名射血分数降低的心力衰竭（HFrEF）成人（72.8±8.4 岁）。
参与者随机分配到 4 周 PRIME 或 COMBO（第 1 阶段）。所有参与者随后均完成了 4 周的 COMBO（第 2 阶段）。每周两次，每次 60 分钟。PRIME 采用低质量、高重复的方案（40%一次重复最大重量[1RM]，8 项力量练习，每项 5 分钟）。COMBO 训练包括联合有氧（40%-60%的峰值有氧能力[VO2]，最多 20 分钟）和抗阻训练（50-70%1RM，8 项运动，两组各 10 次重复）。
我们测量了 VO2、无氧阈（AT）时的 VO2 和肌肉自主收缩（MVC）。
PRIME 组在 8 周后 VO2 显著增加（2.4 mL/kg/min；95%置信区间[CI]：.7-4.1；P =.004），而 COMBO 组仅略有增加（.2；95%CI：-1.5 至 1.8）。这产生了 1.0 的大组间效应量。PRIME 组 AT 时的 VO2 增加（1.6 mL/kg/min；95%CI：.0-3.2），但 COMBO 组没有（-1.2；95%CI：-2.9 至.4），产生了较大的组间效应量。与基线相比，两组的总 MVC 均显著增加；然而，COMBO 组的变化更大（效应量=.6）。
传统的运动方法（COMBO）和 PRIME 均改善了力量。只有 PRIME 训练在有氧能力方面产生了具有统计学意义和临床意义的改善。综上所述，这些发现支持了 PRIME 可能对射血分数降低的心力衰竭老年患者具有潜在优势的假设，并且可能是一种替代运动模式。
