瓣膜手术后或介入治疗后的老年患者，基于运动的心脏康复中增加阻力和平衡训练的影响：随机对照试验。

The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial.

机构信息

Rehabilitation Department, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50161, Kaunas, Lithuania.

University of Zurich, Rämistrasse 71, CH-8006, Zürich, Switzerland.

出版信息

BMC Geriatr. 2021 Jan 7;21(1):23. doi: 10.1186/s12877-020-01964-3.

DOI:10.1186/s12877-020-01964-3

PMID:33413144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7792183/

Abstract

BACKGROUND

To evaluate the short- and mid-term effect of a specially tailored resistance and balance training provided in addition to usual cardiac rehabilitation (CR) care program in older patients after valve surgery/intervention.

METHODS

Single-center (inpatient CR clinic in Lithuania) randomized controlled trial. Two hundred fifty-two patients were assessed for eligibility on the first day of admittance to CR early after (14.5 ± 5.9 days) valve surgery/intervention between January 2018 and November 2019. Participants were coded centrally in accordance with randomization 1:1 using a computerized list. Control group (CG) patients were provided with usual care phase-II-CR inpatient multidisciplinary CR program, while intervention group (IG) patients received additional resistance and balance training (3 d/wk). Patients participated in a 3-month follow-up. Main outcome measures were functional capacity (6 min walk test (6MWT, meters), cardiopulmonary exercise testing), physical performance (Short Physical Performance Battery (SPPB, score) and 5-m walk test (5MWT, meters/second)), strength (one repetition maximum test for leg press), physical frailty (SPPB, 5MWT).

RESULTS

One hundred sixteen patients (76.1 ± 6.7 years, 50% male) who fulfilled the study inclusion criteria were randomized to IG (n = 60) or CG (n = 56) and participated in CR (18.6 ± 2.7 days). As a result, 6MWT (IG 247 ± 94.1 vs. 348 ± 100.1, CG 232 ± 102.8 vs. 333 ± 120.7), SPPB (IG 8.31 ± 2.21 vs. 9.51 ± 2.24, CG 7.95 ± 2.01 vs. 9.08 ± 2.35), 5MWT (IG 0.847 ± 0.31 vs. 0.965 ± 0.3, CG 0.765 ± 0.24 vs 0.879 ± 0.29) all other outcome variables and physical frailty level improved significantly (p < 0.05) in both groups with no significant difference between groups. Improvements were sustained over the 3-month follow-up for 6MWT (IG 348 ± 113 vs. CG 332 ± 147.4), SPPB (IG 10.37 ± 1.59 vs CG 9.44 ± 2.34), 5MWT (IG 1.086 ± 0. 307 vs CG 1.123 ± 0.539) and other variables. Improvement in physical frailty level was significantly more pronounced in IG (p < 0.05) after the 3-month follow-up.

CONCLUSION

Exercise-based CR improves functional and exercise capacity, physical performance, and muscular strength, and reduces physical frailty levels in patients after valve surgery/intervention in the short and medium terms. SPPB score and 5MWT were useful for physical frailty assessment, screening and evaluation of outcomes in a CR setting. Additional benefit from the resistance and balance training could not be confirmed.

TRIAL REGISTRATION

NCT04234087 , retrospectively registered 21 January 2020.

摘要

背景

评估在瓣膜手术后/介入治疗后，除了常规心脏康复（CR）护理方案外，专门定制的阻力和平衡训练对老年患者的短期和中期效果。

方法

单中心（立陶宛住院 CR 诊所）随机对照试验。2018 年 1 月至 2019 年 11 月，在瓣膜手术后/介入治疗后 14.5±5.9 天，对 252 名患者进行了入选评估。根据随机化，使用计算机化列表以 1:1 的比例对参与者进行中央编码。对照组（CG）患者接受常规 II 期-CR 住院多学科 CR 方案，而干预组（IG）患者接受额外的阻力和平衡训练（每周 3 天）。患者参加了 3 个月的随访。主要观察指标为功能能力（6 分钟步行试验（6MWT，米），心肺运动试验），身体表现（简短身体表现电池（SPPB，分数）和 5 米步行测试（5MWT，米/秒）），力量（腿推的一次重复最大测试），身体虚弱（SPPB，5MWT）。

结果

符合研究纳入标准的 116 名患者（76.1±6.7 岁，50%为男性）被随机分配至 IG（n=60）或 CG（n=56）并参加了 CR（18.6±2.7 天）。结果，6MWT（IG 247±94.1 与 348±100.1，CG 232±102.8 与 333±120.7），SPPB（IG 8.31±2.21 与 9.51±2.24，CG 7.95±2.01 与 9.08±2.35），5MWT（IG 0.847±0.31 与 0.965±0.3，CG 0.765±0.24 与 0.879±0.29），所有其他结果变量和身体虚弱程度均显著改善（p<0.05），两组之间无显著差异。6MWT（IG 348±113 与 CG 332±147.4）、SPPB（IG 10.37±1.59 与 CG 9.44±2.34）、5MWT（IG 1.086±0.307 与 CG 1.123±0.539）和其他变量在 3 个月随访中持续改善。IG 组（p<0.05）在 3 个月随访后，身体虚弱程度的改善更为明显。