Taylor Jenna L, Bonikowske Amanda R, Olson Thomas P
Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.
Front Cardiovasc Med. 2021 Sep 3;8:734278. doi: 10.3389/fcvm.2021.734278. eCollection 2021.
Exercise based cardiac rehabilitation (CR) is recognized internationally as a class 1 clinical practice recommendation for patients with select cardiovascular diseases and heart failure with reduced ejection fraction. Over the past decade, several meta-analyses have generated debate regarding the effectiveness of exercise-based CR for reducing all-cause and cardiovascular mortality. A common theme highlighted in these meta-analyses is the heterogeneity and/or lack of detail regarding exercise prescription methodology within CR programs. Currently there is no international consensus on exercise prescription for CR, and exercise intensity recommendations vary considerably between countries from light-moderate intensity to moderate intensity to moderate-vigorous intensity. As cardiorespiratory fitness [peak oxygen uptake (VOpeak)] is a strong predictor of mortality in patients with coronary heart disease and heart failure, exercise prescription that optimizes improvement in cardiorespiratory fitness and exercise capacity is a critical consideration for the efficacy of CR programming. This review will examine the evidence for prescribing higher-intensity aerobic exercise in CR, including the role of high-intensity interval training. This discussion will highlight the beneficial physiological adaptations to pulmonary, cardiac, vascular, and skeletal muscle systems associated with moderate-vigorous exercise training in patients with coronary heart disease and heart failure. Moreover, this review will propose how varying interval exercise protocols (such as short-duration or long-duration interval training) and exercise progression models may influence central and peripheral physiological adaptations. Importantly, a key focus of this review is to provide clinically-relevant recommendations and strategies to optimize prescription of exercise intensity while maximizing safety in patients attending CR programs.
基于运动的心脏康复（CR）在国际上被公认为是针对特定心血管疾病和射血分数降低的心力衰竭患者的1类临床实践建议。在过去十年中，几项荟萃分析引发了关于基于运动的CR在降低全因死亡率和心血管死亡率方面有效性的争论。这些荟萃分析中突出的一个共同主题是CR项目中运动处方方法的异质性和/或缺乏细节。目前，对于CR的运动处方尚无国际共识，各国之间的运动强度建议差异很大，从轻-中度强度到中度强度再到中度-剧烈强度。由于心肺适能[峰值摄氧量（VOpeak）]是冠心病和心力衰竭患者死亡率的有力预测指标，优化心肺适能和运动能力改善的运动处方是CR项目疗效的关键考虑因素。本综述将研究在CR中开具高强度有氧运动处方的证据，包括高强度间歇训练的作用。该讨论将强调与冠心病和心力衰竭患者中度-剧烈运动训练相关的对肺、心脏、血管和骨骼肌系统有益的生理适应性。此外，本综述将提出不同的间歇运动方案（如短时间或长时间间歇训练）和运动进展模型如何影响中枢和外周生理适应性。重要的是，本综述的一个关键重点是提供临床相关的建议和策略，以优化运动强度处方，同时在参加CR项目的患者中最大限度地提高安全性。
