一项在热量限制加有氧运动训练基础上增加抗阻训练治疗肥胖射血分数保留心力衰竭的随机对照试验。
A Randomized, Controlled Trial of Resistance Training Added to Caloric Restriction Plus Aerobic Exercise Training in Obese Heart Failure With Preserved Ejection Fraction.
机构信息
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC (P.H.B.).
Section on Gerontology and Geriatric Medicine, Department of Internal Medicine (B.J.N., D.K.H., W.M.L., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC.
出版信息
Circ Heart Fail. 2023 Feb;16(2):e010161. doi: 10.1161/CIRCHEARTFAILURE.122.010161. Epub 2022 Oct 31.
BACKGROUND
We have shown that combined caloric restriction (CR) and aerobic exercise training (AT) improve peak exercise O consumption (VO), and quality-of-life in older patients with obese heart failure with preserved ejection fraction. However, ≈35% of weight lost during CR+AT was skeletal muscle mass. We examined whether addition of resistance training (RT) to CR+AT would reduce skeletal muscle loss and further improve outcomes.
METHODS
This study is a randomized, controlled, single-blind, 20-week trial of RT+CR+AT versus CR+AT in 88 patients with chronic heart failure with preserved ejection fraction and body mass index (BMI) ≥28 kg/m. Outcomes at 20 weeks included the primary outcome (VO); MRI and dual X-ray absorptiometry; leg muscle strength and quality (leg strength ÷ leg skeletal muscle area); and Kansas City Cardiomyopathy Questionnaire.
RESULTS
Seventy-seven participants completed the trial. RT+CR+AT and CR+AT produced nonsignificant differences in weight loss: mean (95% CI): -8 (-9, -7) versus -9 (-11, -8; =0.21). RT+CR+AT and CR+AT had non-significantly differences in the reduction of body fat [-6.5 (-7.2, -5.8) versus -7.4 (-8.1, -6.7) kg] and skeletal muscle [-2.1 (-2.7, -1.5) versus -2.1 (-2.7, -1.4) kg] (=0.20 and 0.23, respectively). RT+CR+AT produced significantly greater increases in leg muscle strength [4.9 (0.7, 9.0) versus -1.1 (-5.5, 3.2) Nm, =0.05] and leg muscle quality [0.07 (0.03, 0.11) versus 0.02 (-0.02, 0.06) Nm/cm, =0.04]. Both RT+CR+AT and CR+AT produced significant improvements in VO [108 (958, 157) versus 80 (30, 130) mL/min; =0.001 and 0.002, respectively], and Kansas City Cardiomyopathy Questionnaire score [17 (12, 22) versus 23 (17, 28); =0.001 for both], with no significant between-group differences. Both RT+CR+AT and CR+AT significantly reduced LV mass and arterial stiffness. There were no study-related serious adverse events.
CONCLUSIONS
In older obese heart failure with preserved ejection fraction patients, CR+AT produces large improvements in VO and quality-of-life. Adding RT to CR+AT increased leg strength and muscle quality without attenuating skeletal muscle loss or further increasing VO or quality-of-life.
REGISTRATION
URL: https://ClincalTrials.gov; Unique identifier: NCT02636439.
背景
我们已经证明，联合热量限制（CR）和有氧运动训练（AT）可以提高峰值运动耗氧量（VO），并改善射血分数保留的肥胖心力衰竭老年患者的生活质量。然而，在 CR+AT 期间减轻的体重中约有 35%是骨骼肌质量。我们研究了在 CR+AT 中加入阻力训练（RT）是否会减少骨骼肌损失并进一步改善结果。
方法
这是一项随机、对照、单盲、20 周的 RT+CR+AT 与 CR+AT 治疗射血分数保留的慢性心力衰竭和 BMI≥28kg/m2 的肥胖患者的试验。20 周时的主要结局包括（VO）；MRI 和双能 X 线吸收法；腿部肌肉力量和质量（腿部力量÷腿部骨骼肌面积）；堪萨斯城心肌病问卷。
结果
77 名参与者完成了试验。RT+CR+AT 和 CR+AT 在体重减轻方面没有显著差异：平均（95%CI）：-8（-9，-7）与-9（-11，-8；=0.21）。RT+CR+AT 和 CR+AT 在体脂减少[-6.5（-7.2，-5.8）与-7.4（-8.1，-6.7）kg]和骨骼肌减少[-2.1（-2.7，-1.5）与-2.1（-2.7，-1.4）kg]方面没有显著差异（=0.20 和 0.23）。RT+CR+AT 显著增加腿部肌肉力量[4.9（0.7，9.0）与-1.1（-5.5，3.2）Nm，=0.05]和腿部肌肉质量[0.07（0.03，0.11）与 0.02（-0.02，0.06）Nm/cm，=0.04]。RT+CR+AT 和 CR+AT 均显著提高 VO[108（958，157）与 80（30，130）mL/min；=0.001 和 0.002]和堪萨斯城心肌病问卷评分[17（12，22）与 23（17，28）；两者均=0.001]，但组间无显著差异。RT+CR+AT 和 CR+AT 均显著降低左心室质量和动脉僵硬度。没有与研究相关的严重不良事件。
结论
在射血分数保留的肥胖心力衰竭老年患者中，CR+AT 可显著提高 VO 和生活质量。在 CR+AT 中加入 RT 可增加腿部力量和肌肉质量，而不会减少骨骼肌损失或进一步提高 VO 或生活质量。
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