Bjarnason-Wehrens Birna, Schmidt Thomas, Schwaab Bernhard
Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland.
Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Deutschland.
Herzschrittmacherther Elektrophysiol. 2023 Mar;34(1):26-32. doi: 10.1007/s00399-022-00921-4. Epub 2023 Jan 31.
Aerobic endurance training is a core component of exercise training (ET) during cardiac rehabilitation (CR). Improvements of cardiopulmonary performance and symptom-free exercise capacity that can be achieved by ET during CR are essential for patient's prognosis and quality of life. Before initiating exercise training in CR, a detailed risk stratification including incremental exercise testing is required in order to ensure safe and effective exercise training conditions. Cardiopulmonary exercise testing (CPX) with measurement of respiratory gases is considered the gold standard of cardiopulmonary performance diagnostics. The oxygen uptake measured at the highest exercise intensity achieved (peakVO) has strong prognostic implications in primary and secondary prevention of cardiovascular diseases, respectively. The use of CPX with measurement of peakVO and determination of ventilatory thresholds (VT) enables a reliable determination of the individual cardiopulmonary performance (peakVO) and also the aerobic exercise capacity. In addition, CPX is a valuable tool to detect increments in exercise capacity that were achieved by ET during CR. The measurement of peakVO and the determination of ventilatory thresholds are basic parameters for an individually tailored exercise prescription. In addition, the targeted control of aerobic endurance training on the basis of CPX parameters increases the effectiveness and safety of the exercise program during CR. In this article, recommendations for an individual exercise prescription, based on the results of CPX, are given for patients with coronary heart disease (CHD), heart failure, as well as for patients with CHD and concomitant type 2 diabetes mellitus.
有氧耐力训练是心脏康复（CR）期间运动训练（ET）的核心组成部分。CR期间ET所能实现的心肺功能改善和无症状运动能力对患者的预后和生活质量至关重要。在CR中开始运动训练之前，需要进行包括递增运动测试在内的详细风险分层，以确保安全有效的运动训练条件。测量呼吸气体的心肺运动测试（CPX）被认为是心肺功能诊断的金标准。在达到的最高运动强度下测得的摄氧量（peakVO）分别对心血管疾病的一级和二级预防具有很强的预后意义。使用测量peakVO和确定通气阈值（VT）的CPX能够可靠地确定个体心肺功能（peakVO）以及有氧运动能力。此外，CPX是检测CR期间ET所实现的运动能力增加的有价值工具。peakVO的测量和通气阈值的确定是个性化运动处方的基本参数。此外，基于CPX参数对有氧耐力训练进行有针对性的控制可提高CR期间运动计划的有效性和安全性。本文针对冠心病（CHD）、心力衰竭患者以及患有CHD并伴有2型糖尿病的患者，给出了基于CPX结果的个性化运动处方建议。
