Iannetta Danilo, Rouleau Codie R, Chirico Daniele, Fontana Federico Y, Hauer Trina, Wilton Stephen B, Aggarwal Sandeep, Austford Leslie D, Arena Ross, Murias Juan M
Faculty of Kinesiology, University of Calgary, Calgary, Canada.
Department of Psychology, University of Calgary, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada.
Int J Cardiol. 2023 May 15;379:104-110. doi: 10.1016/j.ijcard.2023.03.036. Epub 2023 Mar 18.
To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program.
A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (MET) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HR)] of supervised ET were also obtained. Training responsiveness was quantified on the basis of changes in MET from pre- to post-CR. A cluster analysis was performed to identity clusters demonstrating discrete levels of responsiveness (i.e., negative, low, moderate, high, and very-high). These were compared for several baseline and ET-derived variables which were also included in a multivariable linear regression model.
At pre-CR, baseline MET was progressively lower with greater training responsiveness (F = 44.2, P < 0.01, η = 0.71). Likewise, average training duration (F = 10.7 P < 0.01, η = 0.02) and %HR (F = 25.1 P < 0.01, η = 0.042) quantified during onsite ET sessions were progressively greater with greater training responsiveness. The multivariable linear regression model confirmed that baseline MET, training duration and intensity during ET, BMI, and age (P < 0.001) were significant predictors of MET post-CR.
Along with baseline MET, delta BMI, and age, the dose of ET (i.e., training duration and intensity) predicts MET at the conclusion of CR. A re-evaluation of current approaches for exercise intensity prescription is recommended to extend the benefits of completing CR to all patients.
回顾性分析并比较一大批患者在心脏康复（CR）项目后运动能力改善程度不同时的运动训练（ET）剂量。
分析纳入了2018年1月至2019年12月期间完成12周基于中心且遵循指南的CR项目的2310名患者。在CR前后测定峰值代谢当量（MET），同时获取监督ET的总时长（ET时间）和强度[心率峰值百分比（%HR）]。根据CR前后MET的变化对训练反应性进行量化。进行聚类分析以识别显示不同反应水平（即负反应、低反应、中度反应、高反应和非常高反应） 的聚类。比较这些聚类的几个基线变量和ET衍生变量，这些变量也纳入多变量线性回归模型。
在CR前，基线MET随着训练反应性增强而逐渐降低（F = 44.2，P < 0.01，η = 0.71）。同样，现场ET期间量化的平均训练时长（F = 10.7，P < 0.01，η = 0.02）和%HR（F = 25.1，P < 0.01，η = 0.042）随着训练反应性增强而逐渐增加。多变量线性回归模型证实，基线MET、ET期间的训练时长和强度、体重指数（BMI）和年龄（P < 0.001）是CR后MET的显著预测因素。
除了基线MET、BMI变化量和年龄外，ET剂量（即训练时长和强度）可预测CR结束时的MET。建议重新评估当前的运动强度处方方法，以便将完成CR的益处扩展到所有患者。
