Roxburgh Brendon H, Campbell Holly A, Cotter James D, Reymann Ulla, Williams Michael J A, Gwynne-Jones David, Thomas Kate N
University of Otago, Dunedin, New Zealand.
Arthritis Care Res (Hoboken). 2024 Mar;76(3):393-402. doi: 10.1002/acr.25238. Epub 2023 Dec 20.
Preoperative exercise training, or prehabilitation, aims to optimize cardiorespiratory fitness before surgery to reduce the risk of adverse perioperative events and delayed recovery. However, traditional exercise such as walking and cycling can be difficult for people with degenerative joint diseases of the lower limbs, such as osteoarthritis. The purpose of this study was to compare the effect of three low-impact interventions on cardiorespiratory fitness, physical function, and subjective health before total hip or knee arthroplasty.
This was a randomized controlled trial involving 93 participants with severe knee or hip osteoarthritis awaiting joint replacement surgery. Participants underwent cardiopulmonary exercise testing (to measure peak oxygen consumption [ O ]), then were randomized to heat therapy (Heat; 20-30 min immersed in 40°C water followed by ~15 min light-resistance exercise), high-intensity interval training (HIIT; 6-8 × 60 s intervals on a cross-trainer or arm ergometer at ~90%-100% peak O ), or home-based exercise (Home; ~15 min light-resistance exercise); for up to 36 sessions (3 sessions per week for 12 weeks).
Peak O increased by 16% across HIIT and to a greater extent than Heat (+2.5 mL × min × kg [95% CI: 0.5-4.4], P = 0.009) and Home (+3.2 mL × min × kg [1.2-5.2], P = 0.001). The anaerobic threshold increased across HIIT (+1.5 mL × min × kg [0.7-2.3], P < 0.001) and Heat (+1.2 mL × min × kg [0.4-1.9], P = 0.004), but not Home (-0.5 mL × min × kg [-1.3 to 0.3], P = 0.248). Subjective severity of osteoarthritis was unchanged with any intervention (P ≥ 0.250).
Heat therapy and HIIT improved indices of cardiorespiratory fitness preoperatively in patients who have difficulty performing lower-limb exercise.
术前运动训练，即预康复，旨在优化手术前的心肺功能，以降低围手术期不良事件和恢复延迟的风险。然而，对于患有下肢退行性关节疾病（如骨关节炎）的人来说，步行和骑自行车等传统运动可能会很困难。本研究的目的是比较三种低冲击力干预措施对全髋关节或膝关节置换术前心肺功能、身体功能和主观健康状况的影响。
这是一项随机对照试验，涉及93名等待关节置换手术的重度膝关节或髋关节骨关节炎患者。参与者接受心肺运动测试（以测量峰值耗氧量[O]），然后被随机分为热疗组（Heat；浸泡在40°C水中20 - 30分钟，随后进行约15分钟的轻度抗阻运动）、高强度间歇训练组（HIIT；在交叉训练机或手臂测力计上以约90%-100%的峰值O进行6 - 8次×60秒的间歇训练）或家庭运动组（Home；约15分钟的轻度抗阻运动）；最多进行36次训练（每周3次，共12周）。
HIIT组的峰值O增加了16%，且增加幅度大于热疗组（增加2.5 mL×min×kg[95%CI：0.5 - 4.4]，P = 0.009）和家庭运动组（增加3.2 mL×min×kg[1.2 - 5.2]，P = 0.001）。HIIT组（增加1.5 mL×min×kg[0.7 - 2.3]，P < 0.001）和热疗组（增加1.2 mL×min×kg[0.4 - 1.9]，P = 0.004）的无氧阈值有所提高，但家庭运动组未提高（降低0.5 mL×min×kg[-1.3至0.3]，P = 0.248）。任何干预措施对骨关节炎的主观严重程度均无影响（P≥0.250）。
热疗和HIIT改善了难以进行下肢运动的患者术前的心肺功能指标。
